Contraception Flashcards
contraception mechanisms of action
- prevention of ovulation
- prevention of fertilisation
- prevention of implantation
how can contraception prevent ovulation?
suppress FSH and LH
how can fertilisation be prevented?
no contact e.g. condoms, diaphragm, sterilisation, IUD
how can implantation be prevented?
create hostile environment
classification of contraception
hormonal methods barrier methods intrauterine methods permanent methods fertility awareness methods emergency
non-contraceptive benefits of contraception
pain heavy bleeding irregular bleeding PMS breast tenderness acne hirsutism ovarian cancer
what cancer does contraception protect against?
ovarian
LARC methods
- IUD/IUS
2. implant
consequences of using IUD/IUS
painful insertion
perforation
malposition
expulsion
when can IUD/IUS not be used?
submucosal fibroids
uterine malformations
how long does the IUD last?
up to 10 years
action of IUD
non-hormonal but prevents implantation
when can IUD be used as emergency contraception?
up to 5 days after sex
adverse of the IUD (copper coil)
makes period heavy, longer and more painful in first few months (can co-prescribe NSAIDs)
which method of contraception is the only option after breast cancer?
IUD
is the IUS hormonal?
yes
what are the types of IUS?
mirena
levosert
kyleena
jaydees
what is mirena also licensed to treat alongside contraception?
heavy periods
adverse of IUS
irregular spotting
PV bleeding in first few months then leads to amenorrhoea around 6 months
what is the most effective method of contraception?
implant
how long does the implant last?
3 years
how does the implant work
hormonal (progestogen only)
side effects of implant
invasive procedure with LA
prolonged PV bleeding
what is the criteria used for contraception use?
UKMEC
examples of combined hormonal contraception
OCP
ring
patch
when to start OCP
first 5 days of period OR anytime in cycle if sure not pregnant and use condoms for 7 days
how should the OCP be taken?
21 days then 7 day break (can do tricycling)
what factors affect the effectiveness of the OCP?
impaired absorption (GI conditions) increased metabolism (liver) forgetting
adverse of CHC
nausea acne bleeding breast tenderness venous and arterial thrombosis breast cancer and cervical cancer (always discuss condoms and smear) hypertension arterial disease
what to always discuss when prescribing contraception?
smear
CONDOMS
what cancers does the CHC increase the chance of?
breast cancer
what do migraines with aura risk when on CHC?
ischaemic stroke
what is an aura?
a change occurring 5-20 minutes before onset of headache (usually visual e.g. scotoma)
what do you need to check before prescribing the CHC?
BP
BMI
smear
other RF (VTE)
additional benefits of OCP
ovarian and endometrial cancer acne reduction less bleeding less cysts less PMS PCOS
what cancers do the OCP protect against?
ovarian
endometrial
what is the POP called?
cerelle (desogestrel)
action of POP
inhibits ovulation
when do you start the POP?
begin in first 5 days of period or anytime if sure not pregnant and use condoms for 2 days
when do you take the POP
same time everyday (within 12 hours)
what to do if miss POP?
doesn’t work for 2 days
take pill as soon as realise and use condoms for 2 days (or 7 days in OCP)
is the POP contraindicated in breast cancer?
yes
common adverse of POP
irregular bleeding
two forms on the injection?
depo provera (DMPA injection) sayana press (self-administered)
action of injection
prevents ovulation lowering oestradiol and suppresses FSH
when can the injection not be used?
OP risk factors
good in epilepsy
adverse of injection
nausea weight gain acne headache bleeding limits peak bone mass
how to use the diaphragm?
remove and wash before using again
no longer really used
three options for emergency contraception
- copper coil
- ellaOne
- levonelle
when can levonelle be used
within 72 hours (3 days)
when can ellaone be used?
within 120 hours (5 days)
when can ellaOne not be used?
progesterone contraception
action of emergency morning after pills
delays ovulation
action of copper coil
toxic so prevents implantation
male sterilisation
vasectomy
