Contraception Flashcards
What are the contraception methods that require ongoing action?
→ Oral contraception → barrier methods → Fertility awareness → Coitus interruptus → Oral emergency contraception
What are the methods which prevent contraception by default?
→ IUD/IUI/IUS
→ Progestogen implants
→ progestogen injections
→ Sterilisation
What are the risks of treatment?
→ Cardiovascular → Neoplastic → emotional → infection → allergy → iatrogenic
What are the risks of no treatment ?
→ childbirth related
→ abortion related
→ Social and economic costs
What is the latest progestogen?
→ Drospirenone
What do estrogens act on?
→ Anterior pituitary and hypothalamus
→ directly on the ovary
→ on the endometrium
Where do progestogens act on?
→ Anterior pituitary and hypothalamus → Directly on the ovary → On the endometrium → Fallopian tubes → cervical mucus
How does the combined oral contraceptive work?
→ Supraphysiological levels of progestogens and estrogens are given because this creates negative feedback
→ gnRH is not produced so FSH and LH are not produced
→ no follicle development and no ovulation
What happens if only estrogen is given?
→ Endometrium keeps proliferating
Why is progesterone added to the COCP?
→ Endometrium becomes thin
→ Implantation would not occur
→ Fimbriae become very inactive and delays gamete transport
What are the benefits of combined oral contraception?
→ reliable
→ Safe
→ Unrelated to coitus
→ rapidly reversible
What cancers does the COCP prevent?
→ 1/2 risk of ovarian cancer
→ 1/2 risk of endometrial cancer
What conditions does the COCP help?
→ endometriosis
→ Menorrhagia
→ dysmenorrhoea
What are the cardiovascular risks of the COCP?
→ Arterial - HBP, smoking
→ Venous - DVT, PE, migraine
What are the neoplastic risks of the COCP?
→ breast
→ cervix
→ liver
What are the 3 gastrointestinal risks of COCP?
→ COH/insulin metabolism
→ Weight gain
→ Crohns
What are the 3 hepatic risks of COCP?
→ Hormone metabolisms
→ Congenital nonhemolytic jaundice
→ Gallstones
What are the 3 dermatological risks of COCP?
→ Chloasma
→ Acne
→ erythema multiforme
What are the 3 psychological changes that COCP can have?
→ Mood swings
→ Depression
→ Libido
How do you take the COCP?
→1st packet the 1st day of period
→ 21 pills and stop for a 7 day break
→ restart each new packet on the 8th day
→ if missed pills then no pill free interval
What medications can interact with the COCP?
→ liver enzyme inducing drugs
→ Rifampicin and anti-epileptics
→ Broad spectrum antibiotics
What are the 2 progestogen only implants?
→ Nexplanon
→ Norplant
What is the progestogen only IUD called?
→ mirena
Why is cerelle better than progesterone only pills?
→ As effective as the combined contraceptive
→ no estrogen - no effects on breastfeeding
→ bleeding is as predictable as the combined pill
How do you use the combined vaginal contraceptive (ring)?
→ Vaginal delivery for 21 days
→ remove for 7 days
How do copper containing IUDs work?
→ Destroying spermatozoa
→ Preventing implantation - inflammatory reaction
→ Sterile endometrium due to a foreign body in the uterus
What are the 3 copper bearing IUDs called?
→ Ortho T380
→ Multiload 275
→ Multiload 250
What are the 2 progesterone IUDs called?
→ Mirena
→ Jaydess
What are benefits of IUCDs?
→ Non user dependent → Immediately and retrospectively effective → reversible → longterm → reliable → unrelated to coitus
What are disadvantages of the IUCDs?
→ Fitted by trained medical personnel → Fitting can cause pain and discomfort → periods can become heavier and more painful → no protection against infection → threads can be felt
What are the risks of IUDs?
→ Miscarriage if pregnancy occurs
→ Ectopic
→ expelled if not deep enough
→ Uterus can be perforated
What are absolute contraindications of IUDs?
→ Pelvic inflammatory disease
→ Suspected pregnancy
→ Unexplained vaginal bleeding
→ Abnormalities of uterine cavity
What are relative contradindications of IUDs?
→ not mutually monogamous
→ Nulliparity
→ Menorrhagia/dysmenorrhea
→ Small uterine fibroids
What are advantages of the male condom?
→ Man in control
→ protects against STIs
→ no health risks
What are disadvantages of the male condom?
→ Last minute use
→ needs to be taught
→ Can cause allergies
What are advantages of the female condom?
→ Protects against STIs
→ Can be put in advance
→ not dependent on erection
What are disadvantages of the female condom?
→ Messy
→ Expensive
→ obtrusive
What must caps be used with?
→ Spermicide
What are advantages of diaphragm caps?
→ Can be put in advance
→ protection against cervical dysplasias
What are advantages of suction caps?
→ Suitable for women with poor pelvic muscles
→ unobtrusive
What are disadvantages of diaphragm caps?
→ needs to be taught
→ messy
→ higher UTI
→ higher candidiasis
What are disadvantages of suction caps?
→ Accessible and suitable cervix
→ not easy to find a teacher
→ higher failure rate than diaphragm
How long can sperm and egg survive?
→ egg 24 hrs
→ sperm 5 days
How long does the egg take to reach the uterus and implant?
→ 4 days
What are the advantages of the fertility awareness method?
→ Non medical
→ can be used in 3rd world
→ allowed by catholics
→ closeness between partners
What are disadvantages of the fertility method?
→ Failure rate is user dependent
→ requires skill
→ cooperation
→ limiting sexual activity
What are the 3 post coital pills?
→ EllaOne
→ Levonelle
→ Schering PC4
When can you take emergency contraception?
→ upto 72 hours after unprotected sex
When can you put an IUD in as emergency contraception?
→ upto 5 days after unprotected sex
What does Levonelle contain?
→ 750 mg of levonorgesterel
What is PC4 contraindicated in?
→ focal migraine attack
What is Levonelle contraindicated in?
→ Women taking potent liver enzyme medication
What is EllaOne?
→ selective progestagen receptor
What is the effectiveness of Levonelle upto 24hours?
→ 95%
How do PC4 and levonelle prevent pregnancy?
→ Postpone ovulation in 1st part of cycle
How do copper IUDs prevent pregnancy?
→ Copper kills sperm in 1st part of cycle
→ prevents implantation in 2nd part of cycle
What are the efficacies of COCP, depo provera, IUCDs, IUS, implants and POP?
→ <1/100 woman will get pregnant
