Contraception Lecture Flashcards
Which are the most common forms of contraception?
Combined pill
Sterilisation
What is the ideal contraceptive?
Reversible Effective (100%) Unrelated to intercourse No side effects Protective against STI Non-contraceptive benefits Low maintenance
What is the Pearl Index?
Number of contraceptive failures per 100 women-years of exposure
What is the Life Table Analysis?
Contraceptive failure rate over a specified time-frame, gives cumulative failure rate
What is method failure?
Pregnancy despite correct use of method by user
What is user failure?
Pregnancy because method not correctly used
Why does long-acting reversible contraception have the lowest failure rates?
Minimises user input
When do women most likely ovulate during their cycle?
12-18 days
How long does an egg survive post-ovulation?
24hrs
How long does sperm survive in the uterus?
<4 days
5% survive 7 days
When is the chance of pregnancy highest?
Days 8-19
Which hormones are contained in combined hormonal contraception?
Ethinyl estradiol
Synthetic progesterone
What is the effect of combined hormonal contraception?
Stops ovulation
Affects cervical mucus and endometrium
What problems are associated with a daily pill?
Ineffective if frequent GI upset
What problems are associated with a patch EVRA?
<5% have a skin reaction
What regimes can be used for combined hormonal contraception?
Standard regime (21 on, week off) Tailored regimes to avoid bleeding
What are the non-contraceptive benefits of combined methods?
Regulate bleeding Stop ovulation (can stop PMS) Reduction of function ovarian cysts 50% reduction in ovarian/endometrial cancers Improve acne/hirsutism
Which diseases have reduced rates associated with combined methods?
Benign breast disease
Rheumatoid arthritis
Colon cancer
Osteoporosis
What side effects are associated with the combined methods?
Breast tenderness Nausea Headache First 3mo - irregular bleeds Mood effects Weight gain
What serious risks are associated with combined methods?
Increased risk thrombosis (venous and arterial)
Gall bladder disease
Breast cancer
Combined methods should be avoided in who?
BMI >34 Previous VTE FH VTE Thrombophilic diseases Smokers >35 Hypertensive Age >50 PMH arterial thrombosis Liver tumours
What are the contraindications for progestogen-only pill?
Personal history of Breast cancer or liver tumours
What side effects are associated with progestogen only pills?
Appetite increase Hair loss Mood change Bloating Headache Acne
What is the effect of injectable progestogen?
Prevents ovulation
Alters cervical mucus
Makes endometrium unsuitable for implantation
What are the advantages of injectable progestogen?
Every 12 weeks
70% women amenorrhoeic after 3 doses
Estrogen-free
What are the disadvantages of injectable progestogen?
Delayed return to fertility (9mo)
Reduced bone density
Problematic bleeding first 2 doses
Weight gain 2/3 women
Which contraceptive method has a causal link with weight gain, delayed fertility return and decreased bone density?
Injectable Progestogen
What are the advantages of progestogen implant?
Inhibits ovulation + effect of cervical mucus Can last 3 years Removable No user input No causal effect on weight
What are the disadvantages of progestogen implant?
60% bleed free
30% prolonged bleed
Mood changes
Unpredictable bleeding
What are the advantages of intrauterine contraception?
No user input
Any age/parity
Easily reversible
What are the disadvantages of intrauterine contraception?
Small infection risk
Risk perforation
Risk expulsion (check threads after period)
Conceptions may be ectopic
What are the advantages of copper IUD?
Hormone free
5-10 years
What are the disadvantages of copper IUD?
Heavier crampier periods
How does the Levonorgestrel IUS work?
Affect cervical mucus and endometrium
Slow release progestogen
Low circulating progestogen compared to other methods
What are the benefits of the Mirena coil?
5 years duration
85% of women bleed free by 1 year
What are the main forms of emergency contraception?
Copper IUD (most effective)
Levonelle pill
Ellaone pill
How must Levonelle be taken?
Take within 72hrs
How must ellaone be taken?
Take within 120hrs
When is Ellaone contraindicated?
Breast feeding
Enzyme inducing drugs
Acid reducing drugs
When should you start contraception?
Immediate cover - first 5 days of cycle
Other times - abstain for 7 days, pregnancy test after 4 weeks
When can you get pregnant after delivery?
21 days
When can you get pregnant after miscarriage/abortion?
5 days
When does breastfeeding function as a contraceptive?
First 6 months, if feeding every 4hrs and amenorrhoeic
What are the disadvantages of female sterilisation?
Surgery risks
Regret
1 in 200 failure rate - ectopic
No effect on periods/hormones
What are the advantages of female sterilisation?
Reduced ovarian cancer risk
How long does vasectomy take to become effective?
4-5 months (2 sperm samples at 4 and 5 months)
What is the failure rate of vasectomy?
2 in 100
1 in 2000 after 2 clear samples
What age group are most likely to have an abortion?
20-24
What is a doctors obligation in abortion?
A doctor is obligated to ENSURE a woman is ABLE to access abortion care
What should be covered in an abortion clinic consultation?
Methods of abortion
What to expect and when to seek advice
Contraception/use advice
What complications are associated with surgical abortion?
1-4:1000 perforation
Infection
Risks from GA
Which drugs are used for medical abortion
Mifepristone oral antiprogestogen
48hrs after Misoprostol to expel pregnancy
When can a surgical abortion be given?
5-12 weeks
When can medical abortion be given?
5-24 weeks
What complications are associated with medical abortion?
Failure 1 in 100 <8 weeks Failure 8 in 100 >12 weeks (need surgery if incomplete) Infection - prophylactic antibiotics <1 in 1000 need blood transfusion
