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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the types of contraception

A
  • Combined hormonal
    • Pills, patch, vaginal ring
  • Progesterone only
    • Pill, injectable, implant
  • Intrauterine
  • Emergency
  • Sterilisation
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2
Q

% use of different contraceptions

A
  • Combined hormonal - 25%
  • Progesterone only pill - 5%
  • Progesterone-only implants/injectable - 3%
  • Intrauterine (coil) - 6%
  • Sterilised (male or female) - 28%
  • 12% sexually active not plannying on using
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3
Q

What is used to measure contraceptive failure

A
  • The pearl index
    • Number of contraceptive failures per women-years of exposure
  • Life table analysis
    • Failure rate over a specified time frame
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4
Q

Failure rate of different contraceptions

A
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5
Q

When can pregnancy occur

A
  • If 26-32 day cycle
    • Likely to ovulate 12-18 (2 weeks before period)
    • Egg survives 24 hours
    • Most sperm survive <4 days
  • Highest chance of pregnancy is day 8-19
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6
Q

What are the types of combined hormonal contraception

A
  • Pill
  • Patch - EVRA
  • Vaginal ring - Nuvaring
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7
Q

What is the CHC

A
  • Combination of 2 hormones
    • Ethinyloestradiol (EE) and synthetic progesterone (progestogen)
    • Stop ovulation, also affect cervical mucus and endpmterium
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8
Q

What are the regimes of CHC

A
  • Standrad - 21 days with hormone free week
  • Tailored - tricycling/continuous use
  • Pill taken daily (any time in 24 hours) problems if GI upset
  • Patch changed weekly
  • Ring changed every 3 weeks (can be taken out 3/24 hours)
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9
Q

How does the CHC work

A
  • Negative feedback - ovaries shut down
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10
Q

Non-contraceptive benefits of CHC

A
  • Regulate/reduce bleeding - help heavy or painful periods
  • Stop ovulation - help premenstrual syndrome
  • Reduction in ovarian cyst
  • 50% reduction in ovarian and endometrial cancer
  • Improve acne/hirstruism
  • Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
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11
Q

Side-effects of CHC

A
  • Breast tenderness
  • Nausea
  • Headache
  • Irregular bleeding first 3 months
  • Mood
  • Weight gain - not causal
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12
Q

Serious risks of CHC

A
  • Increased risk of venous thrombosis - DVT, PE
  • Increased risk of arterial thrombosis - MI/ischaemic stroke
  • Avoid if active gall bladder disease or previous liver tumour
  • Increased risk of cervical cancer
  • Increased risk of breast cancer
  • No overall increased cancer risk
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13
Q

When should the CHC be avoided

A
  • BMI>34, previous VET, 1st degree relative VTE <45, thrombophilis e.g. systemic lupus, erythematosus, reduced mobility
  • Smokers >35, personal history arterial thrombosis, focal migraine, >50, hypertension (>140/90)
  • Family history of breast cancer NOT a contraindication (unless BRCA positive)
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14
Q

What is the risk of VTE in CHC use

A
  • 5/100,000 women years in general population
  • 15/100,000 women years with COC use (LNG and NET)
  • 25/100,000 women years with COC use (GSD and DSG)
  • 60/100,000 women years with pregnancy
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15
Q

What is the regime of the progesterone-only pill

A
  • Sam time every day without interval
  • Not good if frequent GI upset
  • Desogesterol pill - 12 hour window
  • Traditional LNG NET pills - 3 hour window period
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16
Q

How does the POP work

A
  • Desogesterol
    • Anovulant - also effects mucus - most bleed free
  • Traditional LNG NET pills
    • 1/3 anovulant, 2/3 mucous effect
    • 1/3 bleed free, 1/3/ irregular, 1/3/ regular
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17
Q

Side effects of POP

A
  • Variable
    • Appetite increase
    • Hair loss/gain
    • Mood change
    • Bloating or fluid retention
    • Headache
    • Acne
  • No increased risk of venous or arterial thrombosis
  • Avoid if current breast or liver cancer past/present
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18
Q

What is the injectable

A
  • Progesterone
  • Aqueous solution of the progesterone depopmedroxyprogesterone acetate depoprovera
  • 150mg 1ml deep im injection every 13 weeks
  • Newer 0.6ml S/C version for self-administration
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19
Q

How does the progesterone injection work

A
  • Prevents ovulation
  • Alters cervical mucous - hostile to sperm
  • Endometrium unsuitable for implantation
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20
Q

Pros of progesterone injection

A
  • Only need to remember every 12 weeks
  • 70% amenorrhoeic after 3 doses
  • Oestrogen free so few contraindications
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21
Q

Cons of progesterone injection

A
  • Delay in return to fertility - average 9 months
  • Reversible reduction in bone density
  • Problematic bleeding after first 2
  • Weight gain 2/3 women - 2-3kg
22
Q

What is the implant

A
  • Subdermal progesterone implant
  • Nexplanon - contains 68mg of progesterone etongestrel dispersed in matrix of ethinylvinylacetate
  • Seen on x-ray
23
Q

Pros of the implant

A
  • Inhibition of ovulation - cervical mucous
  • Lasts 3 years or can be removed
  • No weight gain
24
Q

Cons of the implant

A
  • 60% are almost bleed free but 30% have prolonger/frequent bleeding
  • May cause mood change more often than other methods
25
Q

Pros of the IUD

A
  • LARC - 5-10 years
  • Little user input
  • Any age/parity
26
Q

Cons of the IUD

A
  • Small risk of infection in first 3 weeks <1:1000
  • fitting 10 mins
    • 1:1000 risk of perforation
  • If conceives may be ectopic but so effective risk lower than condoms
  • Not suitable if untreated pelvic infection or distorted endometrial cavity e.g. submucous fibrosis
27
Q

Types of intrauterine contraception

A
  • Copper IUD
  • Levonorgestrel
28
Q

How does the copper IUD work

A
  • Toxic to sperm - stop it reaching egg
  • May prevent implantation
  • Hormone free
  • Can last 5-10 years
29
Q

Cons of the copper IUD

A
  • May make period heavier/crampier
30
Q

How does the levonorgestrel IUS work

A
  • Affects the cervical mucous
    • Most still ovulate
    • Stops fertilisation of the egg
    • May prevent implantation
  • Slow release of progesterone on stem
    • Low circulating levels
  • Reduce menstrual bleeding after 4 months of irregular
31
Q

Types of levonorgestrel IUS

A
  • Mirena - 5 years
    • 85% bleed free after 1 yr
    • Can treat heavy bleeding as part of HRT
  • Kyleena - 5 years, Jaydess - 3 years
    • Less hormone
    • Less likely to be bleed free
32
Q

Types of emergency contraception

A
  • Copper IUD
  • Levonogestrel pill ‘Levonelle’
  • Ulipristal pill ‘Ellaone’
33
Q

Copper IUD as emergency contraception

A
  • Most effective
  • Fit before implantation - within 1200 hours and any time of before day 19 of 28 day cycle
  • Can keep long term
  • <1 pregnancy/100
34
Q

Levonorgestrel pill as emergency contraception

A
  • Take within 72 hours
  • 2-3 pregnancy/100 women
35
Q

Ulipristal pill as emergency contraception

A
  • Within 120 hours
  • MOre contraindications e.g. breastfeeding/enzyme inducing drugs/acid reducing drugs
  • 1-2 pregnancies/100 women
36
Q

When should contraception be started

A
  • In the first 5 days of cycle - give immediate cover
  • Other times need other methods for 7 days and pregnancy test after 4 weeks
37
Q

When should contraception be started after pregnancy

A
  • 21 days after delivery, 5 days after miscarriage or abortion
  • Breast feeding is contraception for first 6 months if feeding every 4 hours and amenorrhoeic
38
Q

What are the drug interactions with contraception

A
  • Enzyme inducing drugs e.g. carbamazepine, topiramate, rifampicin, st johns wort increase metabolism, reding effectiveness of combined pill and patch
    • Does not affect progesterone, IUD
  • May do salpingectomy at planned caesarean if no problems
  • ESSURE - hysteroscopic sterilisation - no longer available
39
Q

How is female sterilisation performed

A
  • laparascopic sterilisation - usually Filshie clips applied across to block tube lumen
40
Q

What are the risks of female sterilisation

A
  • Risk of GA and laparoscopy
  • Irreversible - risk regret
  • Failure rate - 1/200 lifetime
41
Q

Pro of female sterilisation

A
  • No effect on period/hormones
  • Reduces ovarian cancer risk
42
Q

How is a vasectomy performed

A
  • vas deferens divided and ends cauterised - small incision in midline scrotum
  • Local anaesthetic
43
Q

Pros of vasectomy

A
  • <1:100 risk of long-term testicular pain
  • No effects on testosterone or sexual function
  • No increased risk of testicular or prostate cancer
44
Q

Cons of vasectomy

A
  • takes 4-5 months to work - 2 sperm samples sent after 4 and 5 months
    • 2 in 100 not clear
  • Irreversible - anti-sperm antibodies even if reconnected
  • Failure rate after clear samples - 1 in 200 lifetimes risk
45
Q

Epidemiology of abortion

A
  • 1 in 3 UK women
  • 1 in 6 pregnancies in Grampian
  • Most common - 20-24
  • Numbers falling, especially in <20s
  • 90% under 12 weeks
  • Linked to deprivation
46
Q

What happens in a consultation for an abortion

A
  • Scan for gestation and viability
  • Medical history - risk VTE/bleeding/GA/contraceptive eligibility
  • Circumstance - see alone, language, coercion, gender-based violence
  • Discuss methods - contraception
  • FBC/Rhesus group
    • vaginal swab for chlamydia and gonorrhoea
    • STI bloods offered
47
Q

What is a surgical abortion

A
  • MTOP
  • 5-12 weeks
  • Cervical priming - misoprostol 3hrs preop helps dilation and reduces risks (perforation/haemorrhage)
  • GA or LA cervical block
    • Transcervical block - 6-10mm suction catheter
48
Q

What are the complications of surgical aboprtion

A
  • 1-4:100 perforation, <1:100 cervical injury
  • Infection
  • Risks of GA
49
Q

What is a medical abortion

A
  • MTOP
  • 5-24 weeks
  • Mifepristone oral antiprogesterone tablet
  • 36-48 hours later misoprostol uterine contraction initiated which opens cervix and expels pregnancy
  • Average 4-6 hours to pass <12 weeks
  • Mifepristone helps misoprostol work better
50
Q

Complications of medical abortion

A
  • Failure 1 in 100 <8weeks, 8/100 >12 weeks
    • Surgery
  • Infection
  • <1 in 1000 need blood transfusion
51
Q

How is home abortion legal in the UK

A
  • Supply misoprostol to take away from clinic and administer at home
  • Option for those <10 weeks
    • Analgesia supplied
    • Phone advice
    • Follow up at 2 weeks
  • Endorsed by WHO
52
Q

What are the long term effects of aboprtion

A
  • No effect on future fertility or pregnancy/delivery
  • No effect on cancer risk
  • Emotional effects depend on reasons

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