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Contraception and HRT Flashcards

1
Q

What is contraception

whats the point and how

A
  • aims to prevent pregnancy
  • can prevent pregnancy
    • prevent ovulation
    • prevent fertilisationon
    • prevent implantation
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2
Q

Why is contraception important

what can life without contracpetion

A
  • a third of pregnancies are unplanned or unwanted
    • can lead to a health impact
  • spacing pregnancy gives better health outcomes
  • pregnancy is a high risk
    • high risk for people for morbidities
  • it’s about choice/employment/ human rights
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3
Q

Failure rates

What is meant by typical use

A

Typical use - failure rate when used as in real life – not always correctly
- may have other medications that interact, or forget etc

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4
Q

What is meant by the term perfect use

A

Perfect use - failure rate when the method used consistently and correctly at all times

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5
Q

Types of contraception

What methods have no user failure

A
  • Copper Coil (CuIUD) – copper
  • Hormonal Coil (LNGIUD)– levonorgestrel
  • Implant
  • Sterilisation
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6
Q

Types of contraception

What methods can have user failure

A
  • Barrier – External and Internal Condoms, diaphragm
  • Hormonal – Combined pill / patch / ring, POP, injectables
  • Natural family planning and lactational amenorrhoea
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7
Q

What is the role of UK MEC

A

Defines the safety of a contraceptive for individuals with certain characteristics, physical states or medical conditions

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8
Q

What are the UKMEC catagories

A

UKMEC 1: a condition for which there is no restriction for the use of contraceptive method

UKMEC 2: A condition for which the advnatages of using the method generally outweigh the theorirtcial or proven risk

UKMEC 3: A condition where the theortical or proven risks usually outweigh the advntages of using the method

UKMEC 4: A condition which represents an unacceptbale health irsk if the contracpetive is used

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9
Q

What are the things that a long acting reverisble contraception needs to be

A
  • Methods that require administration less than once per cycle or month
  • these are more effective
  • you fit them and forgot
  • More effective
  • Longer lasting
  • Convenient
  • Cost effective
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10
Q

give examples of long acting reversible contraceptions

A
  • can also be fully reversible
  • like the coil, implant, injecting
  • no impact on future fetrlty
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11
Q

what is the….

Implants

duration, method, mechanism, failure rate. fitted

A
  • most effective
  • fitted subdermally over trcipes
  • single rod
  • failure rate 0.03%
  • contains progesterone
    • inhibits ovulation
    • causes thickend cervical muscus
  • Duration - 3 years
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12
Q

Implants

Advantages and disadvantages

A

Advantages

  • highly effective and reversible
  • Reduce HMB and dysmenorrhoea - may cause amenorrhoea
  • Quick return of fertility when removed

Disadvantages / side-effects

  • Fitting and removal procedure required
  • Irregular menstrual bleeding
  • Hormonal side effects – headache, breast-tenderness, changes to skin, mood changes
  • Affected by enzyme inducers
  • No STI protection
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13
Q

Hormonal coils

mechanim, duration, failure rate, fitting, method, examples

A
  • t shaped device
  • sits in womb
  • slowly releases progesterone
  • thin lining of the womb
  • thickens cervical mucus
  • inhibits ovulation in some people
  • Mirena example

Duration of use
- between 3-8 years depending on type
- its 99%

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14
Q

Hormonal coil

advantages and disadvantages

A

Non-contraceptive benefits

  • Reduces menstrual bleeding / may induce amenorrhoea
  • Reduced dysmenorrhoea
  • May reduce pain from endometriosis or adenomyosis

Disadvantages / Side effects

  • Requires pelvic examination and speculum to fit
  • Hormonal - headache, breast tenderness, acne
  • Irregular bleeding - can last up to 9 months
  • Benign ovarian cysts
  • Ectopic risk if pregnancy does occur
  • Expulsion – <1:20
  • No STI protection
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15
Q

Copper coil

mechanim, duration, failure rate, fitting, method

A
  • t shaped
  • has a copper stem

insertition
-inserted into uterus
-has short threads for removal

It works

  • prevents implansation because copper is toxic to sperm and ovum
  • you can use this for 5-10 years
  • and its over 99%
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16
Q

Copper coil

advantages and disadvantages

A

Advantages
- Effective immediately
- Can be used as emergency contraception
- Non-hormonal (?perceived advantage)

Disadvantages / Side effects

  • Requires pelvic examination and speculum to fit
  • May increase menstrual blood loss
    • may make it longer, heaver in some women
  • May worsen dysmenorrhoea
  • Expulsion – <1:20
  • Ectopic risk if pregnancy does occur
  • No STI protection
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17
Q

What are the contrindications of the copper coil

A
  • cant use of >48hr or <4wk post partum
  • cant use if post-partum sepsis
  • cant use for
    • PID (don’t want to make it worse
    • Unexplained vaginal bleeding
    • gestational trophoblastic disease
  • cervical cancer
    • don’t want to spread cancer
  • cardiac arrhythmias
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18
Q

Injections

mechanim, duration, failure rate, fitting, method

A
  • Depo-Provera
    • injected in the gluteal muscle every 12-14 weeks by a doctor or nurse
  • Sayana

How it works

  • Inhibit ovulation
  • Thicken cervical mucus
  • Thin endometrium

Effectiveness

  • Perfect use = >99%
  • Typical use = 96% - due to late injections
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19
Q

Injections

advantages and disadvantages

A

Advantages

  • highly effective, convenient, reversible
  • not affected by other medications/enzyme inducers
  • reduces bleeding and pain, improved PMS
  • reduces the severity of sickle cell crises

Disadvantages/side effects

  • once given cannot be removed
  • menstrual irregularities
  • weight gain
  • no STI protection
  • may delay the return of fertility – up to 1 year
  • hormonal side-effects - same as implant/POP
  • decrease bone mineral density – returns after stopping
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20
Q

Combined hormonal contraception

mechanim, duration, failure rate, fitting, method

A
  • these contain oestrogen and progesterone
    • pill, patch, vaginal ring

Works by

  • prevents ovulation
  • also thickens, cervical mucus, and thins endomterial

Efficacy

  • perfect use there’s 0.3% of failure
  • typical use is 8%
21
Q

combined pills

A
  • contains oestorgen progestrone
  • one pill 8 every day same time
  • rules for missing pill
22
Q

combined vaginal ring

A
  • Ethinyl Oestradiol and Etonogestrel
  • Flexible transparent ring 54mm wide
  • Mode of action – inhibition of ovulation
  • One ring per 21 days
  • Removed for 7 days – withdrawal bleed
  • Not a LARC
  • Perfect use 1% failure
  • Typical use 9% failure
  • Combined Vaginal Ring (Nuvaring)
23
Q

Combined hormonal contraceptives

advantages and disadvantages

A

Benefits
* regular, lighter, less painful periods
* Reduced risk of ovarian / endometrial and colon cancer
* May reduce premenstrual symptoms
* May improve acne

**Disadvantages / risks
** Increase Venous or arterial thrombosis risk
* Increase Heart attack and stroke risk
* Increase Breast cancer risk - reduces with time after stopping the pill
* Increase Cervical cancer risk with longer use - reduces with time after stopping the pill
* Hypertension

Takes 7 days to become effective (if started outside of day1-5 of cycle)

If started within day-1-5 of period then effective immediately.

24
Q

What are the side effects of combined contraceptive methods

A
  • Temporary - headaches, nausea, breast tenderness, mood changes
  • Breakthrough bleeding
  • Effectiveness affected by enzyme inducers
  • No STI protection
  • Pill effectiveness affected by diarrhoea / vomiting (may need to use alternative contraceptives during this time)
25
Q

Patch

mechanim, duration, failure rate, fitting, method

A
  • transdermal
  • e.g Evra
  • can see patch’s quite place
  • you can have 1 patch for 1 week for 3 weeks
  • perfect use there’s a 1% failure
  • typical use is 9%

Efficacy is reduced is over 90kg

-Efficacy may be reduced if > 90 kg (14 stone)
-Not affected by GI upsets (diarrhea/vomiting)

26
Q

Combined hormonal contraceptives contraindications

A

High BMI
*Migraines
*Smoking
*Age
*VTE <45 (patient or 1st degree relative)
*Hypertension
*Thrombophilias

complete list on UKMEC

27
Q

How do we take hormonal contraceptives

A

How to take:
* Standard: take for 21 days, 7 day break (hormone-free interval

there can also be tailored reigimes

28
Q

Progestorone only pill

mechanim, duration, failure rate, fitting, method

A

Synthetic progesterone
* tablets: desogestrel / levonorgestrel / norethisterone / drospirenone
* Should be taken daily at the same time each day, every day
* NO pill-free interval

Mode of action
* Prevent ovulation
* Thicken cervical mucus
* Thin endometrium

Failure rates:
perfect use 1% failure
typical use 9% failure

Be aware – traditional vs desogestrel POPs

29
Q

Progestorone only pill

advantages and disadvantages

A

Benefits
* Effective, reversible
* Now available OTC

Disadvantages / side effects
* Menstrual irregularities
* Same time each day - 12 hour window for desogestrel (3 hour for
* traditional POPs)
* Functional ovarian cysts
* Hormonal (headaches, changes to mood, depression, bloating,
* breast tenderness)
* No STI protection

30
Q

Why are progestrone only pills better

A
  • Much fewer contraindications than combined methods
  • No increased stroke risk
  • Current breast cancer
  • Severe liver disease / liver tumours
  • Stroke/IHD

See UKMEC for full list

31
Q

barrier methods

External condoms

mechanim, duration, failure rate, fitting, method

A
  • Latex/latex free, placed over an erect penis before any contact
  • Acts as a barrier to stop sperm entering the vagina
  • Perfect use = 2% failure
  • Typical use = 17% failure
  • Single use only!
  • Check - date, kite mark, not damaged
  • Avoid – oil based lubricants
  • STI and HIV protection
32
Q

Internal condom

mechanim, duration, failure rate, fitting, method

A
  • inserted before sex
  • loosely lines the vagina, and rectum and partially covers the vulva
  • barrier to sperm

Perfect use 5% failure

typical use is 21%

  • these are single-use only
  • can have protection against STIs and HIV
33
Q

Internal condom: diaphragm

A
  • Reusable flexible latex or silicone device
  • Put into the vagina to cover the cervix
  • Acts as a barrier to sperm
    • Used with spermicide
  • Can be inserted up to 3 hours before sex
  • Needs to be left in for 6 hours after sex
    • for spermcide to work
    • if your going to have more sex needs to have more spermcide
  • Perfect use = 4 - 8% failure
  • Typical use = 12 – 29% failure
  • Do NOT offer STI or HIV protection
34
Q

Natural family planning

how does it work

A

main fertility indicators

  • basal body temperature
  • cervical secretions
  • length of menstrual cycle
    • can use this info to work out fertile window
35
Q

Natural family planning

advantages and disadvantages

A

Advantages

  • can be used to avoid or plan pregnancy
  • there are no side effects physical ones anyway
  • the couples are in control, and may improve communication
  • avoids hormones
  • acceptable to all faiths and cultures

Disadvantages

  • much more reliable cycles
  • need to have regular cycles
    • us ireegualr girlies can’t really do this
  • takes some time to learn this
  • can be time consuming and require motivation
  • things like illness, and lifestyle stress make fertility harder to interpret
  • need to avoid sex or condoms during fertile time
  • and there’s no STI protection
36
Q

Lactational amenorrhea

what is it, when, failure rates etc

A
  • Baby <6m old
  • A woman must be amenorrhoeic
  • Exclusively breastfeeding – 4hrly in day, 6hrly at night
  • If all 3 criteria are met then it should workkk
  • Typical failure rate = 2%
  • Perfect use failure rate = 0.5%
37
Q

Male sterilisation

what is it, failure rate

A
  • vascoectmy → cut vas defferns
  • the failure rate is 1 in 2000
  • its permanent and irrevirvle on NHS
  • doesn’t affect sex drive, erections
  • ejaculation occurs but no sperm
  • need do to contrapcetion for 8-12 weeks in case there was sperm downstream
38
Q

Female sterilsation

what is it, failure rate

A
  • works by tubual occulsaion
  • prevent egg and sperm meeting
  • fails for 1 in 200
  • permanent and irreversible on NHS
39
Q

Types of emergency contraception

name of types

A

copper coil
pill

40
Q

emergency contracpetion

Copper IUD

when, efficacy,

A

Copper IUD
-Can be inserted up to 120 hours after first UPSI
-Or within 5 days of the earliest expected ovulation

-Overall efficacy = 99.9%
-same benefits and risks as for non-emergency copper IUD
-Can be used for ongoing contraception or removed once pregnancy excluded

41
Q

Emergency contraception oral pills

Oral pills: Ulipristal Acetate

name of brand, time taken, mechanism, efficacy,

A

Ulipristal Acetate

  • Current brand = ellaOne - single 30 mg tablet
  • Licensed for up to 120 hours after sex
  • Synthetic progesterone receptor modulator
  • Primary mode of action - delays ovulation
  • Prevents about 60-80% of expected pregnancies
    • copper coil is most effective
  • Effectiveness decreased by progestogen contraception used 7 days before or 5 days after
    • decreased by progesterone
  • Can be used multiple times per cycle
    • if it happens once, can use it again
42
Q

emergency contraception pills

Oral pills: Levonorgestrel

A
  • single tablet usually 1.5mg if BMI is over 26 is 3mg
  • efficacy is 96 hours
  • delays ovulation
43
Q

What is menopause defined as

A
  • Menopause is defined as the cessation of menses for:
    • 12 months > if your over 50 years
    • 24 months <45 years
  • Average age of menopause in UK = 51 years
    • there’s a 7 year lead up to menopause
  • Early menopause = <45years
  • Premature ovarian insufficiency = <40 years
44
Q

Symtoms of menopause

due to reduced oestrogen → since there’s oestrogen receptors EVERYWHERE

A
  • Hot flushes and night sweats
  • loss of libido
  • vaginal dryness
  • skin dryness / dry hair / thinner hair
  • Frequency of micturition, urgency, nocturia
  • lethargy and fatigue
  • low mood/anxiety
  • Arthralgia/myalgia
  • Poor sleep/insomnia
  • Palpitations
45
Q

What are the long-term effects of oestrogen defiency

A
  • increased CVS risk
    • can cause MI
    • stroke
  • reduced bone mineral density
    • bone mass decreases with age
    • we have a lower peak bone mass
    • the decline is much more accelerating in females
  • increase total cholesteral and LDL
  • decreased glucose tolerance or insulin sensitivity
46
Q

How can we help treat menopause symptoms

what do you need to add

A

HRT

  • give hormones
    • if they have uterus add progesterone alongside oestrogen
    • oestrogen grows lining of the womb, so you have progesterone to keep the womb lining in check
  • cyclic
    • half oestrogen
    • half progesterone
  • after years we move them onto a continuous one
47
Q

How do we give HRT

routes of

A
  • can give transdermally
    • or as gel, spray, gel
      • no blood clot risk associated with
  • can take orally
  • can give a hormonal coil as well
  • implants
    • can have oestrogen implants and decide on progesterone
  • can give vaginal oestrogen for vaginal symptoms
48
Q

What are the benefits and risks of HRT

A

Benefits

  • eases symptoms
  • reduces CVS risk
  • protects bone mineral density

Risks

  • through the skin is safer than oral
  • oral
    • risk of DT, PE
    • risk of MI, and stroke
  • not contraceptive
  • increases the risk of breast cancer and endometrial

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