Contraception and HRT Flashcards
What is the purpose of contraception?
To prevent pregnancy either by preventing ovulation, fertilisation or implantation.
Why are birth rates changing?
Family planning Better health and reduced infant mortality Raised living standards Education Employment Migration
What is the ideal contraceptive?
Reversible, simple, painless, easy to use, cheap, 100% effective.
What should be considered when deciding on a contraceptive form?
Pt preferences, hormones, compliance, menstrual cycle problems, fertility options, FHx, contraindications, age
What does the pearl index show?
The measurement of failure of a contraceptive to show its effectiveness.
For every 100 women in a years use of the contraceptive, how many get pregnant.
What is the rate of fertility in young women compared to at 40 and 45years and why?
Natural decline in fertility:
Young = 80/100
40yrs = 40/100
45yrs = 20/100
What is the average age of menopause?
51.5 years
What is the definition of infertility?
Failure to get pregnant after 18-24mnths of regular unprotected intercourse.
What features of intercourse favour fertility?
Instinct, drive, pleasure, timing, raised pH in vagina from vaginal transudate, thinning of cervical mucus, fertility window
When does ovulation occur?
14 days PRIOR to next period
What does natural family planning include?
Rhythm method - ovulation window
Changes in cervical mucus - thin in follicular phase
Changes in cervix - higher and softer during ovulation
Changes in body temp - increases at ovulation
Coitus interrupts
Lactational amenorrhoea (PI 2/100)
What are the advantages and disadvantages of family planning?
+no s.e.
+under couples control
-not reliable
-messy and clinical
What barrier methods are available?
- Condom and femidom (2-15/100)
- Diaphragm and cap
- Spermicides
What is the disadvantage of barrier methods?
User dependent
What is the Combined hormonal contraceptive? How does it work?
Oestrogen and progesterone used for 21 days with a 7 day break. Aim to prevent ovulation through -ve feedback, thicken mucus and change endometrium and fallopian tube.
What are the forms of CHC?
COC
Evra patch
Nuva ring
What are the advantages of CHC?
+Highly effective, convinient and reversible
+Prevents ovulation pain
+controls bleeding
+prevents ovarian cysts
-reduces risk of ovarian and endometrial cancer
+Missed pill window of 24hrs
What are the disadvantages of CHC?
- User dependent
- Affected by enzyme inducers, vomiting and diarrhoea
- Headaches
- weight gain
- leg cramps and bloating
- post pill amenorrhoea
- increased risk of breast cancer
- risk of venous thromboembolism and arterial wall disease
Which hormone causes the increased risk of circulatory disease?
Oestrogen.
Who is CHC contraindicated in?
Smokers FHx of blood clots Migraines Hypertension Increased age Overweight
What is the aim of the progestrone only pill?
Taken throughout cycle with no break to cause changes in mucus, endometrium and anovluation. (0.3-4/100)
What are the advantages of POP?
+Used when CHC is contraindicated
+no increased risk of circulatory disease
+For lactating mothers, smokers, >35, hypertensive, antibiotics
What are the disadvantages of POP?
- Requires regular dose = user dependent and theraputic window of 12hrs
- Irregular cycles
- Ovarian cyst
- Migrains, depression, weight gain
Who is POP contraindicated in?
Pregnancy, undiagnosed genital tract bleeding, migraines
What are LARCs? What are the options available?
Long acting reversible contraceptives
- Injection
- Implant
- IUS/mirena
- IUD
Describe the injection.
0.1-1/100 PI which has the same actions as POP. Given every 8-12 weeks.
What the advantages of the injection?
+highly effective and convenient
+Reduces bleeds so treats anaemia
+reduced pain and pelvic infection
What are the disadvantages of injection?
- cannot be removed
- menstrual irregularities
- delayed return of fertility
- reduced bone mineral density
- migraines, depression, weight gain
What is the implant and its mode of action?
A subdermal implant that inhibits ovulation and increase viscosity of mucus. Last 3 years. PI 0.07/100.
Implanon or nexplanon
Has a barium coating to check location on Xray
What are the advantages and disadvantages of implant?
\+highly effective \+User independent \+reversible -requires surgical removal under local anaesthetic -Migraine, weight gain, depression -irregular bleeds -risk of migrating through venous system
What is mirena?
IUS - a T shaped plastic device that releases hormones from its steroid reservoir around the stem. It lasts 5 years with PI 0.1/100.
Different sizes have a different dose.
What are the advantages and disadvantages of IUS?
+Reduces menstrual bleeds so treats anaemia
+reduces pain, PID and ectopic
+Treat endometriosis or endometrial hypersplasia
-Irregular bleeds
-Hormonal side effects
Who is the IUS contraindicated in?
Pregnancy, liver tumour, undiagnosed vaginal bleeding, pelvic infection, artificial heart valve, hormone dependent tumours
What is the IUD and its mode of action?
A copper device with varying duration of 2-10 years depending on size. PI 0.2-1/100.
It induces a foreign body response in the uterus and is spermicidal. It prevents implantation (anti-abortive)
What are the advantages and disadvantages of IUD?
+Highly effective and reversible
+No unwanted s.e. as no hormone involvement
+independent of intercourse
-Increased risk of ectopic and miscarriage should pregnancy occur
-anti-abortive = ethical objections
-PID, pain, abnormal bleeding
-Uterine perforation or expulsion
What is sterilisation?
An irreversible method of contraception.
Males = vasectomy - risk of prostate and testicular cancer increases
Females = Tubal occlusion - risk of menstrual problems
Why is counselling required before sterilisation?
Risk of failure at 1 in 20 and it is irreversible.
What is emergency contraception? What types are available?
Post coital contraception to prevent ovulation or implantation. It can be hormonal:
-Levonelle
-ellaOne
or copper IUD.
When can Levonelle be used?
Within 72 hours. Efficacy decreases with time. A progesterone agonist
84%<72hrs 63%>72hrs
What is the risk with levonelle?
May cause nausea and vomiting. If vomiting occurs within 2hrs of taking it requires another dose or an alternative method.
When can ellaOne be used and what is it?
Within 5 days (120hrs). A synthetic progesterone receptor modulator to inhibit ovulation. 60% effective
How can the copper IUD be used as emergency contraception?
Can be inserted upto 5 days after with an efficacy of 99.9% as it prevents implantation.
What is the risk with IUD?
Pain, bleeding, infection and requires a procedure.
What are the 3 methods of termination?
Medical <9 wks using antiprogesterone drugs and PGs (95%)
Surgical 9-14 wks via vacciuum or uterus lining scrape and cervical dialtion.
Medical + dilation and evacuation at 14-24 wks. Evacuation via vaccuum, forceps or curettage
What is menopause?
The cessation of menses for >1yr due to the transition into a non-reproductive phase of life. No more eggs available
Why are symptoms experienced as menopause commences and what are they?
Due to reduced oestrogen and progesterone levels.
Hot flushes, night sweats, skin dryness, lethargy, loss of libido, urgency and nocturia
Which hormone is used to diagnose menopause?
FSH as gonadotrophin levels increase to to gonadal insufficiency and lack of sex hormone production.
What is HRT?
Used to help with symptoms and to reduce risk of osteoporotic fractures, AD, insulin resistance and CVD
What types of HRT are there?
Combined - Only if uterus present to prevent endometrial hyperplasia
Oestrogen HRT - For pt with hysterectomy
What is a red flag for endometrial cancers?
Postmenopausal bleeding
When does bone density begin to fall?
At 28 yrs as fertility begins to decline, dramatically falls at 48yrs.
What is the risk of combined HRT?
Breast cancer, CA disease, dementia, stroke (cancer risk due to progesterone)
What is the advantage of oestrogen HRT?
no increased risk of breast cancer and may delay onset of AD
