Contraception + Abortion Flashcards
What are the types of COCP?
Monophasic pills = every pill contains the same levels of O/P (21/28)
- microgynon
- brevinor
Phasic pills = level of O/P changes throughout cycle
- qlaira
- BiNovum
What forms can combined hormonal contraception come in?
COCP
Transdermal patch - changed every 7d, removed for 1/52
Vaginal ring - 21d, removed for 1/52
Describe the mechanism of action of combined hormonal contraceptives
Inhib ovulation = -ve feedback of O/P on hypothalamo-pituitary axis
Progesterone = inhib prolif of endometrium + increase thickness of cervical mucus
Name some POCP and their mechanism of action
Types = femulen, norgeston, oriday, micronor, cerazette
MoA = thickens cervical mucus, supresses ovulation, thins endometrium
List the contraindications for POCP
- Current or past history of breast Ca
- Liver cirrhosis or tumours.
- Lower efficacy in women over the weight of 70kg.
- Stroke or coronary heart disease.
List the forms of progesterone only contraception
POCP
Injection - Depo-Provera, sayana press, noristerat
Implant - Nexplanon
What types of emergency contraception are available?
Morning after pill (delays ov 7d)
- Levonorgestrel = synthetic progesterone
- Ulipristal acetate = progesterone receptor modulator
IUD = copper is toxic to sperm, inflam response
Outline the ‘Natural’ methods of contraception
Abstinence = 100%
Withdrawal method = some sperm released in pre-ejaculate, no STI protection
Fertility awareness = use of fertility indicators to identify infertile/fertile points, no STI protection, unreliable
Lactation amenorrhoea method = suckling disrupts, release of GnRH delaying return of ovulation, only effective up to 6 month after giving birth, unreliable, no STI protection
Describe the ‘Barrier’ types of contraception
Condom = 98% reliable
Female condoms = 98% reliable
Diaphragms
Cervical caps
Protection from STIs, danger of expiring, allergy/sensitivity
Outline the ‘Hormonal Control’ types of contraception
COCP = prevents ovulation by making the hypothalamus think you are in the luteal phase, 21 days, synthetic oestrogen/progestogen, 98% effective if taken correctly, release menstrual disorder, reduces risk of ovarian/endometrial cancer, increased risk of breast Ca/VTE, no STI protection
High dose progestogen (depot/implant) = LARC, inhibit ovulation, thicken cervical mucus, prevent endometrial proliferation, reliable, delay in fertility returning, no STI protection
Low dose progestogen = (mini pill) not going to effect HPG, still get ovulation, thicken cervical mucus, no STI protection, menstrual problems are common
Describe the ‘Prevention of implantation’ method of contraception
Coil: IUS = progestogen, 3-5y, prevents implantation, reduces endometrial proliferation, thickens cervical mucus, insertion unpleasant, no STI protection, Mirena®
Coil: IUD = copper, 5-10y, copper is toxic to sperm/ovum, endometrial inflam reaction preventing implantation, can cause heavy bleeding, insertion unpleasant, no STI protection
Outline ‘Sterilisation’
Vasectomy = vas deferens cut/tied, must confirm success 12-16 weeks after surgery, failure 1 in 2000
Tubal ligation/clipping = fallopian tubes cut/blocked, failure 1 in 200/500 depending on method
Define subfertility
Failure of conception in a couple having regular (every 2/3d), unprotected sex for 1y
Primary = never conceived a child
Secondary = preg before, but diff conceiving again
How can ovulatory disorders be classified?
1) hypothalamic-pituitary failure
2) hypothalamic-pituitary-ovarian dysfunction = polycystic ovarian dysfunction
3) ovarian failure
What uterine/pelvic disorders can lead to infertility?
Uterine fibroids
Endometriosis
Pelvic inflam disease
Developmental abnormality
