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Reproductive systems > Contraception and infertility > Flashcards

Contraception and infertility Flashcards

1
Q

Define contraception

A
  • Any method to prevent pregnancy
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2
Q

What are the different methods of contraception?

A
  • Natural
  • Barrier
  • Hormonal control - short-acting/long-acting reversible
  • Intrauterine (IUD/IUS)
  • Sterilisation
  • Emergency contraception
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3
Q

What are some methods of natural contraception?

A
  • Abstinence
  • Withdrawal
  • Fertility awareness methods
  • Lactational amenorrhoea method
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4
Q

What are the advantages of abstinence?

A
  • 100% effective
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5
Q

What are the disadvantages of abstinence?

A
  • Not an option for most
  • Unprepared if/when sexually active
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6
Q

What are the advantages of withdrawal before ejaculation?

A
  • No devices
  • No hormones
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7
Q

What are the disadvantages of withdrawal before ejaculation?

A
  • Unreliable
  • Some sperm in pre-ejaculate
  • No STI protection
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8
Q

What are some fertility awareness methods?

A
  • Monitoring and recording fertility indicators throughout menstrual cycle
  • Cervical secretions and changes in cervix
  • Basal body temperature
  • Length of menstrual cycle (Calendar method)
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9
Q

What are the advantages of fertility awareness methods?

A
  • No hormonal contraindications
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10
Q

What are the disadvantages of fertility awareness methods?

A
  • Time-consuming
  • Unreliable
  • No STI protection
  • Not suitable for all
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11
Q

Outline the lactational amenorrhoea method

A
  • 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
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12
Q

What are the advantages of the lactational amenorrhoea method?

A
  • No hormonal/contraindications
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13
Q

What are the disadvantages of the lactational amenorrhoea method?

A
  • Unreliable after 6 months
  • No STI protection
  • Not suitable for all
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14
Q

Outline the barrier method

A
  • Provide physical (and chemical) barrier to sperm
  • Condoms
  • Diaphragms/cervical caps
  • Spermicides
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15
Q

What are the advantages of the barrier method of contraception?

A
  • Reliable
  • STI protection
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16
Q

What are the disadvantages of the barrier method of contraception?

A
  • Disrupts intercourse
  • Risk of dislodging
  • Allergy/sensitivity to latex
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17
Q

What are the different types of hormonal control?

A
  • Combined oestrogen and progesterone - COCP, patch, ring
  • Progesterone-only pill
  • LARC - progesterone depot and implant
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18
Q

Give an overview of the combined oral contraceptive pill

A
  • 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
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19
Q

What is the main action of the COCP?

A
  • Prevent ovulation
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20
Q

What is the secondary action of the COCP?

A
  • Reduces endometrial receptivity to implantation
  • Thickens cervical mucus
21
Q

What are the advantages of the COCP?

A
  • Reliable (if used correctly) up to 99%
  • Can relieve menstrual disorders
  • Decrease of risk of ovarian and endometrial cancer
  • Decreases acne severity in some
22
Q

What are the disadvantages of the COCP?

A
  • User dependant
  • No STI protection
  • Medication interaction
23
Q

What are the contraindications of the COCP?

A
  • Raised BMI
  • Migraine with aura
  • Breast cancer
24
Q

What are the side effects of the COCP?

A
  • Menstrual irregularities
  • Breast tenderness
  • Mood disturbance
25
Q

What are the risks of the COCP?

A
  • Risk of CV disease
  • Stroke
  • VTE
  • Breast cancer
  • Cervical cancer
26
Q

What are the effects of high levels of progesterone?

A
  • Enhances negative feedback of oestrogen
  • Pre-ovulation - reduces FSH and LH secretion
  • Inhibits positive feedback of high oestrogen prevent LH surge and ovulation
27
Q

What are the effects of lower levels of progesterone?

A
  • Does not inhibit LH surge
  • Can still ovulate
  • Will thicken cervical mucus
28
Q

Give an overview of low dose progesterone

A
  • 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
29
Q

What are the advantages of the progesterone only pill?

A
  • Reliable up to 99%
  • Can be used if COCP is contraindicated
30
Q

What are the disadvantages of the progesterone only pill?

A
  • No STI protection
  • Strict timing - user dependent
  • Menstrual irregularities
  • Increased risk of ectopic pregnancy
31
Q

Give an overview of the progestogen injection

A
  • High dose progestogen - LARC
  • Inhibits ovulation
  • Thicken cervical mucus
  • Thin endometrial lining
  • Given intramuscularly every 12 weeks
32
Q

What are the advantages of the progestogen injection?

A
  • Reliable
  • No known medication interactions
  • Can be used if oestrogen contraindicated and raised BMI
33
Q

What are the disadvantages of the progestogen injection?

A
  • No STI protection
  • Not rapidly reversible (can take 18 months for fertility to return)
  • Menstrual irregularities
  • Can thin bones
34
Q

Give an overview of the progestogen implant

A
  • Small subcutaneous tube inserted in arm
  • High dose progestogen - LARC
35
Q

What are the main actions of the progestogen implant?

A
  • Inhibit ovulation
  • Thicken cervical mucus
  • Thin endometrial lining
36
Q

What are the advantages of the progestogen implant

A
  • Reliable
  • Lasts for up to 3 years
  • Can be used if oestrogen is contraindicated and BMI is raised
  • Fertility returns faster than injection
37
Q

What are the disadvantages of the progestogen implant?

A
  • No STI protection
  • Menstrual irregularities
  • Complications with insertion and removal
38
Q

What is the main action of the intrauterine system?

A
  • Progestogen-releasing coil - local
  • E.g. Mirena
  • Main action is to prevent implantation and reduce endometrial proliferation
  • Thickens cervical mucus
  • Ovulation usually continues
39
Q

What is the main action of the intrauterine device?

A
  • Copper-containing coil
  • Main action: copper toxic to ovum and sperm, preventing fertilisation
  • Secondary actions: cervical mucus changes, endometrial inflammatory reactions inhibit implantation
40
Q

What are the advantages of intrauterine contraceptives?

A
  • Convenient
  • Effective up to 99%
  • LARC - from 3-10 years
  • IUS for treatment of menorrhagia
41
Q

What are the disadvantages of intrauterine contraceptives?

A
  • No STI protection
  • Complications with insertion (perforation)
  • Menstrual irregularities
  • Displacement/expulsion may occur
42
Q

What are the different mechanisms of sterilisation?

A
  • Vasectomy
  • Tubal ligation/clipping
43
Q

Give an overview of vasectomy

A
  • Vas deferens snipped or tied to prevent sperm entering ejaculate
  • Under local anaesthetic
  • Must do post-vasectomy semen analysis (PVSA) 12 weeks post procedure
44
Q

Give an overview of tubal ligation/clipping

A
  • Fallopian tube occluded to prevent ovum transport
  • Under local/general anaesthetic
45
Q

What are the three types of emergency contraception?

A
  • Levonorgestrel - morning after pill
  • EllaOne - selective progesterone
  • Copper IUD
46
Q

How does levonorgestrel act as a morning after pill?

A
  • High dose progesterone
  • Prevents ovulation
  • Can be taken up to 72 hours post unprotected sexual intercourse
47
Q

How does EllaOne act as a morning after pill?

A
  • Ulipristal acetate
  • Selective progesterone receptor modulator
  • Inhibits/delays ovulation
  • Taken up to 120 hours post unprotected sexual intercourse
48
Q

How long after unprotected sex can the copper IUD act as emergency contraception?

A
  • Up to 5 days ovulation
49
Q

How do we decide which contraception to use?

A
  • 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

Reproductive systems (20 decks)

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