Contraception And Infertiity Flashcards
Briefly define cotraception
Any method to prevent pregnancy • Blocking transport of sperm to avoid fertilisation of oocyte • Disrupting the HPG axis to interfere with ovulation • Inhibiting implantation of the conceptus into endometrium
What are categories of contraception
Can be broadly split into: 1. Natural
- Barrier
- Hormonal Control
- Prevention of implantation
- Sterilisation
- Emergency contraception
What is the withdrawal method
Abstinence
Advantages
• Only 100% reliable method of contraception Disadvantages
• I’m sure you can work this out
Withdrawal method Withdrawing before ejaculation Advantages • No devices/hormones Disadvantages • Not reliable ◦ ?
What are pros and cons of fertility awareness methods
Fertility Awareness Methods Use of fertility indicators to identify fertile and infertile points of the menstrual cycle:
• Cervical secretions • Basal body temperatures • Length of menstrual cycle
Advantages
• No hormones/contraindications Disadvantages
• Unreliable
• No protection from STI
What is the lactatuonal amenorrhoea method
Lactational amenorrhoea method
Breastfeeding delays the return of ovulation after childbirth
• Suckling stimulus disrupts release of GnRH
• Affects feedback cycle of HPG axis
Relies on exclusive breast feeding (no formula milk etc)
Only effective up to 6 months after giving birth (could actually get pregnant 21 days after giving birth)
Female must be amenorrheic
Advantages • No hormones/contraindications Disadvantages • Unreliable • No STI prevention
What are barrier methods
Male/Female condoms Diaphragm/Caps
Physical barriers- preventing entrance of sperm into the cervix Can also used with spermicide so additional chemical barrier
Advantages • Reliable – 98% effective (if used correctly) •Protection from STIs •Male condom is widely available Disadvantages •
Describe hormonal control
Combined Oestrogen and Progestogen
• COCP
• Vaginal ring
• Patches
Progesterone Depot (LARC) • High dose progestogen Progesterone Implant (LARC) • High dose progestogen
Low dose progestogen
• POP
Decsribe the roll of progesterone
See slide
What is cocp
Pill containing combination of synthetic oestrogen and progestogen
Lots of types available - strength of each hormone varies
Principal action:
• Prevents ovulation (tricks into thinking in luteal phase)
Secondary action:
•Reduces endometrial receptivity to inhibit implantation
•Thickens cervical mucus to inhibit penetration of sperm 98% effective if taken correctly
What are missedpill rules
-link in web
What are the advantages and disadvantages of teh cocp
Advantages 98% effective User Can relieve menstrual disorders Reduces risk of ovarian cysts Reduces risk of ovarian cancer and endometrial cancer
Disadvantages
No protection from STIs
Contraindications eg BMI, migrations, breast cancer
Side effects: breakthrough bleeding, breast tenderness, mood disturbance
Increased risk of: breast and cervical cancer, VTE, MI/Stroke
What is the projector one injection
Intramuscular injection given at intervals
Principal action:
• Prevents ovulation
Secondary action:
•Thickens cervical mucus to inhibit penetration of sperm
• Prevents endometrial proliferation
Advantages
Reliable – eliminates risk of user failure
Does not disrupt sexual intercourse
It can be useful for women who can’t use contraception that contains oestrogen.
Disadvantages Appointment needed every 12 weeks!!! Contraindications and side effects Delay in fertility returning No STI protection
What is the progesterone implant
Small flexible tube about 40mm long is inserted under the skin Lasts for three years Principal action:
• Inhibits ovulation
Secondary action: •Thickens the cervical mucus •Prevents endometrial proliferation
Advantages
Reliable – eliminates risk of user failure LARC
It can be useful for women who can’t use contraception that contains oestrogen.
Natural fertility returns quickly when removed
Disadvantages Minor procedure to insert. Side effects No STI protection
What is the progesterone only pill
Low dose
Taken every day, without a break
Principal action: Thicken cervical mucus Ovulation is usually not prevented
Advantages Quickly reversible It does not interrupt sexual intercourse Can be used where the COCP is contraindicated
Disadvantages User dependant!! Menstrual problems are common Interacts with other medication Risk of ectopic pregnancy Does not protect from STI
What is the coil
Progestogen-releasing plastic device Works for 3–5 years
Principal action: Prevents implantation and reduces endometrial proliferation
Secondary action: thickens cervical mucus
Can prevent heavy sinful periods
Intrauterine device - IUD Plastic device with added copper
Works for 5-10 years
Principal action: Copper is toxic to sperm and ovum
Secondary action: endometrial inflammatory reaction preventing implantation and changes consistency of cervical mucus
