Contraception Flashcards
What is the most commonly used form of female contraception?
Combined hormonal contraception (CHC)
What are the different options for male contraception?
Condom
Vasectomy
What are some characteristics of an ideal contraceptive? (there is none that is completely ideal - but if)
- 100% reversible
- 100% effective
- Free of adverse side effects
- Protection against STI’s
- Low maintenance
What is one benefit of LARC (long acting reversible contraceptives)?
Minimize user input due to long acting nature, more convenient and minimizes chance of user error leading to pregnancy
When is a woman most likely to become pregnant with regards to her ovulation cycle?
Likely to ovulate around day 12-18
Egg survives 24 hours
Sperm survive less than 4 days (5% may survive a week)
So sex within days 8-19 of a woman’s cycle is most likely to cause pregnancy
What are the different forms of combined hormonal contraception? How often do each need to be administered?
Pill - needs to be taken daily
Skin Patch - changed weekly
Vaginal ring - changed every 3 weeks (can take out for 3 hours in every 24)
Which hormones are administered by combined hormonal contraception devices?
Ethinyl Estradiol - synthetic oestrogen
Progestogen - synthetic progesterone
Work by inhibiting ovulation, also cause changes in cervical mucus and endometrium
What are the benefits of combined hormonal contraceptives?
Regulate / reduce bleeding (help heavy periods)
Stop Ovulation
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne and hirsutism
Reduce benign breast disease, RA, colon cancer and osteoporosis
What are some possible complications associated with combined hormonal contraception?
- Breast tenderness / weight gain
- Nausea / headache
- Irregular bleeding for first 3 months
- Increased risk of arterial & venous thrombosis
- Avoid if active gall bladder disease / prev liver tumour
- Increased risk of cervical and breast cancer
What hormones are used in the progestogen only pill (POP)? How do they work? How often do they need to be taken?
Desogestrel or Levonorgestrel (both progesterone analogues)
Work by making cycles anovulant (no ovulation), also affect mucus.
Desogesterel - most cycles bleed free, LNG - 1/3 bleed free
Need to be taken daily
What are some complications associated with the progestogen only pill?
Appetite increase Hair loss / gain Mood change Bloating or fluid retention Headaches Acne
Need to avoid POP if current breast cancer or previous / present liver tumour
What hormone is in “the jag” (injectable progestogen)? How often does the injection need to be taken & where is it injected?
progestogen depomedroxyprogesterone acetate
150mg 1 mL deep intramuscular injection into the upper outer quadrant of the buttocks every 13 weeks
How does the injectable progestogen shot work?
- Prevents ovulation
- Alters cervical mucus making it hostile to sperm
- Makes endometrium unsuitable for implantation
What are some of the complications associated with injectable progestogen?
Delay in return to fertility - avg. 9 months
Reversible reduction in bone density (osteoporosis risk)
Problematic bleeding especially over first 3 doses
Weight gain (2/3 of women gain 2-3kg)
What is the subdermal progestogen implant made out of?
4cm long, 2mm wide rod containing:
- 68mg progestogen etonogestrel core
- Rate controlling membrane made from ethinyl vinyl acetate
Implanted subdermally
How long does the progestogen implant last? How does it work?
Can last 3 years or be removed at any time during this
Inhibits ovulation and has an effect on cervical mucus
What are some complications associated with the progestogen implant?
30% of women have prolonged / frequent bleeding
More significant mood alteration than other progestogen only methods
How long does intrauterine contraception (the coil) last for? What are some benefits?
Long acting reversible contraception - lasts 5-10 years
Requires little upkeep, effects immediately reversible when removed
How do copper IUD’s (intrauterine devices) work? What are some possible complications?
Toxic to sperm - stop sperm reaching the egg. May also prevent implantation of fertilized egg. Non-hormonal
May make periods heavier / crampier
Not a contraindication to MRI
How does the Levonorgestrel IUS (intrauterine system) work? How long is it effective for?
Affect cervical mucus and endometrium, prevent fertilization and possibly implantation. Most women still ovulate. Also reduces menstrual bleeding after 4 months
Works via slow release of low dose progestogen
Lasts for 3-5 years depending on model
What are the most effective options for emergency contraception?
Copper IUD is most effective, fit before implantation, less than 1 pregnancy per 100 women. Can keep method long term if patient likes it
Levonorgestrel pill (plan B) - take within 72 hours. 2-3 pregnancies per 100 women
Ulipristal pill - take within 120 hours, 1-2 pregnancies per 100 women. More contraindications (drugs / breast feeding)
When should a woman start contraceptives with regards to her cycle?
Start within first 5 days of cycle
Women can also get pregnant 21 days after delivery, or 5 days after miscarriage / abortion
What drugs can reduce the effectiveness of the pill, patch, ring, POP and implant?
Enzyme inducing drugs
Eg. carbamezapine, topiramate, rifampicin
What are some examples of barrier methods of contraception?
- Male condom
- Female condom
- Diaphragm (covers the cervix so sperm can’t get into the uterus)
- Sponge with spermacide (similar to diaphragm)
- Cervical cap (similar to diaphragm)
What are some surgical options for female sterilization?
Laparoscopic sterilization - clips placed across fallopian tubes to block lumen
Salpingectomy - removal of fallopian tubes
What are some benefits to female sterilization? Some possible complications?
Risk of pregnancy reduced to 1/200 lifetime
No effect on periods / hormones
Reduces ovarian cancer risk
Irreversible - risk regret
Risk of general anaesthetic and laparoscopy
How is a vasectomy done? Is it completely effective? Possible complications?
Vas deferens is divided and ends cauterized, under local anaesthetic usually in primary care. Takes 4-5 months to be effective
2% do not get clear sperm samples - ineffective, if clear samples 1/2000 risk of pregnancy
1/100 risk lifelong testicular pain
No effect on testosterone or sexual function
