Contraception Flashcards
Which contraceptive methods require ongoing action by the individual?
- Oral contraception
- Barrier methods
- Fertility Awareness
- Coitus Interruptus
- Oral Emergency contraception
Which contraceptive methods prevent conception by default?
- IUCD/IUI/IUS
- Progestogen implants e.g. in arms
- Progestogen injections
- Sterilisation
What is the perfect contraceptive?
It does not exist
What are the risks of contraceptives?
- Cardiovascular problems
- Neoplastic (cancer)
- Emotional (affects the brain)
What are the risks of insertion of foreign bodies?
- Infection related
- Allergy
- Iatrogenic (harm caused by the medical profession)
What are the risks of no contraceptive treatment?
- Childbirth related
- Abortion related
- Social costs
- Economic costs
What are the benefits of contraceptive treatment?
- Non-contraceptive
- Psychosexual
- Choice
- Sexual health
- Cost savings
- Female equality
What are the benefits of no contraceptive treatment?
- Non-interference
- Population growth
- Control of women
What is an example of combined oral contraception?
EthinylOestradiol, Synthetic Oestrogen - 20,30, 35, 50 micrograms
What do oestrogens act on?
- On anterior pituitary and hypothalamus
- Directly on the ovary
- On the endometrium
What does oestrogen do?
It causes negative feedback that means it switches off LH and FSH which stops follicular development and stops ovulation.
What happens if there is only oestrogen? What happens if there is oestrogen and progesterone?
- 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).
What happens during ovulation if someone is on COCP?
When there is ovulation, there will be limited endometrium for it to implant into.
What do progestogens do?
Reduce cilia action tha makes the egg not able to implant
What does progestogen act on?
- On anterior pituitary and hypothalamus
- Directly on the ovary
- On the endometrium
- On the fallopian tubes
- On cerivcal mucus
What are the contraceptive benefits of the COCP?
- 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
What are the non-contraceptive benefits of the COCP?
- Halve ca ovary
- Halve ca endometrium
- Helps endometriosis, menorrhagia, dysmenorrhoea
What are the cardiovascular risks of the COCP?
- Arterial: progestogen, High BP
- Smoking: over 35, can’t use COCP
- Venous: Oestrogen-VTE-clotting disorders (DVT, PE, Migraine).
What are the neoplastic risks of the COCP?
- Only can cause liver cancer but this is rare.
- Doesn’t cause breast cancer
- Doesn’t cause Cervical cancer - this is caused by HPV.
What are the gastrointestinal risks of COCP?
- Doesn’t cause weight gain but oestrogen can increase appetite.
- COH/insulin metabolism
- Crohns disease
What are the hepatic risks of COCP?
- Hormone metabolisms
- Congenital nonhaemolytic jaundices
- Gall stones
What are the dermatological risks of COCP?
Cholasma (red cheek rash)
Acne (COCP is good for this)
Erythema multiforme
What are the psychological risks of COCP?
- Mood swings
- Depression
- Libdio (may decrease)
COCP rules
- Start 1st packet on 1st day of the menstrual period
- Take 21 pills and stop for 7 day break
- Restart new packet on 8th day - do not start new packets late
What do liver enzyme inducing drugs do?
- Affect metabolising of both oestrogen and progestogen
- Beware rigampicin and anti-epileptics
What do broad spectrum antibiotics do?
Affect enterohepatic circulation of oestrogen only (40%)
What is the combined vaginal contraceptive?
Same as COCP expect vaginal delivery (ring) for 21 days. Remove for 7 days.
What are the progestogen only methods?
- Implants
- Hormone releasing IUCD
- POPs
- Injectables
What are the default progestogen methods and give examples?
Implants
- Nexplanon
- Norplant (LNG)
Hormone releasing IUCD (Coil)
- Mirena IUS
What are the user dependent progestogen methods and give examples?
POPS
- Desogestrel (Cerelle) mostly used
Injectables
- Depo Provera (MPA) - 12 weekly
- Noristerat (NET)
Why is cerelle better than older POPs?
- 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
How are coils used?
Copper bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and may be left in situ long term.
How do coils act on the uterus?
- Destroying spermatozoa
- Preventing implanation
How do the coils destroy spermatozoa?
The copper ions degenerate off the devices and are spermicidal
How do the coils prevent implantation?
Inflammatory reaction and prostaglandin secretion as well as a mechanical effect - endometritis (inflammation) that isn’t good for conception.
How long are coils left?
They are left in situ for 5 years
What happens if a coil is inserted after the 40th birthday?
This could be left until after the menopause if the woman wishes without being replaced.
Name some examples of copper bearing
- 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
Name some examples of hormone bearing
- Mirena (IUS): 5 years
What are the benefits of the coil?
- Non-user dependent
- Immediately and retrospectively effective
- Immediately reversible
- Can be used long term
- Extremely reliable
- Unrelated to coitus
- Free from serious medical dangers
What are the disadvantages of the coil?
- 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
What are the risks of the coil?
- 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)
What is an absolute contraindications?
The event or substance could cause a life-threatening situation.
What is an relative contraindications?
Caution should be used when two drugs or procedures are used together.
What are the absolute contraindications of the coil?
- Current pelvic inflammatory disease
- Suspected or known pregnancy
- Unexplained vaginal bleeding
- Abnormalities of the uterine cavity
What are the relative contraindications of the coil?
- Nullparity: a myth
- Past history of pelvic inflammatory disease: not relavant
- Not in mutually monogamous relationship: not relavant
- Menorrhagia /Dysmenorrhoea
- Small uterine fibroids
What are the advantages for the female and male condoms?
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
What are the disadvantages for the female and male condoms?
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
Describe the diaphragm caps
- 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
Advantages and disadvantages of diaphragm caps
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
Describe the suction (cervical) caps
- Made of plastic
- Suction to cervix or vaginal vault
- Different sizes
- Must be used with spermicide and left in 6 hours or more
Advantages and disadvantages of suction caps
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
What is the fertility awareness contraception method?
- 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
What is the advantages of fertility awareness?
- Non medical
- Can be used in 3rd wor;d
- Allowed in the catholic church
- Can result in closeness of understanding between partners
What is the disadvantages of fertility awareness?
- Failure rate heavily user dependent
- Requires skilled teaching
- May require cooperation between partners
- May involve limiting sexual activity
- Can cause strain
What is the nautral family planning contraceptive method?
- Temperature
- Rhythm
- Cervix position
- Cervical mucus
- Persona
- Lactational amenorrhoea (LAM)
What the emergency contraceptions?
- Postcoital Pills
- Schering PC4
- Copper bearing IUCDs
- Levonelle
- ellaOne
When should postcoital pills be used?
up to 72 hours after unprotected sexual intercourse
When should copper bearing IUCDs be used after sexual intercourse?
Up to 5 days after presumed ovulation or 5 days after one single episode of UPSI at any time of the cycle
What form of contraception is being phased out?
PC4 is being replaced by Schering and Levonelle that is more effective with fewer contraindications and side effects
What do PC4 and Levonelle 2 act on?
- Act on postponing ovulation in 1st part of the cycle
- Act by preventing implantation in 2nd part of the cycle
What do Copper IUCDs act on?
- Copper kills sperm in 1st part of the cycle
- Device prevents implantation in 2nd part of the cycle
