Contraception Flashcards
What are your chances of getting pregnant each year when not using contraception
85%
What percentage of pregnancies in the UK each year are unplanned
50%
Around 1/3 of these end in abortion
What are the different categories of contraception
Long acting reversible contraception
Non- long acting reversible contraception
Irreversible procedures
How does hormonal contraception work
Prevent ovulation (pill) Works locally (hormonal coil)
How does a copper IUD prevent pregnancy
Prevents implantation
Does withdrawal work as a method of contraception
NO
What is coitarche
Age of having sex for the first time
What are the absolute contraindications to combined hormonal contraception
Migraines with aura
More 35 years old and smoking more than 15 cigarettes/day
History of thromboembolic disease or thrombogenic mutation
History of stroke or ischaemic heart disease
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
Aside from contraception, what can the combined pill be used for
Period regulation Helps with menorrhagia and dysmenorrhea Help with acne Endometriosis Help symptoms of PMS and PCOS
Is bleeding on contraception a true period
NO
Its a withdrawal bleed
How long does it take the copper IUD to start working
As soon as it is fitted
Can be inserted during any point during the menstrual cycle (once pregnancy is
excluded)
Therefore can be used as emergency contraception within 5 days of unprotected sex
How long does it take the hormonal IUS to start working
Takes 7 days to start working after insertion
Immediate if within 1st 5 days cycle, within 21
days postpartum, within 5 days abortion/miscarriage
How long does a copper IUD last
5-10 years
Can be removed at any time
Though it can fall out
Which coil is hormonal
The Mirena
The copper one is not hormonal
Which IUD can be used as emergency contraception
The copper coil
If it is inserted within 5 days of unprotected sex
What happens after IUD insertion
Some women get cramping pain and light bleeding following insertion
Need to check that the threads are still in place 4-6 weeks after insertion as risk of expulsion
What are the risks of IUD/IUS
It can fall out - 1/20 risk in first 3 months
Small risk of infection - PID risk in first 20 days
Slightly higher risk of ectopic pregnancy when getting pregnant on an IUD
advantages
Spotting weeks/months after insertion – usually settles by 6/12
Uterine perforation in 2/1000 insertions
What hormones are found in combined contraceptive
Oestrogen (inhibits ovulation) and progesterone (thickens mucus)
Includes pill, patch and ring
What is the typical fail rate for the combined contraceptives
9%
Due to compliance issues
How do you start someone on COC
Start in first 5 days of period - will be effective immediately
At any time in cycle when reasonably sure not pregnant - it will take 7 days to take effect so advise condoms for this time
How is the COC taken
Take daily for 21 days followed by a 7 day break
During the break you have a withdrawal bleed – not a real period
Can run packs together to avoid this
What factors can affect the effectiveness of the COC
Impaired absorption – GI conditions Increased metabolism – Liver enzyme induction, Drug interaction Forgetting
What are the risks of combined hormonal contraception
Venous thrombosis
Arterial thrombosis
MI and stroke risk (with other risk factors)
Increased risk of some cancers - breast, cervical
Hypertension
What has the higher risk of VTE - pregnancy or CHC
Pregnancy
What follow up is required for CHC
Check smear status
Discuss signs and risks of VTE
Check and record BP regularly
Why cant someone with aura migraines use CHC
Increases their risk of ischaemic stroke
At what age is it contraindicated to use CHC
Age over 35 is a relative contraindication
Which cancers does CHC protect against
Ovarian and endometrial cancers
Also colorectal
Why is CHC useful for acne
High oestrogen is beneficial for acne
What are the side effects of CHC
Spots Nausea Headache Bleeding Breast tenderness Low libido Mood changes Irregular bleeding – most common in 1st 3/12 use
How do you take the progesterone only pill
Take it every single day – DO NOT take the 7 days break
Needs to be taken at the same time (rough 12 hour window)
How do you start someone on progesterone only contraception
Day 1 – 5 of period for immediate contraceptive effect
OR
Anytime if reasonably certain not pregnant plus condoms for 7 days
If switching from combined oral contraceptive, immediate protection if continued
directly from the end of a pill packet (day 21)
What is the main side effect of progesterone only contraception
Can get a lot of irregular bleeding
What is the main side benefit of progesterone only contraception
Does not have the risks of the combined – blood clots, CV events etc
Very few contraindications – easier to prescribe to more people
Reversible immediately on stopping
How is depoprovera given
Depo is a large IM injection of progesterone hormone that lasts 3 months
Needs to be given every 3 months by a doctor
How is sayana press given
A self-administered form of progesterone injection– given in stomach or thigh
Given every 13 weeks
What are the benefits of the contraceptive injections
Very effective
Long-acting and less user dependent - don’t have to remember a pill everyday
Can be taken at any time during the menstrual cycle, as long as patient is not
pregnant
Usually causes amenorrhea - 50% in first year
Used in people with learning disabilities to stop their periods if they struggle to cope with having periods
Also used in treatment of heavy menstrual bleeding, dysmenorrhoea,
endometriosis
What are the disadvantages of the contraceptive injections
Injection cannot be reversed once given
Delayed return to fertility (up to 12 months)
Irregular bleeding – usually first 3/12 use
Potential for weight gain
Can lead to osteopenia as it lowers your estradiol – similar to post-menopause
Long term users must have DEXA scans
No protection against STIs
Hormonal side effects
How is the diaphragm used
It is a reusable circular dome made of thin, soft, silicone which is inserted into the vagina before sex (up to 3 hours or more spermicide is needed) Covers the cervix to prevent sperm from getting into the uterus Put spermicide along the rim, fold it up and insert into the vagina – it will slot into place Have to leave it in for 6 hours after sex – gives it time to kill the sperm
What are the potential complications of a vasectomy
Anaesthetic risk Pain - chronic scrotal pain Infection Swelling or bruising Bleeding /haematoma Failure Reversal procedures not always successful and unavailable on NHS
Why do you need a semen sample following a vasectomy
Need to wait for a sperm free semen analysis before you can say it’ll be effective - need other contraception until then
Semen sample is taken twice, at 12 and 16 weeks after procedure to ensure that semen is sperm-free
Which type of oral contraceptive needs to be taken at the same time every day
The progesterone only pill
Are condoms better for STI prevention or contraception
High failure rate so not a good contraceptive
Better for STI prevention