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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

Which contraceptive methods require ongoing action by the individual?

A
  • Oral contraception
  • Barrier methods
  • Fertility Awareness
  • Coitus Interruptus
  • Oral Emergency contraception
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2
Q

Which contraceptive methods prevent conception by default?

A
  • IUCD/IUI/IUS
  • Progestogen implants e.g. in arms
  • Progestogen injections
  • Sterilisation
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3
Q

What is the perfect contraceptive?

A

It does not exist

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4
Q

What are the risks of contraceptives?

A
  • Cardiovascular problems
  • Neoplastic (cancer)
  • Emotional (affects the brain)
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5
Q

What are the risks of insertion of foreign bodies?

A
  • Infection related
  • Allergy
  • Iatrogenic (harm caused by the medical profession)
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6
Q

What are the risks of no contraceptive treatment?

A
  • Childbirth related
  • Abortion related
  • Social costs
  • Economic costs
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7
Q

What are the benefits of contraceptive treatment?

A
  • Non-contraceptive
  • Psychosexual
  • Choice
  • Sexual health
  • Cost savings
  • Female equality
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8
Q

What are the benefits of no contraceptive treatment?

A
  • Non-interference
  • Population growth
  • Control of women
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9
Q

What is an example of combined oral contraception?

A

EthinylOestradiol, Synthetic Oestrogen - 20,30, 35, 50 micrograms

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10
Q

What do oestrogens act on?

A
  • On anterior pituitary and hypothalamus
  • Directly on the ovary
  • On the endometrium
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11
Q

What does oestrogen do?

A

It causes negative feedback that means it switches off LH and FSH which stops follicular development and stops ovulation.

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12
Q

What happens if there is only oestrogen? What happens if there is oestrogen and progesterone?

A
  • Oestrogen will cause proliferation of the endometrium
  • With progesterone, it will cause a singular effect on the endometrium that causes it to become thinner (not proliferate).
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13
Q

What happens during ovulation if someone is on COCP?

A

When there is ovulation, there will be limited endometrium for it to implant into.

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14
Q

What do progestogens do?

A

Reduce cilia action tha makes the egg not able to implant

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15
Q

What does progestogen act on?

A
  • On anterior pituitary and hypothalamus
  • Directly on the ovary
  • On the endometrium
  • On the fallopian tubes
  • On cerivcal mucus
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16
Q

What are the contraceptive benefits of the COCP?

A
  • Reliable
  • Safe
  • Unrelated to coitus: don’t have to insert it on to anything
  • Women in control
  • Rapidly reversible - don’t take for 10 days and period will come back
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17
Q

What are the non-contraceptive benefits of the COCP?

A
  • Halve ca ovary
  • Halve ca endometrium
  • Helps endometriosis, menorrhagia, dysmenorrhoea
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18
Q

What are the cardiovascular risks of the COCP?

A
  • Arterial: progestogen, High BP
  • Smoking: over 35, can’t use COCP
  • Venous: Oestrogen-VTE-clotting disorders (DVT, PE, Migraine).
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19
Q

What are the neoplastic risks of the COCP?

A
  • Only can cause liver cancer but this is rare.
  • Doesn’t cause breast cancer
  • Doesn’t cause Cervical cancer - this is caused by HPV.
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20
Q

What are the gastrointestinal risks of COCP?

A
  • Doesn’t cause weight gain but oestrogen can increase appetite.
  • COH/insulin metabolism
  • Crohns disease
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21
Q

What are the hepatic risks of COCP?

A
  • Hormone metabolisms
  • Congenital nonhaemolytic jaundices
  • Gall stones
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22
Q

What are the dermatological risks of COCP?

A

Cholasma (red cheek rash)
Acne (COCP is good for this)
Erythema multiforme

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23
Q

What are the psychological risks of COCP?

A
  • Mood swings
  • Depression
  • Libdio (may decrease)
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24
Q

COCP rules

A
  1. Start 1st packet on 1st day of the menstrual period
  2. Take 21 pills and stop for 7 day break
  3. Restart new packet on 8th day - do not start new packets late
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25
Q

What do liver enzyme inducing drugs do?

A
  • Affect metabolising of both oestrogen and progestogen

- Beware rigampicin and anti-epileptics

26
Q

What do broad spectrum antibiotics do?

A

Affect enterohepatic circulation of oestrogen only (40%)

27
Q

What is the combined vaginal contraceptive?

A

Same as COCP expect vaginal delivery (ring) for 21 days. Remove for 7 days.

28
Q

What are the progestogen only methods?

A
  • Implants
  • Hormone releasing IUCD
  • POPs
  • Injectables
29
Q

What are the default progestogen methods and give examples?

A

Implants

  • Nexplanon
  • Norplant (LNG)

Hormone releasing IUCD (Coil)
- Mirena IUS

30
Q

What are the user dependent progestogen methods and give examples?

A

POPS
- Desogestrel (Cerelle) mostly used

Injectables

  • Depo Provera (MPA) - 12 weekly
  • Noristerat (NET)
31
Q

Why is cerelle better than older POPs?

A
  • As effective as COCP
  • No oestrogen - cis e.g. breastfeeding
  • Favourable side effect profile vs older POPs
  • Bleeding as predictable as COCP
  • 12 hour window
32
Q

How are coils used?

A

Copper bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and may be left in situ long term.

33
Q

How do coils act on the uterus?

A
  • Destroying spermatozoa

- Preventing implanation

34
Q

How do the coils destroy spermatozoa?

A

The copper ions degenerate off the devices and are spermicidal

35
Q

How do the coils prevent implantation?

A

Inflammatory reaction and prostaglandin secretion as well as a mechanical effect - endometritis (inflammation) that isn’t good for conception.

36
Q

How long are coils left?

A

They are left in situ for 5 years

37
Q

What happens if a coil is inserted after the 40th birthday?

A

This could be left until after the menopause if the woman wishes without being replaced.

38
Q

Name some examples of copper bearing

A
  • Ortho T 380: 8-12 years
  • Multiload 375: 5 years
  • Multiload 250: 5 years (standard and short)
  • Nova T 380: 5 years
  • Nova T 200: 5 years
  • GyneFix (IUI): 5 years
39
Q

Name some examples of hormone bearing

A
  • Mirena (IUS): 5 years
40
Q

What are the benefits of the coil?

A
  • Non-user dependent
  • Immediately and retrospectively effective
  • Immediately reversible
  • Can be used long term
  • Extremely reliable
  • Unrelated to coitus
  • Free from serious medical dangers
41
Q

What are the disadvantages of the coil?

A
  • Has to be fitted by a trained medical personnel
  • Fitting may cause pain or discomfort
  • Periods may become heavier and painful
  • Doesn’t offer protection against infection
  • Threads may be felt by the male
42
Q

What are the risks of the coil?

A
  • Miscarriage if left in situ if a pregnancy
  • If pregnant, it is taken as an ectopic pregnancy unless proven otherwise.
  • May be expelled
  • Uterus may be perforated (1/1000 insertions)
43
Q

What is an absolute contraindications?

A

The event or substance could cause a life-threatening situation.

44
Q

What is an relative contraindications?

A

Caution should be used when two drugs or procedures are used together.

45
Q

What are the absolute contraindications of the coil?

A
  • Current pelvic inflammatory disease
  • Suspected or known pregnancy
  • Unexplained vaginal bleeding
  • Abnormalities of the uterine cavity
46
Q

What are the relative contraindications of the coil?

A
  • Nullparity: a myth
  • Past history of pelvic inflammatory disease: not relavant
  • Not in mutually monogamous relationship: not relavant
  • Menorrhagia /Dysmenorrhoea
  • Small uterine fibroids
47
Q

What are the advantages for the female and male condoms?

A

MALE

  • Man in control
  • Protects against STIs
  • No serious health risks
  • Easily available (free at Family Planning Clinics)

FEMALE

  • Woman in control
  • Protects against STIs
  • Can be put in, in advance and left inside after erection lost
  • Not dependent on male erection to work
48
Q

What are the disadvantages for the female and male condoms?

A

MALE

  • Last minute use
  • Needs to be taught
  • May cause allergies
  • May cause psycho sexual difficulties
  • Higher failure rate among some couples
  • Oily preparations rot rubber

FEMALE

  • Obtrusive
  • Expensive
  • Messy
  • Rustles during sex
  • Uncertain failure rate
49
Q

Describe the diaphragm caps

A
  • Made of latex
  • Fit across vagina
  • Sizes 55-95 mm in 5 cm jumps
  • Must be used with spermicide and left in at least 6 hours after sexual intercourse
50
Q

Advantages and disadvantages of diaphragm caps

A

Advantages

  • Women in control
  • Can be put in advance
  • Offers protection against cervical dysplasias
  • Perceived as “natural”

Disadvantages

  • Needs to be taught
  • Messy
  • Higher failure rate than most other methods
  • Higher UTI
  • Higher Candiasis
51
Q

Describe the suction (cervical) caps

A
  • Made of plastic
  • Suction to cervix or vaginal vault
  • Different sizes
  • Must be used with spermicide and left in 6 hours or more
52
Q

Advantages and disadvantages of suction caps

A

Advantages

  • Suitable for women with poor pelvic muscles
  • No problems with rubber allergies
  • Very unobstrusive
  • Woman in control

Disadvantages

  • Needs an accessible and suitable cervix
  • Higher failure rate than diaphragm
  • Not easy to find experienced teacher
53
Q

What is the fertility awareness contraception method?

A
  • Prediction of ovulation? 14/7 before period
  • Sperm can survive 5 days in female tract
  • Ova can survive 24 hours
  • Ova are fertilised in the fallopian tube and take 4 days to reach the uterus and implant
  • Cervical mucus is receptive to sperm around the time of ovulation
  • Use periodic abstinence/alternative contraception to avoid pregnancy
  • Time intercourse to pre-ovulatory phase to conceive
54
Q

What is the advantages of fertility awareness?

A
  • Non medical
  • Can be used in 3rd wor;d
  • Allowed in the catholic church
  • Can result in closeness of understanding between partners
55
Q

What is the disadvantages of fertility awareness?

A
  • Failure rate heavily user dependent
  • Requires skilled teaching
  • May require cooperation between partners
  • May involve limiting sexual activity
  • Can cause strain
56
Q

What is the nautral family planning contraceptive method?

A
  • Temperature
  • Rhythm
  • Cervix position
  • Cervical mucus
  • Persona
  • Lactational amenorrhoea (LAM)
57
Q

What the emergency contraceptions?

A
  • Postcoital Pills
  • Schering PC4
  • Copper bearing IUCDs
  • Levonelle
  • ellaOne
58
Q

When should postcoital pills be used?

A

up to 72 hours after unprotected sexual intercourse

59
Q

When should copper bearing IUCDs be used after sexual intercourse?

A

Up to 5 days after presumed ovulation or 5 days after one single episode of UPSI at any time of the cycle

60
Q

What form of contraception is being phased out?

A

PC4 is being replaced by Schering and Levonelle that is more effective with fewer contraindications and side effects

61
Q

What do PC4 and Levonelle 2 act on?

A
  • Act on postponing ovulation in 1st part of the cycle

- Act by preventing implantation in 2nd part of the cycle

62
Q

What do Copper IUCDs act on?

A
  • Copper kills sperm in 1st part of the cycle

- Device prevents implantation in 2nd part of the cycle

Repro (11 decks)

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