Contraception Flashcards
What is the most commonly used contraceptive fertility control method?
Combined hormonal contraception
what contraception has low maintenance?
Implant or IUT
only male contraception?
condoms/vasectomy
what would be the most effective contraception
vasectomy followed by implant
what method of contraception has a delay in reversibility?
injections
what is the pearl index
the number of contraceptive failures per 100 women-years of exposure
Life Table Analysis provides ?
the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure
what does Long-Acting Reversible Contraception minimise
user input and so minimises user failure rates
Long-Acting Reversible Contraception can fail in what 2 ways?
Method failure
User failure
When can sex cause pregnancy ?
26-32 day cycle and not on hormonal contraception
sex causing pregnancy - ovulation time?
Likely ovulate day 12-18 ( 2 weeks before period)
How long does an egg survive
24 hours
average sperm survival time?
less than 4 days
highest chance of pregnancy is from sex on days?
8-19
what is in the combined hormonal contraception?
ethinyl estradiol (EE) and synthetic progesterone (progestogen
How does the the combined hormonal contraception work?
Stop ovulation, also affect cervical mucus and endometrium
standard procedure for Combined hormonal contraception?
21 days with a hormone free week
Different types of combined hormonal contraception
pill, patch and vaginal ring
What is tricycling?
3 packs of pills and one week off - only 5 bleeds per year instead of 13
- no need for uncomfortable inconvenient withdrawal bleed, avoids forgetting to restart after break
How is the combined pill taken?
daily anytime in 24 hrs- ? Phone app
How is the combined patch taken?
(EVRA TM) changed weekly- < 5% have skin reaction
How is the combined ring used?
changed every 3 weeks
can take out for 3 hrs in 24 so may prefer to take out for sex
Combined methods - Non-contraceptive benefits (6)
Regulate/reduce bleeding- help heavy or painful natural periods
Stop ovulation- may help premenstrual syndrome
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne / hirsutism
Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
Troublesome Side effects of combined contraceptive?
- Breast tenderness
- Nausea
- Headache
- Irregular bleeding first 3 months
Mood ? Causal or other life events
Weight gain- not causal
Serious Risks associated with CHC use? -
when should you avoid it?
venous thrombosis- DVT
IF BMI >34, reduced mobility,
Increased risk arterial thrombosis- MI / ischaemic stroke - smokers >35 , focal migraines, hypertension
CHC - when would you not give it to someone (what conditions may they have)
if active gall bladder disease or previous liver tumour
CHC can increase the risk of?
what is not a contraindication for the risk of breast cancer?
cervical cancer- but data predates HPV vaccine
- breast cancer
- non BRCA family history
the risk of VTE increases from?
2 per 100,000
the use of the pill trebles what?
Risk of venous thromboembolism
How is the Progestogen-only pill (POP) ‘ mini-pill’ taken?
same time every day without a pill-free interval
When are the pills not a good choice?
GI upset
what has a 12 hour window period?
- what does this pill also affect?
Desogestrel pill
- mucus, most are bleed free
the traditional LNG NET
pills have what hour window? - 2/3 of the pill relies on?
how is the period affected by these pills?
3 hours
- a cervical mucus effect
- 1/3 bleed free, 1/3 irregular, 1/3 regular
Bonus of the mini-pill?
Oestrogen free- so very few contraindications
Personal Hx Breast cancer / liver tumour
Progestogenic side effects? (6)
Appetite increase ACNE Hair loss/gain Mood change Bloating or fluid retention Headache
The contraceptive dose progestogens has no increased risk of?
venous or arterial thrombosis
When should you avoid the mini pill?
Breast cancer / liver tumour
What solution is inside the progestogen injection?
depomedroxyprogesterone acetate DepoproveraTM
How is the injection given?
150 mg 1ml deep intramuscular injection into the upper outer quadrant of the buttock every 13 weeks
What does the injection do? (3)
- prevents ovulation
- It alters cervical mucus making it hostile to sperm
- Makes endometrium unsuitable for implantation
3 positives of the injection?
- Only need to remember every 12-14 weeks
- 70% women amenorrhoeic after 3 doses
- Estrogen-free so few contraindications
Negatives of the injection? (4)
- Delay in return to fertility – average 9 months
- Reversible reduction in bone density- discuss her other risks for osteoporosis
- Problematic bleeding especially first 2 doses
- Weight gain 2/3 women gain 2-3 kg
The injection has what 3 effects?
effect on weight gain , delayed return of fertility and bone density
What does the ‘rod’ contain?
- what is the rod covered in?
68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA).
- The rod is then covered in a rate controlling membrane made from EVA.
4 features of the Progestogen Implant?
- Inhibition of ovulation + effect on cervical mucus
- Can last 3 years- or be removed at any time
- No user input needed
- No causal effect on weight
2 negative effects of the Progestogen Implant?
- 30% have prolonged / frequent bleeding
- 30% have prolonged / frequent bleeding
Intrauterine contraception ‘The Coil’ has how many years of use?
5-10 years
what contraception method has an infection risk?
- WHAT SHOULD you offer?
IUD
STO testing to those with new partner or under 25
How long does the IUD take to fit?
10 mins
with the IUD, there is a slight risk for?
- when is it not suitable? (2)
ectopic pregnancy
- untreated pelvic infection or distorted endometrial cavity eg submucous fibroids/ bicornuate / previous ablation
How does the copper IUD work?
Toxic to sperm -stop sperm reaching egg- may sometimes prevent implantation of fertilised egg
The copper IUD is?
What can it negatively do?
Hormone free
May make periods heavier/crampier
Levonorgestrel IUS - what does it affect?
what can it stop/prevent?
cervical mucus and endometrium most women still ovulate
Stop fertilisation of egg- may prevent implantation fertilised egg
How does Levonorgestrel IUS work?
- what are the progestogen levels like?
- what does it reduce?
Slow release progestogen on stem
Low circulating progestogen levels compared with pill/implant/injection
Reduce menstrual bleeding after up to 4 months initial irregular bleeding
What are the 3
types of Levonorgestrel IUS - how long do they work?
Mirena TM- 5 years contraception
KyleenaTM – 5 years and JaydessTM- 3 years (more likely to bleed but have less hormone)
What can be prescribed to treat heavy menstrual bleeding ?
Mirena
Emergency contraception - 3 types
Copper IUD most effective option
- Levonorgestrel pill-’Levonelle’
- Ulipristal pill ‘ellaone
When should you take Levonorgestrel pill-’Levonelle’?
within 72 hrs
If 100 women use will be 2-3 pregnancies
When should you take ‘ellaone’
- what are the contraindications?
within 120 hrs
- breast feeding/enzyme inducing drugs/ acid reducing drugs
If 100 women use will be 1-2 pregnancies
Copper IUD as Emergency contraception - when would you fit it?
within 120 hours or by day 19 of a 28 day cycle
When to start contraception. - when will you be covered?
- if you start at other times in a cycle, you need to..?
first 5 days of cycle
- need condoms /abstain for next 7 days and do pregnancy test after 4 weeks
When can you get pregnant after delivery, miscarriage or abortion
5 days
Breast feeding acts as a?
contraceptive only for first 6 months+ if feeding every 4 hours +amenorrhoeic
A breastfeeding woman can use ?
any type of contraception.
What drug interactions can reduce the
effectiveness of combined pill, patch, ring and POP and implant?
- how do they do this?
Enzyme inducing drugs eg carbamazepine,
topiramate, rifampicin, St Johns Wort
Increase the
metabolism of progestogen and oestrogen
What is not affected by drug interactions? (2)
Injectable progestogens and Copper or Levonorgestrel IUD
Laparoscopic Sterilisation- what is this?
Filshie clips applied across tube to block tube lumen metal/silicone OK for MRI
Laparoscopic Sterilisation is?
what does it have risks of?
- what does it reduce the risk of?
Irreversible- risk regret
- GA and laparoscopy
ovarian cancer risk, has no effect on periods or hormones
when may a salpingectomy be performed?
planned caesarean section if baby seems
well and discussed in advance
Essure is
hysteroscopic sterilisation
What is divided in a vasectomy?
Vas deferens divided and ends cauterised small incision midline scrotum
How long does it take for a vasectomy to be effective?
4-5 months - sperm samples are sent in
A vasectomy is?
irreversible - -sperm antibodies even if vas reconnected
A vasectomy has no known effects on?
testosterone or sexual function
- risk testicular or prostate cancer
how many women will have an abortion?
- most common age group?
- when are most carried out?
1 in 3
1 in 6 in grampain
20-24
- 90% are carried out in under 12 weeks
Staff have a right to refuse participation in an abortion as long as?
it does not affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman
Clinic consultation for abortion? - what to include
– reasons for considering abortion- see alone
language line , check no coercion or gender based violence
Discuss methods of abortion
- contraception afterwards
- STI swabs / tests
Termination of PregnancySurgical - 5-12 weeks
Cervical priming- misoprostol 3 hrs preop helps dilation and reduces risk perforation/ haemorrhage
- GA or LA cervical block
- Transcervical - 6-10mm suction catheter
Complications of abortion surgery?
infection
- risks from GA - perforation, cervical injury
Termination of PregnancyMedical (MTOP)- 5-24 weeks - what is given?
Mifepristone oral antiprogestogen tablet
36-48 hours later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
- Average 4-6 hours to pass pregnancy under 12 weeks
- Mifepristone helps Misoprostol work better
Complications of Mifepristone oral antiprogestogen tablet
?
Infection
- rare but may need blood transfusion
- can fail
Home Abortion - what is legal?
to supply misoprostol for woman to take away from clinic for home self administration
What is home abortion good for?
women who are under 10 weeks gestation and prefer a home procedure and and ‘healthy’. Analgesia supplied. Phone advice 24/7. Follow up low sensitivity pregnancy test at 2 weeks.
Women taking the abortion pill home need to take?
mifepristone in clinic/hospital
Longterm effects of Abortion? (3)
- No effect on future fertility or pregnancy or delivery
- No effect on cancer risks
Emotional effects depend on reasons for abortion/ pre-existing mental health issues