Contraception and abortion Flashcards
Personal reasons for birth control
- health of the babies and mothers
- plan for and space for children in a family
- avoid pregnancy
Societal reasons for birth control
- adolescent pregnancies
- unintended pregnancies
- limiting the size of the population
- economics
Cross-cultural variations in contraceptions
- coitus interruptus (pull out)
- coitus obstructus (sperm in the bladder)
- coitus reservatus (no ejaculation)
- wassen met cola ??
- essarium (blokkert doorgang voor sperma
- borstvoeeding ??
Considerations in birthcontrol options
- permanent or reversible
- effectiveness
- side effects
- user’s motivation
- lack of partner involvement
- forgetfulness
- accessibility/costs
- ability to follow directions
- ability to prevent STi transmission
- individual health
- individual comfort level
- individual sexual behavior
- intervention performed by medical staff?
Failure rate of contraception
- effectiveness
The pregnancy rate occuring using a particular contraceptive method –> the percentage of women who will be pregnant after a year of use
- perfect users and typical users
Effectiveness: 100 - failure rate
Hormonal birthcontrol methods
Highly effective
- pill
- patch
- vaginal ring
- implant
- injections
–> voorkomen een ovualtie
Nadelen hormonale anticonceptie
- hormonale gezondheidsproblemen (bijv. trombose)
- verergert borstkanker
- interactie met medicatie
- gewichtstoename
- minder seksuele interesse en opwinding
Combination birth control pills
Contain estrogen and progestin
- 21 days on the pill, 7 days of or a placebo
- variations to this pattern have been introduced: 84 days on, 7 placebo (women has a period only once in three months)
How the pill works
Mainly by preventing ovultion (ther is no egg)
- Estogen: levels are high at the start and inhibits FSH production so there is no ovulation
- Progestin: keeps cervicl muscle thick, making the path for sperm hard and inhibits implantation. Inhibits LH for the ovulation
(dis)advantages of combination pill
Advantages:
- highly effective if used properly
- does not interfere with intercourse
- some advantageous side effects
Disadvatages:
- soem serious side effects
- cost
- all the burden of contraception placed on the woman
- no protection against STIs
Progestin pills (mini-pill)
To avoid estrogen related side effects
- change the cervical mucus, such that sperm cannot get through, inhibiting implantation and ovulation
- useful for women who cannot use the combination pill
- produce irregular menstrual periods
Driefasenpil
Je krijgt stabiele niveaus van oestrogeen binnen, maar drie fases van progesteron. Voordeel is dat het de totale homoonblootstelling vermindert
Patch (ortho evra)
- administered through the skin
- lasts 7 days (totaal 3 weken met stopweek)
Vaginal ring (NuvaRing)
- a flexible, transparent ring (plastic)
- inserted high in the vagina
- effective for 21 days met stopweek
Emergency contraceptive
- pill form for emergency
- to prevent pregnancy (most effective within first 24 hours)
Depo-Provera DMPA
- prikpil
A progestin administered by injections, inhibiting ovulation, thickening cervical mucus and inhibiting growth of endometrium
- somewhat more effective than the pill
- mus be repeated every 3 months for max. effectiveness
- most users experience no menstrual periods
- kan osteoperos (botuitdunning) veroorzaken
Implants
- thin rod ror tube constaining progestin
- inserted under the skin of the woman’s arm
- effective for four years
Intrauterine devide (IUD)
- a small piece of plastic or metal that is inserted into the uterus by a health professional
- remains in place until the woman wants to have it removed
- creates an environment that is toxic to both sperm and eggs
Diaphragm
- inserted into the vagina and fits snugly over the servix
- blocks the entrance to the uterus
- must be used with a contraceptive cream or jelly ro kill sperm
- Has a typical failure rate of 12%
- comes in different sizes
- kan TSS veroorzaken
FemCap, Lea’s shield and the Sponge
- vaginal barriers similar to the diaphragm
- fitted over the cervix
- should be used with a spermicide or microbicide
The Male condom
A thin sheath that fits over the penis
- widespread use for contraception and protection against diseases dates from about 1843
- catches semen and prevents it entering
- perfect user failure rate is about 2%; typical user failure rate is about 13%
–> many failures result from improper or inconsistent use
The Female condom
One ring of the female contom is inserted into the vagina while the other is spread over the vaginal entrance
- prevents sperm from entering the vagina and blocks the entrance to the uterus
- perfect-user failure rate is 5%; typical user failure rate is 21%
Calendar method
Assumption: ovulation occurs about 14 days before the onset of menstruation
Regular: abstinence between day 10 and day 17
Standard days method (SDM)
A women who knows that she is regular, whit a cycle lenght of between 26 and 32 days, abstains from days 8 to 19
Basal body termperature method
Intercourse would be safe beginning about three days after ovulation
Cervical mucus method
The woman determines when she ovulates by checking her cervical mucus
Sympto-thermal method
Combines the basal body temperature method and the cervical mucus method
Unreliability of body temperature method
0.2-0.5 degrees higher during ovulation
–> sex, a night out, drug/alcohol use, sickness, late night, medication can higher the bodytemperature as well
Vasectomy
Male sterilization
- vas deferens is tied or cut
–> prevents sperm from being ejaculated
Vasovasostomy reverseses it
Female sterilization
Blocking the fallopian tubes: in different ways
Laparoscopy: magnifying instument in abdomen
Minilaparotomy: immediately after birth
Transcervical: through the cervix and uterus
Abortion
Removal of a implanted fertilized egg
Vacuum aspiration method
Most common method of firts trimester abortion - until week 14 or 15
- suck out the contents of the uterus including the fetal tissue
Dilation and evacuation
Used especially for later abortions (second trimester)
- similar to the vacuum aspiration method but must be done in a hospital as the fetus is relatively large by the second trimester
Mifepristone
- Progesterone is needed for implantation and development
- mifepristone blocks progesterone so endometrium is sloughed off
- Prostaglandins after 24-48 hours caused contraction of uterus and embryo expulsion
Methotexate
Een combinatiedrug die giftig is voor de embryo. Het wekt samentrekken van de baarmoeder op, wat de embryo laat uitdrijven
Nieuwe condooms
Dunnere condooms die niet van latex zijn of condooms die kunnen worden omgedaan voor de erectie
Hormonale anticonceptie mannen
Veel methodes die zijn ontwikkeld zorgen ervoor dat de spermaproductie stopt, maar ook dat het libido omlaag gaat. Er is progressie voor een mannenpil, maar de meest hoopvolle methode is een crème die aangebracht wordt op armen en schouders
RISUG
Injectie van poreus polymer in de vas door en smalle incisie. Sperma kan door het polymeer, maar het maakt de membraan kapot waardoor de spermacellen niet levensvatbaar zijn. Het lijkt op een vasectomy, maar het is makkelijk omkeerbaar
Microbicides
Substanties die bicrodes doden en hopelijk ook sperma
Betere pil
Een neiuwe pil wordt ontwikkeld waardoor het libido niet meer omlaag gaat
Vaginale ringen
de nieuwe ring moet 12 maanden blijven zitten
Sperma bindende bedels
Kleine bedels met een eiwit waaraan sperma bindt waardoor ze niet opzoek gaat naar eitjes. Deze bedeltjes worden aangebracht in de baarmoeder
Omkeerbare sterilisatie
Injecteren van vloeibare siliconen in de eileiders, wat hard wordt en zorgt voor een plug die later verwijderd kan worden wanneer een vrouw zwanger wi l worden
