Contraception LARC Flashcards
every 2 seconds there are how many births and how many deaths
9 births
3 deaths
what happens to the basal body temp during a cycle
goes up after ovulation
increase by >0.2
has to be sustained for 3 days after at least 6 days of lower temp
cervical mucous before and after ovulation
post thick and sticky
after thinner, watery, stretchy
cervical position when fertile/less fertile
fertile - high in vagina soft and open
less fertile - low firm and closed
during a standard 28 cycle which days are the most fertile
8-18
criteria for breast feeding
exclusive VF
less than 6/12 post natal
amenorrhoeic
UK MEC categories
- no restriction
- advantages outweigh risks
- risks generally outweigh advantages
- unacceptable risk
pear index is calculated how
number of accidental preg x 1200 / total number of months of exposure
list the types of LARC and the difference between the types
injectable contraceptive - depo, sayana
depo - IM
sayana - SC version
VLARC
IUD
IUS
Implant
how does LARC work how often is it given how long does it last what are the other effects what is the failure rate
inhibits ovulation every 13 weeks lasts 14 weeks makes mucous thick and sticky makes endometrium thinner and less likely for implantation 0.2%
what examination is done before a LARC is given
BP and BMI recorded
smear test check
risk factors for osteoporosis
what is a person at risk of with injections and what other risks are there
osteo
underweight, anorexia, steroid use, FH, smoking, low trauma fracture, hypothyroid, coeliac, rheumatoid, IBD, chronic renal disease
when is depo started
how long does it take depo to start
when can depo be given if the first window is missed
up to and including day 5 without the need for additional contraception - before ovulation that month
7 days
after 5 days if certain not pregnant and needs to use condoms/abstain for the following 7 days
how can a person be reasonably certain that they are not pregnant
not had sex since their last periods
using reliable contraception
<7 days since last normal period
<4 weeks post partum and not breast feeding
breast feeding, amen and <6 months post partum
negative preg test and >3 weeks since UPSI
starting depo post partum
post TOP
if preg cannot be excluded
up to day 21 with immediate cover
up to day 5
do preg test in 3 weeks if neg then give depo
side effects of depo
weight gain due to stimulation in appetite
delayed in returning fertility
irregular bleeding - commonest SE
osteo risk
which is more cost effective LARC or VLARC
VLARC
IUD shape hormonal? contains what gold standard how does it work
T shaped non hormonal copper and plastic 380mm2 copper copper is toxic to sperm and ovum joining
IUD primary mode of action
other action
failure rate
prevention of fertilisation
inflam response in endometrium making it a toxic environment
0.6-0.8% (1/200)
IUS what is it
types
what is the drawback for the second one
T shaped device with elastomere core (prog core)
52mg levonorgestrel
20 mcg daily released - decreases to 10 a day in year 5
13.5mg
14ug per day for first 24 days
decreases to 5ug per day at 5 years
not licensed for heavy periods and hormone replacement therapy
IUS primary mode of action
other actions
failure rate
effect on implantation
can also stop ovulation (in some women)
endometrium made thinner, cervical mucous thicker
0.2% (1/500)
what are some contra indications of IUD/IUS
current pelvic infection abnormal uterine anatomy wilsons disease preg - esp if HCG are high sensitivity to any of the constituents gestational trophoblastic disease where bHCG levels are abnormal/persistently raised endometrial cancer cervical cancer awaiting treatment
what examination is done prior to insertion of IUS/IUD
PV to check uterine size/position
BP/pulse if condition indicates e.g. anxious, ht
when can an IUD be fitted
within the first 7 days of a period any time - if not pregnant 5 days after UPSI for EC 5 days after predicted ovulation 48 hours or >4 weeks post partum immediately post TOP
when can an IUS be fitted
what is it not used for
within the first 7 days of a period
any time if not preg
not used for EC - doesn’t work quick enough - takes 7 days to have an effect
if fitted outwith the 7/7 - use condoms
within 48 hours or >4 weeks post partum
immediately post op TOP up to day 7
SE/problems with IUD
heavy prolonged menses
pain, infection, PIV - increased risk in first 20 days
perforation
expulsion
higher post 2nd trimester abortion, post natal
ectopic risk 9-50% if become pregnant
SE of IUS
lighter, less frequent bleeding, can be erratic pain, infection PID in first 20 days perforation expulsion ectopic risk lower
what is an implant
how long is it licensed for
what does it contain
single non biodegradable subnormal rod
3 years
68mg ENG - released 60/70ug in weeks 5-6 and 25-30 per day at the end of the 3rd year
how does an implant work
other mechanisms
failure rate
inhibitor of ovulation
effects on endometrium and mucous
0-0.1%
when can an implant be fitted
within first 5 days of cycle
up to day 5 post first/second trim abortion
on or before day 21 post partum
additional precautions first 7 days if she id not preg, quick start after EC, off license
switching from another method to implant
when is immediately effective
when should she take extra precautions
immediate affective if fitted within 14 weeks of last active pill or depo
within 2-3 weeks of COC, patch, vaginal ring
additional precautions for 7 days if changing from POP or LNG-IUS
or switching from non hormonal method
side effects of implant
irregular bleeding
weight gain
acne
nerve damage/vascular injury
deep insertion
