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
What are the possible complications of abortion?
Haemorrhage
Infection, sepsis
DIC
Cervical tears
Psychological trauma
Anaesthetic complications
What are the options for abortion <7w?
MEDICAL - Early medial abortion (EMA)
- mifepristone (antiprogesterone) = receptor modulator, decidua breakdown, shedding of endometrium, uterine contractions
- misoprostol (prostaglandin) = soften cervix
SURGICAL - Manual vacuum aspiration (MVA), US guided/ checking falling HCG post abortion
What are the options for abortion <7-15w?
Early medical termination of preg (TOP)
Surgical TOP
- Cervical preparation with a misoprostol (prostaglandin) is an option prior to surgery and should be routine for nulliparous women or >10w
What are the options for abortion >15w?
Mid trimester surgical abortion by dilatation and evacuation (D+E) preceded by cervical preparation, mostly non NHS agencies (BPAS)
Beyond 18w this is usually a 2 stage procedure
- Surgical - cervical slow dilation (misoprostol/hygroscopic cervical dilator) and evacuation
- Medical - with mifepristone and prostaglandin
List the contraindications for abortion
Ectopic
Haemorrhagic disorders
CKD
Hepatic failure
Outline the aftercare for abortion
Anti D for Rh-ve women, Abx, no sex/tampons, follow up, contraceptive plans
