Contraception Flashcards
key contraceptive methods available
Natural family planning (“rhythm method”) Barrier methods (i.e. condoms) Combined contraceptive pills Progesterone only pills Coils (i.e. copper coil or Mirena) Progesterone injection Progesterone implant Surgery (i.e. sterilisation or vasectomy)
natural / barriers / hormonal / IUD / sterilisation
emergency contraception
available after unprotected intercourse.
- Ellaone- levongesterol (72 hrs)
- Copper Coil
UK Medical Eligibility Criteria to contraceptive
UKMEC 1: No restriction in use (minimal risk)
UKMEC 2: Benefits generally outweigh the risks
UKMEC 3: Risks generally outweigh the benefits
UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)
meaning of 99% ?
if an average person used this method of contraception correctly with a regular partner for a single year, they would only have a 1% chance of pregnancy.
perfect use vs typical use
effectiveness of contraception
natural family planning
perfect: 95 – 99.6%
typical: 76%
Condoms
perfect: 98%
typical: 82%
Combined oral contraceptive pill
perfect: > 99%
typical: 91%
Progestogen-only pill
perfect: > 99%
typical: 91%
Progestogen-only injection
perfect: > 99%
typical: 94%
Progestogen-only implant
perfect: > 99%
typical: > 99%
Coils (i.e. copper coil or Mirena)
perfect: > 99%
typical: > 99%
Surgery (i.e. sterilisation or vasectomy)
perfect: > 99%
typical: > 99%
risk factors and contraindications for the following conditions:
- breast cancer
- cervical / endometrial cancer
- wilson’s disease
breast cancer- avoid any hormonal contraception. okay to have copper coil and barrier methods
cervical or endometrial cancer: avoid intrauterine system (mirena)
wilson’s: avoid copper coil
in which instances is the COCP contraindicated?
- Uncontrolled hypertension (particularly ≥160 / ≥100)
- Migraine with aura
- History of VTE
- Aged over 35 smoking more than 15 cigarettes per day
- Major surgery with prolonged immobility
- Vascular disease or stroke
- Ischaemic heart disease, cardiomyopathy or atrial fibrillation
- Liver cirrhosis and liver tumours
- Systemic lupus erythematosus and antiphospholipid syndrome
contraception for older and perimenopausal women
- In women under 50 after last period, give contraception for 2 years
- In women over 50 give contraception for 1 year
- HRT will not prevent pregnancy
- COCP can be used up until 50 y/o to treat perimenopausal symptoms
- stop the progesterone injection (Depo) BEFORE 50 years because there is a risk of osteoporosis
investigtions for a woman who is amenorrhoic (menopause) (when taking progesterone only contraception)
- FSH blood test results are above 30 IU/L on two tests taken six weeks apart
- (continue contraception for 1 more year)
- 55 years of age
contraception for under 20
Combined and
progestogen-only pills are unaffected by younger age
The progestogen-only implant is a good choice of long-acting reversible contraception (UK MEC 1)
The progestogen-only injection is UK MEC 2 due to concerns about reduced bone mineral density
Coils are UKMEC 2, as they may have a higher rate of expulsion
fertilisation after childbirth
fertility returns 21 days after birth. contraception is not required up to this point. considered fertile after 21 days.
need contraception 7 days when staring the combined pill or 2 days for the POP
contraception after childbirth
Lactational amenorrhea is over 98% effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods).
The progestogen-only pill and implant are considered safe in breastfeeding and can be started at any time after birth.
The combined contraceptive pill should be avoided in breastfeeding (UKMEC 4 before 6 weeks postpartum, UKMEC 2 after 6 weeks).
A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).
Example of barrier methods
- physical barrier to semen entering the uterus and causing pregnancy
- only method to protect against STI
- condoms (if allergy to latex can use polyurethane condoms)
- diamphragms and cervical caps: silicone cups that fit over the cerbix. leave in place 6 hrs after sex. use with spermicide gel
- dental dams: oral sex to provide a barrier between mouth and uvula, vagina or anus. Chlamydia Gonorrhoea Herpes simplex 1 and 2 HPV (human papillomavirus) E. coli Pubic lice Syphilis HIV
COCP
contains progesterone and oestrogen. licensed for use up to age of 50 years.
MOA:
Preventing ovulation (this is the primary mechanism of action)
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
oestrogen and progesterone has negative feedback on the hypothalamus and AP to supress release of GnRH, LH and FSH.
COCP withdrawl bleed
endometrial lining is stable when taking the COCP so when it stops the lining of the uterus breaks down and sheds. this is not classed as part of the natural menstrual cycle.
in extended use without a pill free period you can get breakthrough bleeding.
