contraception Flashcards
forms of combined hormonal contraception (CHC)
pill, patch, vaginal ring
what hormones are in CHC
ethinyl estradiol
progestogen
how does CHC work
stops ovulation, also effects cervical mucous and endometrium
standard regime of CHC
21 days with hormone free week
tricyclic/continuous use CHC
no need for inconvenient withdrawal bleed and avoids forgetting to restart after break
when is CHC patch changes
weekly
when is CHC ring changed
every 3wks (can take out for 3hrs every day so may want to do that for sex)
non-contraceptive benefits of CHC
regulate/reduce bleeding - help heavy, painful periods
stop ovulation - help prementrual syndrome
reduction in functional ovarian cysts
50% reduction ovarian and endometrial cancer
improve acne/hirsutism
reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteporosis
side effects of CHC
tender breasts nausea headache irregular bleeding first 3mo mood? casual or other live events weight gain - not causal
serious risks associated with CHC
venous thrombosis - PT, DVT (avoid if BMI>34, prev VTE)
arterial thrombosis - MI, stroke (avoid smokers >35, Hx, Age>50, BP >140/90)
risk cervical ca
risk breast ca (aviooid if Hx)
when is the progestogen only pill (POP) not a good idea
if they have frequent GI upset
how is progestogen only pill to be taken
same time everyday without a pill-free interval
desogestrel POP
12hr window
nearly all cycles no ovulation, also affects mucus
most bleed free
traditional LNG/PET POP
3hr window
1/3 anovulant, 2/3 rely on cervical mucus effect
1/3 bleed free, 1/3 irregular bleeds, 1/3 regular period
POP contraindications
personal history of breast cancer or liver tumour
POP side effects
increased appetite hair loss/gain mood change bloating or fluid retention headache acne
how is ‘the jag’ given
150ml 1mg IM injection into upper quadrant buttock every 13wks
how does ‘the jag’ work
prevents ovulation
alters cervical mucus making it hostile to sperm
makes endometrium unsuitable for implantation
pros of injectable progestogen
only need to remember every 12-14wks
70% amenohorrhoeic after 3 doses
oestrogen free so few contraindications
cons of injectable progestogen
delays in return to ferility - avg 9mo
reversible reduction to bone density
problematic bleeding esp 1st 2 doses
weight gain
pros of intrauterine contraception (the coil)
little user input after fitting
used for any age + parity
(side) effects immediately reversible upon removal
cons of the coil
1:1000 risk perforation
5:100 risk expulsion: check threads after period
not suitable if untreated pelvic infection or distorted endometrial cavity e.g. submucus fibroids
how does copper IUD work
toxic to sperm
stop sperm reaching egg
may sometimes prevent implantation of fertilised egg
con of copper IUD
may make periods heavier/crampier
does copper IUD contain hormones
no it’s hormone free
how long does copper IUD last
5/10yrs depending on type
how does levonorgestrel IUD work
affects cervical mucus and endometrium, most women still ovulate
stop fertilisation of egg and may prevent implantation of fertilised egg
hormones with levonorgestrel IUD
slow release progestogen on stem, low circulating progestogen levels compared with pill, implant, injfection
levonorgestrel IUD effect on menstrual bleeding
reduce menstrual bleeding after up to 4months initial irregular bleeding
what does the rod contain
68mg of the progestogen etonogestrel dispersed in a matrix of EVA
then covered in a rate controlling membrane made frmo EVA
how does subdermal progestogen implant (rod) work
inhibition of ovulation and effect on cervical mucus
how long can rod last
3yrs but can be removed at any time
pros of the rod
no user input needed
no casual effect on weight
cons of the rod
60% almost bleed free but 30% have prolonged/frequent bleeding
may cause mood change more often than other progestogen only methods
forms of emergency contraception + pregnancy chances
copper IUD (most effective) <1 in 100
levonorgestrel pill - levonelle 2-3 in 100
ulipristal pill - ellaone 1-2 in 100
when does copper IUD need to be fitted for emergency contraception
before implantation - within 120hrs UPSI
when does levonorgestrel pill need to be taken
within 72hrs
when does ulipristal pill need to be taken
within 120 hours
contraindications of ulipristal pill
breast feeding
enzyme inducing drugs
acid reducing drugs
when in cycle to start contraception
if first 5 days of cycle then have immediate cover
if start another time of cycle need condosms/abstain and pregnancy test after 4wks
when can u get pregnant after giving birth
21 days after
when can you get pregnanct after misscarriage/abortoin
5 days after
when is breast feeding contraceptive
1st 6mo + if feeding every 4hrs + amenorrhoeic
what forms of contraception do enzyme inducing drugs e.g. carbamazepine, topiramate reduce effectiveness
CHC pill, patch and ring and POP + implant
how do enzyme inducing drugs reduce effectiveness of some contraceptives
increase metabolism of progestogen and oestrogen
female sterilisation procedure
laparoscopic sterilisation: usually filshie clips applied across tube to block lumen
metal/silicone ok for MRI
vasectomy procedure
vas deferens divided and ends cauterised, small incision midline scrotum
local anaesthetic - mostly done in primary care
how long does vasectomy take to be effective
4-5months
2 sperm samples sent in by post after 4 and 5 months to check
is vasectomy reversible
no, anti-sperm antibodies even if vas reconnected
when can surgical (STOP) abortion be carried out
5-12wks
surgical abortion procedure
cervical priming: misoprostol 3hrs pre-op helps dilation and reduce risk perforation/haemorrhage
GA or LA cervical block
trans-cervical 6-10mm suction catheter
surgical abortion complications
1-4:1000 perforation
<1:100 cervical injury
infection
risks from GA
medical (MTOP) abortion when can it be performed
5-24wks
medical abortion procedure
mifepristone oral anti-progestogen tablet
36-48hrs later misoprostol initiates uterine contraction which open cervix and expels pregnancy
mifepristone helps misoprostol work better
how long does MTOP take to pass pregnancy
average 4-6hrs under 12wks
MTOP complications
failure in 1 in 100<8wks, 8 in 100 >12 weeks need surgery for incomplete abortion
infection - test and prophylactic antibiotics
<1 in 100 need blood transfusion
CHC contraindications
BMI >34 prev Hv VTE, arterial thrombus, breast cancer smoker >35ys BP 140/90 age >50 migraine w aura
