Contraception Flashcards
What is the Fertility Awareness method?
The awareness of the fertile period during a cycle and either abstaining or using the barrier method during that time
State the four subtypes of Fertility Awareness
Standard Days
Cervical Mucous
Basal Body Temp
Sympothermal
Describe the ‘Standard Days’ subtype of Fertility Awareness
If your cycle is between 26 and 32 days long, days 8-19 are the most fertile
Describe the ‘Cervical Mucous’ subtype of Fertility Awareness
Just prior to ovulation the oestrogen levels increase which makes the mucous thin and stretchy to optimise fertilisation
Be aware that intercourse/breast feeding/female hygiene products can falsely alter
Describe the ‘Basal Body Temp’ subtype of Fertility Awareness
Temperature increase of atleast 0.2 degrees with an increase in Progesterone
Fertility peaks a few days before this (so not very efficient)
Describe the ‘Sympothermal’ subtype of Fertility Awareness
Combines Cervical Mucous and Basal Body Temperature
Describe the Lactational Amenorrhoea method
Full or almost exclusively breastfed
<6 months old
Menses not returned
Describe the pathophysiology of Lactational Amennorhoea
Prolactin supresses GnRH release from hypothalamus
FSH and LH decreases and therefore Oestrogen
What is the difference between Diaphragms and Caps?
Diaphragms should lie diagonally between pubic bone and posterior fornix
Caps sit directly over the cervix and must be left in place for 6-8 hours
What is the pathophysiology of the COCP?
Supresses FSH and LH hence decreasing ovulation
Thickens cervical mucous
Describe the two types of COCP
Monophasic - each pill contains the same amount of oestrogen and progesterone
Phasic - levels of hormones vary across the pills, therfore it is important they’re taken in order. Aims to reduce SE
Name 5 contraindications to the COCP
BMI>35 Breast Feeding Hypetensive Migraines with Aura Smoker aged > 35
What cancers does the COCP decrease the incidence of, and what do they increase the incidence of?
Reduced risk of ovarian/uterine/colon
Increased risk of breast and cervical
Give three drug interactions of the COCP
Rifampicin
Anticonvulsants (Carbemazepine)
Antiretrovirals
Describe the pathophysiology of the Progesterone Onlly pill
Thickens cervical mucous and thins endometrium
State two benefits of POP
Can be used when breast feeding
Avoids CVS risks of Oestrogen
State three disadvantages of POP
Menstrual problems (Amenorrhoea and break through) Taken at exactly the same time Increased risk of Ovarian Cysts and Breast Cancer
State three benefits of Nexplanon
Lasts for three years
Can be used when breast feeding or at high BMI (replaced sooner)
Decreases risk of endometrial cancer
State three disadvantages of Nexplanon
Irregular bleeding
Painful
Increased risk of breast cancer
Describe 3 Progesterone only injections
Depo-Provera every 12 weeks
Sayana Press every 13 weeks
Noristerat every 8 weeks
A benefit of PO injections is that there are no known interactions. Describe 5 disadvantages.
Delayed return in fertility Increased body weight Decreased mineral bone density Persistent bleeding Increased breast cancer risk
What is the IUD?
AKA the Copper Coil
Creates inflammatory reaction within the endometrium rendering it unfavourable for fertilised egg
Can be used as emergency contraception if fitted within 5 days
What is the IUS?
AKA Mirena Coil (progesterone releasing)
First line therapy for menorrhagia
Second line therapy for dysmenorrhoea
Give 5 contraindications to the Coil
Infection Less than a month PP Uterine structure abnormalities Copper Allergy Gynae malignancy
Give 3 advantages to the Coil
Good ‘non hormonal’ option
Can be used when breast feeding
Fertility returns to normal
Give 3 disadvantages to the Coil
Risk of infection/perforation
Irregular bleeding for up to 6 months
Increased risk of Ectopic Pregnancy
Give two pill options for Emergency Contraception
Levonorgestrel (able to be used for 72hrs after) Ulipristil Acetate (SPRM - available for use for 120 hours)
Where is Nexplanon inserted?
Subdermally, non dominant arm
How does the Depo-Provera and Nexplanon provide contraception?
Inhibits ovulation
How long does it take for POP to be effective?
2 days
What are the Fraser guidelines?
Specific guidelines to providing contraception to under 16s without parental involvement
Describe the Fraser Guidelines
1) The young person understands the advice given to them
2) The young person cannot be persuaded to have their parents informed (either the patient or the doctor telling them)
3) The young person is likely to have sexual intecourse anyway
4) Unless the person receives the contraception, their physical or mental health will suffer
5) It is in their best interest
