Contraception Flashcards
Types of barrier contraception
Male condoms
Female condoms
Diaphragms
Cervical caps
Advantages of male condoms
Not contraindicated by any condition exception latex allergy, in which other materials (such as polyurethane) can be used, with similar efficiency rate
It is the only contraceptive method mentioned that is controlled by the male
Widely available and simple to use, and only need to be used immediately before intercourse
Are protective against many STIs
Advantages of female condoms
No contraindications
Less likely to tear than the male condom
May protect against some STIs
Can be inserted up to 8 hours before intercourse
Advantages of the diaphragm/cap
Can be inserted up to 3 hours before intercourse
Disadvantages of male condom
Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time
Can reduce sensitivity and/or arousal
Disadvantages of female condom
Perfect use is rarely achieved – may become dislodged or couple may lack motivation to use them every time
Penis may be inserted between condom and vaginal wall
Can be noisy and/or uncomfortable for the woman during intercourse
Disadvantages of diaphragm/cap
Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time
They require prior planning and careful insertion
They require measuring and fitting to find the correct size – any weight gain or pregnancy mandates a refitting
They are associated with a higher risk of urinary tract infections - due to the position of the diaphragm/cap putting pressure on the urethra
STI transmission not reduced
Method of action of combined hormonal contraception
Inhibit ovulation - negative feedback on hyothalamo-pituitary axis - prevents LH surge Progesterone also - inhibits proliferation of endometrium - increases thickness of cervical mucus
Types of COCP
Monophasic - every pill contains same levels of oestrogen and progesterone
- Microgynon 30
- Brevinor
Phasic pills - level of oestrogen and progesterone in pills change throughout cycle
- Qlaira
- BiNovum
Types of contraceptive transdermal patch
5x5cm patch stuck onto upper arm, abdomen, buttock or back
Ortho Evra
- applied and changed every 7 days for 3 weeks then 7 patch free days
Can be used whilst swimming/bathing
Types of contraceptive vaginal ring
NuvaRing
- plastic ring inserted into vagina
- sits in for 21 days then 7 free days before inserting new ring
Advantages of combined hormonal contraception
Non invasive
More effective than barrier methods if taken correctly
Sex doesn’t need to be interrupted to use contraception
Menses tends to become regular, lighter and less painful, also allowing for control over timing of menses
Reduced risk of cancer of the ovary, uterus and colon
Reduced risk of functional ovarian cysts
Normal fertility returns immediately after stopping usage
Disadvantages of combined hormonal contraception
User dependent
Some temporary adverse effects such as headaches, breast tenderness and mood changes can be experienced by some women
Blood pressure may increase
Women may experience breakthrough bleeding and spotting for the first few months
Increased risk of venous thromboembolism
Small increase in risk of myocardial infarctions and strokes
Small increase risk of breast and cervical cancer
Contraindications of combined hormonal contraception
BMI greater than 35
Breast feeding
Smoking over the age of 35
Hypertension
History of or family history of venous thromboembolisms
Prolonged immobility due to surgery or disability
Diabetes mellitus with complications e.g. retinopathy
History of migraines with aura
Breast cancer or primary liver tumours
UKMEC Categories
Category 1 - no restriction
Category 2 - condition where advantages generally outweigh theoretical or proven risks
Category 3 - risks outweigh advantages
Category 4 - unacceptable health risk
Category 3 for COC
Postpartum 0 to 6 weeks without VTE risk factors
Postpartum 3-6 weeks with other VTE risk factors
Smoke < 15 cigarettes/day or stopped smoking < 1 year ago
BMI > 35
Complicated organ transplant
Category 4 for COC
Postpartum 0-3 weeks with other VTE risk factors
Indications for emergency contraception
Sexual intercourse without contraception
Contraceptive method has failed
Types of emergency contraception
Emergency hormonal contraception
- Levonorgestrel - synthetic progesterone
- delays ovulation for 5-7 days
- licensed for use within 72 hours
- Ulipristal acetate - progesterone receptor modulator
- delay ovulation for 5-7 days
- licensed for use within 120 hours
IUD
- inserted within 5 daysContraindications of levonorgestrel
No absolute contraindications
Efficacy may be reduced by
- diseases of malabsorption - Crohn’s
Enzyme inducing drugs - rifampici
Contraindications of ulipristal acetate
Diseases of malabsorption e.g. Crohn’s
Hypersensitivity to Ulipristal Acetate
Severe hepatic dysfunction
Enzyme inducing drugs e.g. rifampicin
Breast feeding – avoid breastfeeding for 7 days after taking UPA
Asthma insufficiently controlled by corticosteroids
Drugs increasing gastric pH e.g. omeprazole, ranitidine
Contraindications of copper IUD
Uterine fibroids with distortion of the uterine cavity
Documented or suspected PID
Documented or suspected STI
Follow up for emergency oral contraception
Seek help if vomiting occurs within 2-3 hours
Adverse effects of emergency hormonal contraception
Nausea
Dizziness
Menstrual disturbance
Abdo pain
Follow up for IUD
Increased risk of ectopic pregnancy - alert if next period is > 5 days late
Adverse effects of IUD
Pelvic infections
Expulsion of IUD
Bleeding
Pelvic pain
Types of progesterone only contraceptives
Progesterone only pill
Implant
Injections
Method of action of progesterone only pill
Thicken cervical mucus
- inhibit ovulation
- thinning of endometrium
Advantages of POCP
More effective than barrier methods when taken correctly
Sex doesn’t need to be interrupted to use contraception
Can be used in many patients for whom the combined oral contraceptive is contraindicated
May reduce risk of endometrial cancer
Disadvantages of POCP
User dependent and has to be taken at the same time each day
Can produce irregular menstruation (4 in 10 women) or amenorrhoea (2 in 10 women)
Some adverse affects, such as headaches, breast tenderness and skin changes, may be experienced when POCP’s are first started
30% increased risk of ovarian cysts
Small increased risk of breast cancer
Contraindications of POCP
Current or past history of breast cancer
Liver cirrhosis or tumours
Lower efficacy in women over the weight of 70kg
Stroke or coronary heart disease
Mechanism of action of implant
Inhibit ovulation
- thickening of cervical mucus
- thinning of endometrium
Advantages of implant
Extremely effective
Can be used in women for whom the combined oral contraceptive pill is contraindicated
Users don’t have to think about contraception for 3 years
Can be used when breastfeeding
Normal fertility returns as soon as implant is removed
Effective in women of all body mass (although earlier replacement recommended in women with high BMI)
May reduce the risk of endometrial cancer
Disadvantages of implant
About 50% of women experience changes in menstrual bleeding and bleeding patterns are likely to remain irregular
Fitting and removing the implant may cause some pain, bruising and irritation
Small increased risk of breast cancer
The implant can sometimes bend or break in situ
Contraindications of implant
Pregnancy Unexplained vaginal bleeding Liver cirrhosis or tumours History of breast cancer Stroke or transient ischaemic attacks whilst using the implant
Mechanism of action of injectables
Inhibition of ovulation and cervical mucus
Advantages of injection
A very effective form of contraception
Users don’t have to think about contraception for as long as the injection lasts
No known interactions with any drugs
It can be used when combined hormonal contraceptives are not recommended such as in women with migraine and who are breast feeding
Can be used in women with a BMI < 35
May reduce the risk of endometrial cancer
Disadvantages of injection
Not rapidly reversible – can take up to a year to return to normal fertility and menstruation can take several months to return to normal
Up to 50% of women stop usage within a year due to altered bleeding patterns including persistent bleeding
Increase in body weight, up to 2-3kg over a year
May be a slightly increased risk of breast cancer
Loss of bone mineral density with long term use (over a year of use), although there is no evidence that it increases the risk of fracture
Contraindications of injection
Current Breast cancer (within 5 years)
History of severe arterial disease or very high risk factors
Pregnancy
Diabetes with any vascular disease e.g. retinopathy
People who will want to return to fertility in the near future
