Contraception and infertility Flashcards
Define contraception
- Any method to prevent pregnancy
What are the different methods of contraception?
- Natural
- Barrier
- Hormonal control - short-acting/long-acting reversible
- Intrauterine (IUD/IUS)
- Sterilisation
- Emergency contraception
What are some methods of natural contraception?
- Abstinence
- Withdrawal
- Fertility awareness methods
- Lactational amenorrhoea method
What are the advantages of abstinence?
- 100% effective
What are the disadvantages of abstinence?
- Not an option for most
- Unprepared if/when sexually active
What are the advantages of withdrawal before ejaculation?
- No devices
- No hormones
What are the disadvantages of withdrawal before ejaculation?
- Unreliable
- Some sperm in pre-ejaculate
- No STI protection
What are some fertility awareness methods?
- Monitoring and recording fertility indicators throughout menstrual cycle
- Cervical secretions and changes in cervix
- Basal body temperature
- Length of menstrual cycle (Calendar method)
What are the advantages of fertility awareness methods?
- No hormonal contraindications
What are the disadvantages of fertility awareness methods?
- Time-consuming
- Unreliable
- No STI protection
- Not suitable for all
Outline the lactational amenorrhoea method
- Breastfeeding after childbirth to avoid pregnancy
- Delays the return of ovulation by disrupting gonadotrophin release
- Can be effective for up to 6 months postnatally
- But patient has to breastfeed exclusively and there must be complete amenorrhoea
What are the advantages of the lactational amenorrhoea method?
- No hormonal/contraindications
What are the disadvantages of the lactational amenorrhoea method?
- Unreliable after 6 months
- No STI protection
- Not suitable for all
Outline the barrier method
- Provide physical (and chemical) barrier to sperm
- Condoms
- Diaphragms/cervical caps
- Spermicides
What are the advantages of the barrier method of contraception?
- Reliable
- STI protection
What are the disadvantages of the barrier method of contraception?
- Disrupts intercourse
- Risk of dislodging
- Allergy/sensitivity to latex
What are the different types of hormonal control?
- Combined oestrogen and progesterone - COCP, patch, ring
- Progesterone-only pill
- LARC - progesterone depot and implant
Give an overview of the combined oral contraceptive pill
- Contains combination of synthetic oestrogen and progesterone
- Many brands are available - strength/type of hormones vary
- Usually taken for 21 days with a 7 day break or 21 days and 7 placebo pills
- Break relieves endometrium so it doesn’t build up too much
What is the main action of the COCP?
- Prevent ovulation
What is the secondary action of the COCP?
- Reduces endometrial receptivity to implantation
- Thickens cervical mucus
What are the advantages of the COCP?
- Reliable (if used correctly) up to 99%
- Can relieve menstrual disorders
- Decrease of risk of ovarian and endometrial cancer
- Decreases acne severity in some
What are the disadvantages of the COCP?
- User dependant
- No STI protection
- Medication interaction
What are the contraindications of the COCP?
- Raised BMI
- Migraine with aura
- Breast cancer
What are the side effects of the COCP?
- Menstrual irregularities
- Breast tenderness
- Mood disturbance
What are the risks of the COCP?
- Risk of CV disease
- Stroke
- VTE
- Breast cancer
- Cervical cancer
What are the effects of high levels of progesterone?
- Enhances negative feedback of oestrogen
- Pre-ovulation - reduces FSH and LH secretion
- Inhibits positive feedback of high oestrogen prevent LH surge and ovulation
What are the effects of lower levels of progesterone?
- Does not inhibit LH surge
- Can still ovulate
- Will thicken cervical mucus
Give an overview of low dose progesterone
- Thickens cervical mucus
- Reduces cilia activity in fallopian tubes
- Ovulation is not prevented
- Taken daily with no breaks
- Must be taken at the same time each day
What are the advantages of the progesterone only pill?
- Reliable up to 99%
- Can be used if COCP is contraindicated
What are the disadvantages of the progesterone only pill?
- No STI protection
- Strict timing - user dependent
- Menstrual irregularities
- Increased risk of ectopic pregnancy
Give an overview of the progestogen injection
- High dose progestogen - LARC
- Inhibits ovulation
- Thicken cervical mucus
- Thin endometrial lining
- Given intramuscularly every 12 weeks
What are the advantages of the progestogen injection?
- Reliable
- No known medication interactions
- Can be used if oestrogen contraindicated and raised BMI
What are the disadvantages of the progestogen injection?
- No STI protection
- Not rapidly reversible (can take 18 months for fertility to return)
- Menstrual irregularities
- Can thin bones
Give an overview of the progestogen implant
- Small subcutaneous tube inserted in arm
- High dose progestogen - LARC
What are the main actions of the progestogen implant?
- Inhibit ovulation
- Thicken cervical mucus
- Thin endometrial lining
What are the advantages of the progestogen implant
- Reliable
- Lasts for up to 3 years
- Can be used if oestrogen is contraindicated and BMI is raised
- Fertility returns faster than injection
What are the disadvantages of the progestogen implant?
- No STI protection
- Menstrual irregularities
- Complications with insertion and removal
What is the main action of the intrauterine system?
- Progestogen-releasing coil - local
- E.g. Mirena
- Main action is to prevent implantation and reduce endometrial proliferation
- Thickens cervical mucus
- Ovulation usually continues
What is the main action of the intrauterine device?
- Copper-containing coil
- Main action: copper toxic to ovum and sperm, preventing fertilisation
- Secondary actions: cervical mucus changes, endometrial inflammatory reactions inhibit implantation
What are the advantages of intrauterine contraceptives?
- Convenient
- Effective up to 99%
- LARC - from 3-10 years
- IUS for treatment of menorrhagia
What are the disadvantages of intrauterine contraceptives?
- No STI protection
- Complications with insertion (perforation)
- Menstrual irregularities
- Displacement/expulsion may occur
What are the different mechanisms of sterilisation?
- Vasectomy
- Tubal ligation/clipping
Give an overview of vasectomy
- Vas deferens snipped or tied to prevent sperm entering ejaculate
- Under local anaesthetic
- Must do post-vasectomy semen analysis (PVSA) 12 weeks post procedure
Give an overview of tubal ligation/clipping
- Fallopian tube occluded to prevent ovum transport
- Under local/general anaesthetic
What are the three types of emergency contraception?
- Levonorgestrel - morning after pill
- EllaOne - selective progesterone
- Copper IUD
How does levonorgestrel act as a morning after pill?
- High dose progesterone
- Prevents ovulation
- Can be taken up to 72 hours post unprotected sexual intercourse
How does EllaOne act as a morning after pill?
- Ulipristal acetate
- Selective progesterone receptor modulator
- Inhibits/delays ovulation
- Taken up to 120 hours post unprotected sexual intercourse
How long after unprotected sex can the copper IUD act as emergency contraception?
- Up to 5 days ovulation
How do we decide which contraception to use?
- UK medical eligibility criteria for contraceptive use
- Helps clinicians decide what contraceptives they can safely recommend based on the medical conditions of patients in their care
