Contraception (LARC) Flashcards
What physical reasons do people have for having consensual sex?
- Pleasure
- Release of sexual tension
- Attraction to one person
- Stress relief
- Mood booster
- Exercise
What emotional reasons are there for consensual sex?
- Love
- Commitment
- Sexual curiosity and novelty
- Nurturance => create/maintain intimacy
- Gratitude
- Need for affection
What insecurity reasons may cause people to have consensual sex?
- boost self-esteem/ social status
- keep partner
- Feeling “sense of duty”
- Internal pressure (to fit in)
- External pressure (partner(s), peers, social media)
What goal-based reasons may cause people to have consensual sex?
- To improve social status and reputation
- To enhance power
- To seek revenge or foster jealousy
- For financial/material gain
- To make a baby
How many women get pregnant in a year if they are NOT using contraception?
85% of women get pregnant in a year
How many pregnancies in the UK are unplanned?
40%
Unplanned pregnancies DO NOT mean they are unwanted!
If a woman is faced with an unplanned pregnancy, what options does she have?
- Have the baby and keep it
- Termination of pregnancy
- Have a baby and give it up for adoption
What are the 3 mechanisms of action of contraception?
Prevention of ovulation
Prevention of fertilisation
Prevention of implantation
What contraceptive methods prevent ovulation?
- hormonal methods (including emergency contraception)
What contraceptive methods prevent fertilisation?
- condoms
- diaphragm + spermicide
- female and male sterilisation
- IUD
- hormonal methods (cervical mucous effect creates physical barrier)
What contraceptive methods prevent implantation?
- IUD (especially copper “coil” when used as emergency
contraception) - hormonal methods (hostile endometrium => egg doesn’t want to implant)
How are contraceptives normally classified?
Hormonal - COCP, POP, Vaginal Ring, Patch, Injection, Implant
Barrier methods - condoms, diaphragm(plus spermicide)
Intrauterine - copper “coil” IUD, hormone “coil”- IUS
Permanent - sterilisation
“Fertility awareness methods”- • Temperature, calendar, cervical secretion monitoring
Emergency Methods - Copper IUD, Pill
What is the difference in terminology between “Family planning”, “Contraception” and “Birth control”?
Birth control includes the possibility of abortion
What are the main things to consider when choosing the best contraceptive method with a patient?
- their personal preference
- age
- life situation
- non-contraceptive benefits
- accessibility of method
- medical eligibility/ contraindications to any methods
What non-contraceptive benefits can hormonal contraception give?
- lighter, more regular periods
- less intermittent bleeding
- less PMS
- less breast tenderness
- less Ovarian cysts, Endometriosis and Ovarian cancer (if ovulation is suppressed)
- less Acne
What is perfect vs typical use of a contraceptive?
Perfect - as if a robot was using it (=> eliminates user failure)
Typical - average of normal people using the method
How can user failure occur in patients using barrier methods such as condoms or a diaphragm?
Condoms:
- used too late
- wrong lube (oil-based)
- wrong technique
- inconsistent use
- wrong storage
Diaphragm:
- used too late
- removed too early
- wrong technique
- inconsistent use
- no damage checks
- no replacements
How can hormonal forms of contraception be used wrongly by patients?
- poor compliance/ late injection
- wrong use/storage (ring)
- Late replacement when coming off
- drug interaction with OTC drugs (St John’s Wort),
- no extra precaution when quickstarting
How can user failure be caused iatrogenically?
Not enough guidance given on initiation of contraceptive method
What are the main disadvantages and risks of intrauterine devices/systems?
- Invasive
- Quick but often painful insertion
- risk of perforation, PID, malposition/expulsion
HOw long can the copper IUD last after insertion?
10 years
What is one drawback of the copper coil that presents within the first 3 months?
- makes periods heavier, longer and more painful, during the first 3 months post insertion
What patient group may the copper coil be suitable for if they cannot have additional hormones?
- women after breast cancer
What other uses does the Mirena coil have other than contraception?
- treats heavy periods
- part of HRT
- OTHERS - endometriosis, hyperplasia etc
Spotting common in the weeks or months after insertion. TRUE/FALSE?
TRUE
What percentage of patients with a Mirena coil experience amenorrhoea by 6 months after insertion?
≈ 50% of amenorrhoea on Mirena® at 6/12
How long does the Nexplanon implant last in women?
3 years
What are the main disadvantages to the Nexplanon implant?
- invasive
- Main side effect: prolonged PV bleeding
How can the prolonged bleeding on the Nexplanon implant be treated?
With the combined oral contraceptive pill
