Contraception and Abortion Care Flashcards
what proportion of pregnancies are unplanned?
1/3
what are the best methods of contraception
Long acting reversible contraception (IUD, IUS, implant) are best method of contraception because they reduce risk of patient error and are cheaper
describe the principles of prescribing contraception to under 16s
fraser guidelines (gillick competence). Doctor should believe that
o Able to retain and recall information and understand advice given
o Encouraged to discuss with parents
o Patient will have active sexual life anyway
o Mental or physical health may suffer
o In best interests to receive contraception
CONDOM
description
Barrier contraception stopping sperm reaching egg
They are no longer packaged in a spermicidal gel as it added little to efficacy and caused irritation and allergic reaction in some women
Often packaged in a water based lubricant
CONDOM
- advantages
- disadvantages
1. Easily accessible Cheap to buy Free of charge on health care services Very good as barrier to infection 98% effective when used effectively
- User dependent
May split or tear if not used correctly
FEMALE CONDOM
description
Sits inside vagina and form an artificial lining
FEMALE CONDOM
- advantages
- disadvantages
- 95% affective when used correctly
2. not popular
COCP
description
Contains oestrogen and progestogen
21 day supply
Typical dose of ethinylestradiol of 20-40micrograms
Stops ovulation
Thicken cervical mucus preventing passage of sperm, thins lining of uterus preventing impantation
COCP
what are the types of preparations
- Monophasic: same amount of progesterone and oestrogen
- Phasic: concentration varies
COCP
advantages
Reliable and reversible Reduce dysmennorrhoae and menoorhagia Reduce PMT Reduce risk of ovarian, endometrial and colon cancer Reduce the risk of PID Effective for acne Reduce risk of fibroids and ovarian cysts >99% effective Fertility quick to return
COCP
disadvantages
Long list of contraindications and cautions
Progestrogens cause :headache, Breast tenderness, breakthrough bleeding
Oestrogens cause: Nausea and vomiting, Fluid retention, Mood changes
Inc risk of cardiovascular disease (Thromboembolism)
Contraindications
- Migraine – with typical focal aura, or severe migraine >72hrs,
- Personal history venous or arterial thrombosis,
- Heart disease assoc c DVT or PE, Stroke
- Liver disease
- BP>160/95
- Age >50, or age >35 and smoker
- Smoker >40/day
Avoid if two or more of following:
- Fx venous thromboembolism / arterial disease, obesity, long-term immobilization, varicose veins.
- DM, hypertension, smoking, >35yrs, obesity, migraine
- NB: epilepsy drugs interfere with pill so need higher dose in epileptics.
SKIN PATCH
description
3 patches, first applied on day 1 of cycle, second on day8 and third on day 15
Remove old patch each time
Remove third patch on day 22
Withdrawal bleeding during patch free week
SKIN PATCH
disadvantages
higher risk of thromboembolism
VAGINAL CONTRACEPTIVE RING
description
Small rubber ring that can be inserted into vagina by patient and sits around cervix
Stays in place for 3 weeks
Remove after 3 weeks and have 1 week without 1
Withdrawal bleeding during ring free week
POP
description
Used when COC is contra-indicated
Used in those on COC before/during/after surgery
Thickens cervical mucus, thins lining of womb, highre dose also inhibits ovulation
Take the missed pill and the next pill s soon as you remember. If the missed pill was >3 hours late (12 hours for cerazette), then you are not protected, and condoms should be used for 2 days.
- Emergency contraception is recommended if unprotected sex has occurred during this two day window
Vomiting and diarrhoea
-If this occurs within two hours of taking the pill, use condoms or another method of contraception for 2 days after
POP advantages
> 99% effective
Can be taken in those with CI to COC ie. breastfeeding, older women, cardiovascular risk, DM
35yrs who smoke
normal fertility resumed immediately
POP disadvantages
Not as effective as COC
Dysfunctional bleeding ie. irregualar, IMB. In many cases, bleeding is reduced or event absent
Breast tenderness, acne, weight change, headaches
Small inc ectopic pregnancy
Increased risk of ovarian cysts
contraindications
Previous cysts or ectopic – may have slight inc risk ectopic if get pregnant
IMPLANTS
description
Rod shaped device subcutaneously in upper arm and slowly releases progesterone, giving contraception for 3 year
Progesterone released slowly
Prevents ovulation
Thickens cervical mucous
Prevents proliferation of the endometrium, making implantation difficult.
IMPLANT
advantages
Efficacy:
- 99.5% effective
- 1 woman in 200 will get pregnant in the course of a year when used as the sole form of contraception
LARC – long-acting reversible contraception
- LARC methods tend to be more effective (‘set and forget’) than other methods (e.g. pill or condoms)
Lasts up to 3 years
Simple procedure to insert and remove with local anaesthetic
Does not effect bone density (unlike injectable progesterone)
Quick to reverse when removed
Benefits over POP
- More likely to inhibit ovultion
- Less likelihood of periods
- Reduced risk of ovarian cysts and ectopic pregnancy
- No interactionwith non-enzyme inducing antibacterials
IMPLANT
disadvantages
Unpredictable bleeding patterns – 20% will have amenorrhoea, 60% have irregular periods, 20% will have frequent or prolonged bleeding – most of these will improve within 3 months. This can be alleviated with:
- Tranexamic acid – 1g/6-8h for up to 5 days – an antifibrinolytic, can reduce menorrhagia by 50%
- Mefanamic acid – 500mg/8h – an NSAID – antiprostaglandin – taken during periods of heavy bleeding, can reduce menorrhagia by 30%. Is also useful for dysmenorrhoea. Contraindicated in peptic ulcer disease
- Other NSAIDs may also be beneficial
- Removal of the implant
- Use of the COCP for 3 months in conjunction with the implant
Additional training required by practitioner for insertion and removal – can restrict access to the method
Breast tenderness, headache, mood changes
Side effects Acne Breast tenderness Mood swings Changes in libido Infection Small risk of local infection at the implant site Affect on periods – can make them shorter, longer, heavier or lighter, and the response is unpredictable. If bleeding is particularly heavy or persistent, it can be treated with…
