Contraception Flashcards
What is the pearl index?
Number of contraceptive failures per 100 women against years of exposure
What is a benefit of long acting reversible contraception (LARC)?
Minimises user input and so minimises failure rates
What is method failure?
Pregnancy despite correct use of method by user
What is user failure?
Pregnancy because method not used correctly
When is the highest chance of pregnancy from sex?
Day 10-17
BUT Sperm survival and ovulation is variable so natural methods can fail even if abstain/barrier on most fertile days
What is combined hormonal contraception?
Combination of Ethinyl Estradiol (EE) and Synthetic Progesterone
Stops ovulation and affects cervical mucus and endometrium
What is the standard regime for combined hormonal contraception?
Pill taken daily
Patch changed weekly
Ring changed every 3 weeks
What are some non-contraceptive benefits of combined methods?
Regulate/reduce bleeding
Stopping ovulation may help premenstrual syndrome
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne/hirsutism
Reduce benign breast disease, RA, colon cancer and osteoperosis
What are some slight negative side effects of combined method?
Breast tenderness Nausea Headache Irregular bleeding first 3 months Mood
What are some serious risks associated with CHC?
Increased DVT and PE risk
Increased arterial thrombosis risk (MI, Stroke)
Increased cervical cancer risk but data precedes HPV vaccine
Increased breast cancer risk
What is one contraindication for the POP?
Frequent GI upset
What is the window period for desogestrel pill?
12 hours
What is the window period for traditional LNG NET pills?
3 hours
List some progestogenic side effects.
Appetite increase Hair loss/gain Mood change Bloating Fluid retention Headache Acne
What are the effects of injectable progestogen?
Prevents ovulation
Alters cervical mucus to make it hostile to sperm
Makes endometrium unsuitable implantation
What is the regime for injectable progestogen?
Injected into right upper buttock every 13 weeks
What are the effects of the progestogen implant?
Inhibition of ovulation
Effect on cervical mucus
No user input needed
No causal effect on weight
Is the copper IUD a contraindication to MRI?
No
What are some benefits of the copper IUD?
Hormone free
Can last 5-10 years depending on type
What is a drawback of copper IUD?
May make periods heavier/crampier
How does the copper IUD work?
Toxic to sperm
May sometimes prevent implantation of fertilised egg
What is the most effective emergency contraception?
Copper IUD
Fit before implantation ie within 120 hours
What are the main emergency contraceptives?
Copper IUD
Levongestrel
Ulipristal (Ellaone/UPA)
What is the effect of enzyme inducing drugs on contraception?
Increases metabolism of progestogen and oestrogen
Reduces effect of CHC
Name some common enzyme inducing drugs.
Carbamazepine
Topiramate
Rifampicin
St Johns Wort
What is female sterilisation?
Laparoscopic sterilisation
Usually Filshie clips applied across tube to block lumen
Irreversible
What is a vasectomy?
Vas deferens divided and ends cauterised
Does vasectomy affect testosterone or sexual function?
No
Which age group gets the most abortions?
20-24
What proportion of UK women will have an abortion at some point?
1 in 3
What rights does the 1967 Abortion Act give healthcare workers?
Staff have a right to refuse participation as long as this 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
Must ensure woman can access abortion care
What criteria must be met to support a woman’s request?
2 doctors sign support
Under 24 weeks
Pregnancy poses greater to risk to physical/mental health of pregnant woman or existing children of the pregnant woman than termination
Substantial risk that the child may suffer from physical or mental abnormalities as to be seriously handicapped
How does mifepristone work?
Oral antiprogestogen tablet mifepristone
36-48 hours later misopristol initiates uterine contraction which opens cervix and expels pregnancy
Is home abortion legal?
Yes
Misoprostol may be supplied to a healthy woman under 10 weeks gestation for self administration
Does abortion affect future fertility, pregnancy or delivery?
No
