Contraception and LARC Flashcards
Outcomes/ options for an unwanted pregnancy
- Keep the baby
- Terminate the pregnancy
- Give up the baby for adoption
Methods and MOA of contraception
- Prevention of ovulation- hormonal methods (including EC)
- Suppress LH and FSH - Prevention of fertilisation - mechanical or surgical barrier by direct toxicity
- condoms
- diaphragm + spermicide
- Sterilisation (M & F)
- IUD
- hormonal methods (cervical mucous effect) - Prevention of implantation - “hostile” endometrium or direct toxicity
- IUD (especially copper coil as EC)
- hormonal methods
Can spermicides be used alone?
No. Only to be used with diaphragm
Contraception classifications
- Hormonal and non-hormonal
- Male and Female
- Long acting and short acting
- Reversible and Permanent
- Combined and progesterone only
- Based on mechanism
Average age of sexual activity in the UK
15-16
Factors influencing choice of contraceptive method
HER PERSONAL PREFERENCE Age Mental Capacity Frequency and type of sex Relationship status Pregnancy risk STI risk Previous experience with contraceptive method Future pregnancy plans: short and long term Child protection or wellbeing concerns
What is the major complication/CI of contraceptive pills?
Migraines
Non contraceptive benefits of hormonal contraception
Period pain Heavy menstrual bleed Irregular PV bleed Ovulation pain PMS Cyclical breast tenderness Ovarian cysts (if ovulation is suppressed) Endometriosis Ovarian cancer (if ovulation is suppressed) Acne or hirsutism (CHC only)
Contraceptive effectiveness: method vs user failure
Method failure - problem with the method
User failure - problem with the use
= PERFECT USE VS TYPICAL USE
Reasons for user failure - condom
used too late wrong lube (oil based) Wrong technique inconsistent use wrong storage
Reasons for user failure - diaphragm
used too late
removed too early
wrong technique
inconsistent use
What are the two types of IUD?
Mirena: contains progesterone which thickens the cervical plug and prevents the entry of sperm
Copper: No hormones, prevents sperm from fertilising egg
What is the lifeline of IUD contraception?
Copper: 5-10 years
Mirena: 5 years
Does the coil interfere with regular periods?
Mirena: yes
Copper: no
What is UK MEC
UK Medical Eligibility Criteria
Guidance for contraception
Categorisation of all methods into 4 groups (ABCD) I. Always useable II. Broadly usable III. Counsel/caution IV. Don't use it
Used for contraception ONLY
Guide not a replacement for clinical judgement
More pro choice compared to BNF and MIMS
Less relevant for therapeutic use
Risks of UKMEC
VTE
CVD
Liver problems
Hormones and copper coils
LARCs
Long lasting (between 3- 10 years, depending on device)
Very effective (< 1 % failure rate)
Invasive
Quick but often painful insertion
Average insertion pain: pain scale 3/10 for parous women and 5/10 for nulliparous women
Mainly prevent fertilisation but also effect to prevent implantation
Risk of copper coils
Perforation (small risk, 1:1000-1500)
PID (1:200)
Malposition/expulsion (1:20)
CI of copper coils
Submucosal fibroids
Copper IUD
Can last up to 10 years (depending on device)
If inserted ≥ 40 years can be kept in till menopause
Non-hormonal
Can be used as emergency (post-coital) contraception
SE of copper coil
Especially in the first 3 months post insertion:
Heavier periods
More painful and longer periods
How to manage SE of copper coil?
NSAIDs (ex. Ibuprofen)
Help with pain and bleeding
Which method of contraception to recommend to women post breast cancer?
Copper coil
Which is more effective, IUS (hormone) or IUD?
IUS
