Contraception (Non-LARC) Flashcards
What factors may affect a patient’s choice of contraception?
- Effectiveness
- Feeling of being “In Control”
- Long/Short term
- Non-contraceptive benefits
- Procedure
What are the 3 methods of combined hormonal contraception?
- Combined pill
- Patch (Evra)
- Vaginal Ring
Describe the failure rate of the combined oral contraceptive pill in both perfect and typical use?
Perfect = 0.3% (=> 0.3 per 100 people get pregnant) Typical = 9% (=> 9 people per 100 get pregnant)
When is a combined oral contraceptive usually started in relation to a females period cycle?
Start in first 5 days of period
OR
At any time in cycle when reasonably sure not pregnant, (PLUS use condoms for 7 days)
How is a combined oral contraceptive pill normally taken ?
Usually taken daily for 21 days followed by a 7 day break
can be tricycled (extended use) or taken continuously BUT this is currently “off license”
What may affect the effectiveness of the combined pill?
Impaired absorption
=> GI conditions (e.g. Crohn’s/UC)
Increased metabolism
=> Liver enzyme induction => Drug interaction
Forgetting !!!
What are the main risks of the combined oral contraceptive pill?
- Venous thrombosis
- Arteria+ l thrombosis
- Slight increase in risk of some cancers (Breast, cervical)
What can affect a females VTE risk on the combined pill?
- Type of progestogen in the pill (i.e. newer generation = higher risk)
- level of oestrogen in the pill
Does VTE risk go up or down in pregnancy and the post-partum period?
UP - even higher than that of patients on the pill
Background Risk - 2/10,000
COCP - 5-7/10,000
Pregnancy - 21-30/10,000
Post-Partum - 130-140/10,000
How should VTE risk be counselled in patients starting the COCP?
- inform patient of typical DVT/PE symptoms
- prompt return to doctor
What arterial risks come with the COCP?
Slight increase in
- BP
- MI
- Ischaemic stroke
What medical condition is a contraindication to the COCP?
Migraines WITH AURA => increased stroke risk!
if patients have migraines without aura be cautious but don’t rule this out as a potential treatment option
Above what age are contraceptives rarely given and why?
Above 35
- due to risk benefit analysis
What cancers does the COCP protect females against?
ovarian and endometrial cancers
What are the non-contraceptive benefits of COCP?
- Acne treatment
- Less bleeding
- Fewer ovarian cysts (due to less cyclical folllicle development)
- Less Premenstrual syndrome (PMS)
- Useful in pts with Polycystic Ovarian Syndrome PCOS
What are the most common side effects of the combined oral contraceptive pill?
Nausea
Spots/acne
bleeding
breast tenderness
What methods of contraception are progestogen ONLY?
- Progestogen Only Pill
- Subdermal implant (Nexplanon)
- DMPA (Depo-Provera/Sayana Press)
How is the progestogen only pill started?
Day 1 – 5 of period
OR
Anytime if reasonably certain not pregnant PLUS condoms for 2-7 days
What are the effects of the low estradiol and suppressed FSH levels that females experience on the hormonal contraceptive injections?
Depo-Provera/Sayana Press cause low oestrogen/FSH
=> predispose to osteopenia
How can patients manage the osteopenia that may result from hormonal contraceptive injections?
Weight bearing exercise
high calcium intake
(Refer for DEXA scan if worried)
How effective is a diaphragm (+ spermicide) as a contraceptive method (typical use)?
71-88% effective
How should a diaphragm and spermicide typically be used?
- Spermicide applied to rim
- Diaphragm folded longitudinally and inserted into vagina, positioned over cervix
- Must be left in up to 6 hours after sex
- Spermicide must not be applied >3 hours before sex or else reapplication is required
What should be covered when counselling patients on a vasectomy?
- Risks and benefits
- female sterilisation VS other methods (not as effective as implant, IUD etc => 2-3/1000 failure rate)
- Regret – reversal? (Everyone’s situation changes)
Local or general anaesthetic can be used to complete a vasectomy. TRUE/FALSE?
TRUE
Male vasectomy can be completed with a “no-scalpel” approach. TRUE/FALSE?
TRUE
What complications can arise from having a vasectomy?
- Anaesthetic
- Pain
- Infection
- Bleeding /haematoma
- failure (early/late)
How can a female vasectomy be carried out and which of these methods is usually used in the UK?
- Banding
- Banding and removal
- Essure (coiled wire)
- Clip (USED IN UK)
What is meant by “Natural Family Planning”?
Patients use the “rhythm method” and try to have sex when they are least fertile
- some older patients use this method as they want a space between kids, but aren’t too bothered about getting pregnant again soon
How effective is the “Natural Family Planning” method with typical use?
76% effective
=> 24% get pregnant
