Contraception LARC Flashcards
What is the world’s most widely used contraceptive method
withdrawal
What are the ascects of ‘natural’ family planning
Body temp cervical mucous cervical position 'standard days' Breast feeding
What happens to body temperature when a woman is ovulating
it increased by more than 0.2 degrees celcius
sustained for three days after at least six days of lower temp
What happens to cervical mucous around ovulation
thick and stick post ovulation
occurs for at least three days after a thinner, watery mucous
What is the cervical position when fertile
high in vagina, soft and open
When are the most fertile days in a standard 28 day cycle
8 to 18
how effective is breast feeding as a contraceptive
if three criteria are me it is 98 percent effective
- exclusively breast feeding
- less than 6/12 post natal
- amenorrhoeic
What is the pearl index
represents no of contraceptive failures per 100 women users/year-
(no of accidental pregnancies x 1200)divided by total months of exposure
What are the options for LARC or VLARC?
LARC- injectable contraception ie depo provera
VLARC- IUD, IUS, implant
What is the primary mode of action of depo provera
inhibits ovulation
progesterone only
What other effects does depo provera have?
effects cervical mucus and endometrium
What is the peal index of depo provera
0.3 percent
What are the side effects of depo provera
weight gain
delay in return of fertility
irregular bleeding
risk osteoporosis
What are the risk factors for osteoporosis
anorexia/underweight steroid use xs alcohol immobile FHx Smoking Low trauma fracture Chronic condition eg hypothyroid, coeliac, RA, hyperparathyroid, IBD, renal disease
When can depo be started
Up to and including day 5 of a cycle without need for additional protection
Beyond day 5 a woman con start depo providing she is reasonably certain she is not pregnant and uses condoms/abstains for 7 days
What is ‘reasonably certain’ a woman isn’t pregnant
no sex since last period
consistant with contraception
- less than seven days of a normal period
- less than than four weeks post partum
breast feeding with criteria met
negative pregnancy test more than 3 weeks since UPSI
when can depo be given post partum
up to day 21
when can depo be given after TOP
up to day five
What is the IUD
t shaped non hormonal device containing copper and plastic (some silver etc is used to prevent corrosion)
gold standard - 380mm2 copper
what is the primary mode of action of the IUD
prevents fertilisation
creates inflammatory response in endometrium
How long is the IUD licenced to be kept in for
5-10 years
What is the pearl index of the IUD
0.5 percent (1 in 200)
What is the IUS?
Two types- 52mg LNG-IUS (20mcg levonorgestrel daily, decreasing to 10ug per day at 5 years) liscenced for 5 yrs
- 13.5mg LNG-IUS (14ug per day for first 24 days, decreasing to 5ug per day at 5 years) liscenced for 3 years
progesterone only device
what is the primary mode of action of the IUS
effects implantation
endometrium is rendered unfavourable for implantation
what is the pearl index of the IUS
0.2 percent (1 in 500)
What are the contraindication to IUD/IUS
current pelvic infection abnormal uterine anatomy pregnancy sensitive to constituents gestational trophoblastic disease where bhcg levels abnormal endometrial cancer cervical cancer awaiting treatment
When can an IUD be fitted
Within in the first 7 days of a period
Any time provide reasonably certain not pregnant
Up to 5 days after UPSI ( for EC)
OR
Up to 5 days after predicted date of ovulation
Either within 48 hrs or > 4 weeks post partum
Immediately post TOP ( if products of conception seen)
When can an IUS be fitted?
Within the first 7 day of a period
Any time provide reasonably certain not pregnant
NOT used for EC
If fitted out with first 7/7- use condoms for first 7/7
Either with in 48 hrs or > 4 weeks post partum
Immediately post TOP ( if products conception seen)
What are the side effects of the IUD
heavy prolonged menses pain, infection PID risk increased in first 20 days Perforation Expulsion Ectopic pregnancy risk
What are the side effects of IUS
Lighter, less frequent bleeding Pain, infection PID increased in first 20 days Perforation 1-2/1000 Expulsion- same as IUD Ectopic risk?? …….Overall 0.01 to 0.1 per 100 women yrs Maybe higher with lower does version?? failure
What is the implant
single, non biodegradable subdermal rod
can be used for 3 yrs
contains 68mg of eng- releases 60/70ug per day in weeks 5-6
25-30ug per day end of 3rd year use
what is the primary mode of action of the implant
inhibition of ovulation
other - effects endometrium and cervical mucous
what is the pearl index of the implant
0 to 0.1 percent
when can an implant be fitted
No need for additional precautions:
Within first 5 days of cycle
Up to day 5 post first/second trimester abortion
On or before day 21 postpartum
Need for additional precautions first 7 days
If it is reasonably certain she is not pregnant
“quick start” after emergency contraception
Off licence
When can you switch to the implant from another form of contraception
immediately effective if fitted after last active pill pack taken or depo still within 14 weeks
if weeks 2-3 of coc, patch or ring
need additional contraception if
- change from POP or IUS
-switching from non hormonal method (IUD)
what are the side effects of the implant
irregular bleeding wt gain acne nerve damage deep insertion
