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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the most commonly used form of female contraception?

A

Combined hormonal contraception (CHC)

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2
Q

What are the different options for male contraception?

A

Condom

Vasectomy

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3
Q

What are some characteristics of an ideal contraceptive? (there is none that is completely ideal - but if)

A
  • 100% reversible
  • 100% effective
  • Free of adverse side effects
  • Protection against STI’s
  • Low maintenance
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4
Q

What is one benefit of LARC (long acting reversible contraceptives)?

A

Minimize user input due to long acting nature, more convenient and minimizes chance of user error leading to pregnancy

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5
Q

When is a woman most likely to become pregnant with regards to her ovulation cycle?

A

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

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6
Q

What are the different forms of combined hormonal contraception? How often do each need to be administered?

A

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)

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7
Q

Which hormones are administered by combined hormonal contraception devices?

A

Ethinyl Estradiol - synthetic oestrogen
Progestogen - synthetic progesterone

Work by inhibiting ovulation, also cause changes in cervical mucus and endometrium

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8
Q

What are the benefits of combined hormonal contraceptives?

A

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

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9
Q

What are some possible complications associated with combined hormonal contraception?

A
  • 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
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10
Q

What hormones are used in the progestogen only pill (POP)? How do they work? How often do they need to be taken?

A

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

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11
Q

What are some complications associated with the progestogen only pill?

A 
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

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12
Q

What hormone is in “the jag” (injectable progestogen)? How often does the injection need to be taken & where is it injected?

A

progestogen depomedroxyprogesterone acetate

150mg 1 mL deep intramuscular injection into the upper outer quadrant of the buttocks every 13 weeks

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13
Q

How does the injectable progestogen shot work?

A
  1. Prevents ovulation
  2. Alters cervical mucus making it hostile to sperm
  3. Makes endometrium unsuitable for implantation
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14
Q

What are some of the complications associated with injectable progestogen?

A

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)

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15
Q

What is the subdermal progestogen implant made out of?

A

4cm long, 2mm wide rod containing:

  • 68mg progestogen etonogestrel core
  • Rate controlling membrane made from ethinyl vinyl acetate

Implanted subdermally

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16
Q

How long does the progestogen implant last? How does it work?

A

Can last 3 years or be removed at any time during this

Inhibits ovulation and has an effect on cervical mucus

17
Q

What are some complications associated with the progestogen implant?

A

30% of women have prolonged / frequent bleeding

More significant mood alteration than other progestogen only methods

18
Q

How long does intrauterine contraception (the coil) last for? What are some benefits?

A

Long acting reversible contraception - lasts 5-10 years

Requires little upkeep, effects immediately reversible when removed

19
Q

How do copper IUD’s (intrauterine devices) work? What are some possible complications?

A

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

20
Q

How does the Levonorgestrel IUS (intrauterine system) work? How long is it effective for?

A

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

21
Q

What are the most effective options for emergency contraception?

A

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)

22
Q

When should a woman start contraceptives with regards to her cycle?

A

Start within first 5 days of cycle

Women can also get pregnant 21 days after delivery, or 5 days after miscarriage / abortion

23
Q

What drugs can reduce the effectiveness of the pill, patch, ring, POP and implant?

A

Enzyme inducing drugs

Eg. carbamezapine, topiramate, rifampicin

24
Q

What are some examples of barrier methods of contraception?

A
  • 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)
25
Q

What are some surgical options for female sterilization?

A

Laparoscopic sterilization - clips placed across fallopian tubes to block lumen

Salpingectomy - removal of fallopian tubes

26
Q

What are some benefits to female sterilization? Some possible complications?

A

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

27
Q

How is a vasectomy done? Is it completely effective? Possible complications?

A

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

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