Contraception Flashcards
If no contraception is used what is the chance of getting pregnant?
85%
What percentage of pregnancies are unplanned?
40%
Name three mechanisms of action of contraception
Prevention of ovulation
Prevention of fertilisation
Prevention of implantation
How does contraception prevent ovulation?
Suppresses FSH and LH by negative feedback
How can fertilisation be prevented?
Mechanical Barrier - condoms/diaphragm
Surgical Barrier - sterilisation
Direct toxicity - spermacide/IUD
How is implantation prevented?
Thinning of womb lining to create a hostile environment
What does LARC stand for?
Long Acting Reversible Contraception
What methods of contraception are not advised?
Withdrawal and abstinence
State some of the factors to consider when choosing contraception
- Personal preference
- Age
- Mental Capacity
- Wellbeing/child protection
- Relationship
- Pregnancy risk/future planning
- STI
- Practical issues (storage of pill etc)
- Compliance
- Allergy/medications
- BMI/BP
- PMH
- Family history
- Invasive procedure
- Side effects
- Non-contraceptive benefits
Describe the two types of effectiveness
Typical use/user failure rate
Perfect use/method
Why are condoms often not effective?
Put on too late, wrong lube (oil based), wrong technique, wrong size, damaged, expired
Why are diaphragms often not effective?
Put in too late, removed too early, wrong technique
Why is the pill often not effective?
Compliance problems, too late starting, drug interaction, quick starting
What are the three main types of LARC?
Copper Coil
Hormonal Coil
Rod
State the complications of the procedure to insert the coil
Perforation
PID
Malposition/expulsion
When are coils contraindicated?
Submucosal fibroids
Uterine malformation
How long does the copper coil last?
10 years, if >40years old it can stay until menopause
What is a down side of the copper coil?
Often periods become heavier and longer and more painful - NSAIDs can help
In what circumstances may the copper coil be the only option?
After breast cancer
Emergency - up to 5 days after sex
Name four types of hormonal coil
Mirena
Levosert
Kyleena
Jaydess
What is the non-contraception use of mirena coil?
HRT
Endometriosis
Hyperplasia
What happens to bleeding on the mirena coil?
Irregular spotting/PV bleeding common in first months then high chance of no/irregular periods after 6 months
How long can the implant be kept in for?
3 years
What is the main side effect of the subdural implant?
PV bleeding - very unpredictable but important to exclude other causes if it does occur
How can bleeding with the implant be controlled?
COCP
How do LARC methods work?
Prevent fertilisation and implantation
How do combined hormonal methods work?
Prevention of ovulation
What is the efficacy of combined hormonal methods?
Perfect use 0.3%
Typical 8%
How do you start the combined hormonal methods?
Start in first 5 days of period
At any time in the cycle when not pregnant but use condoms for 7 days
What are the three regimes?
Take daily for 21 days followed by 7 days break (withdrawal bleed)
Continuously for 3 packs, then stop for 7 days (tricycling)
Continuously until bleed, stop for 4 days and then start again
What are the risks of combined oral contraceptive pill?
Venous thromboembolism (5-12%) Systemic hypertension (140/90) Arterial disease (MI/Stroke) Migraine with aura Age >35 years Breast cancer Cervical cancer - HPV/condom use and smear
What can alter the effectiveness of COCP?
Impaired absorption
Increased metabolism
Forgetting
State the benefits of combined oral contraception
Reduction in ovarian cancer and endometrial cancer
Improvement of acne
Less PMS, PCOS, bleeding, fewer functional cysts
What are the common side effects of combined hormonal contraception?
Nausea
Bleeding
Acne
Breast tenderness
What is the efficacy of the progestogen only pill?
Perfect <1%
Typical 9%
How does the progestogen only pill work?
Inhibits ovulation
- older forms not as reliable as act on cervical mucous
Describe starting progesterone only pill
Start in day 1-5 of period
Anytime if not pregnant but must use condoms for 7 days (injection/implant), 2 days for pill
What is the only contraindication for the progesterone only pill?
Breast cancer
What are the common side effects of the progesterone only pill?
Nausea, spots, irregular bleeding, headaches
What is the regime for taking the pill?
Take the pill at the same time everyday, >12 hours late it won’t work for 2 days
How do the injections work?
Lower estradiol and suppress FSH
What is the efficacy of injections?
Perfect 0.3%
Typical 3%
When are the injections very useful?
Epilepsy - unaffected by enzyme inducing drugs
What are the side effects of injections?
Nausea, weight gain, spots, headache, bleeding
Why must the injection be used with caution?
Bone health - it can reduce peak bone mass
Describe the diaphragm
71-88% effective
Not often used but involves no hormones. Used with spermicide and must be kept in for at least 6 hours post sex. Wash in warm water and put in a box.
What are the three types of emergency contraception?
Levonorgestrel
Ella one - ulipristal
Copper coil
How does emergency contraception work?
Delays/inhibits ovulation
How long after sex can emergency contraception be used?
Levonorgestrel - within 72 hours
ella one - within 120 hours
copper coil - within 5 days
Which type of emergency contraception makes the pill less effective?
ella one
Which form of emergency contraception can be used more than once in a cycle?
Lenonorgestrel
Name the side effects of emergency contraception
Menstrual irregularities
Nausea, vomiting
Headache, dizziness, breast tenderness, diarrhoea
What forms of contraception are safe to use in patients on epilepsy medication?
Depo provera/Sayana press
Hormonal IUD
Copper IUD
