Contraception (repro) Flashcards
1
Q
Methods of contraception
A
Methods requiring ongoing action by individual: - oral contraception - barrier methods - fertility awareness - coitus interruptus - oral emergency contraception Methods which prevent contraception by default: - IUCD/IUI/IUS - progestogen implants - progestogen injections - sterilisation
2
Q
The perfect contraceptive
A
- 100% reliable
- 100% safe
- non user dependant
- unrelated to coitus
- visible to woman - no ongoing medical input
- completely reversible within 24 hours
- no discomfort
3
Q
Risks of contraception
A
Risks of treatment: - cardiovascular - neoplastic - emotional - infection related - allergic - iatrogenic Risks of no treatment: - childbirth related - abortion related - social costs - economic costs
4
Q
Benefits of contraception
A
Benefits of treatment: - non contraceptive - psychosexual - choice - sexual health - cost savings - female equality Benefits of no treatment: - non interference - population growth - control of women
5
Q
COCP oestrogen
A
- Combined oral contraception (COC)
- EthinylOestradiol. - 20, 30, 35, 50 micrograms
Acts on:
- anterior pituitary and hypothalamus
- directly on ovary
- endometrium
6
Q
COCP progestogen
A
- Norethisterone (Notethindrone) and Levonorgestrel (older 2nd gen)
- Desogestrel, Gestodene and Norgestimate (Noregestromin) (newer 3rd gen)
- Drospirenone (lastest, derived from Spironolactone)
Acts on:
- anterior pituitary and hypothalamus
- directly on ovary
- endometrium-
- fallopian tubes
- cervical mucus
7
Q
Benefits of COCP
A
Contraceptive: - reliable - safe - unrelated to coitus - woman in control - rapidly reversible Non contraceptive: - halve ca ovary - halve ca endometrium - helps endometriosis, menorrhagia and dysmenorrhoea
8
Q
Risks of COCP
A
- Cardiovascular:
arterial (progestogen, HBP, smoking) and venous (oestrogen, VTE, clotting disorders (DVT, PE, migraine)) - Neoplastic - breast, cervix, liver
- Gastrointestinal - COH/insulin metabolism, weight gain, Crohns disease
- Hepatic - hormone metabolisms, congenital nonhaemolytic jaundices, gall stones
- Dermatological - chloasma, acne, erythema multiforme
- Psychological - mood swings, depression, libido
9
Q
COCP pill rules
A
- start 1st packet 1st day of a menstrual period
- take 21 pills and stop for 7 day break (PFI)
- restart each new packet on 8th day (same)
- do not start new packets late
- if late or missed pills in 1st 7 days, use condoms
- if missed pills in last 7 days. no PFI
10
Q
COCP Interacting Medicine
A
Liver enzyme inducing drugs:
- affect metabolising of both oestrogen and progestogen
- beware rifampicin and anti-epileptics
Broad spectrum antibiotics:
-affect enterohepatic circulation of oestrogen only (40%)
11
Q
Combined vaginal contraceptive
A
- same as COCP except vaginal delivery (ring) for 21 days
- remove for 7 days
- Advantage: don’t have to take every day
12
Q
Progesterone only methods
A
Default methods:
- Implants: Nexplanon, Norplant (LNG)
- Hormone releasing IUCD: Mirena IUS (LNG)
User Dependant methods:
- POPs: Desogestrel (Cerelle), Norethisterone, Ethynodiol diacetate, Levonorgestrel, Norgestrel
- Injectables: Depo Provera (MPA) (12 weekly), Noristerat (NET)
13
Q
Cerelle POP
A
Why Cerelle is better than older POPs:
- as effective as COCP
- no oestrogen (CIs eg breastfeeding)
- favourable side effect profile vs older POPs
- bleeding as predictable as COCP
- 12 hour window
14
Q
IUCDs
A
- copper bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners
- may be left in situ. long term and act by:
1) destroying spermatozoa
2) preventing implantation - inflammatory reaction and prostaglandin secretion as well as a mechanical effect
15
Q
IUCDs types
A
1) Copper bearing:
- Ortho T380 (8-12yr)
- Multiload 375 (5yr)
- Multiload 250 (5yr standard and short)
- Nova T380 (5yr)
- Nova T200 (5yr)
- GyneFix (IUI) (5yr)
2) Hormone bearing:
- Mirena (IUS) (5yr)
16
Q
IUCDs benefits
A
- non user dependant
- immediately and retrospectively effective
- immediately reversible
- can be used long term
- extremely reliable
- unrelated to coitus
- free from serious medical dangers
17
Q
IUCDs disadvantages
A
- has to be fitted by trained medical personnel
- fitting may cause pain or discomfort
- periods may become heavier and painful
- it does not offer protection against infection
- threads may be felt by male
18
Q
IUCDs risks
A
- miscarriage if left in situ if a pregnant
- ectopics
- may be expelled
- the uterus may be perforated
19
Q
IUCDs absolute contraindications
A
- current pelvic inflammatory disease
- suspected or known pregnancy
- unexplained vaginal bleeding
- abnormalities of uterine cavity
20
Q
IUCDs relative contraindications
A
- nulliparity
- past history of pelvic inflammatory disease
- not in mutually monogamous relationship
- menorrhagia/ dysmenorrhoea
- small uterine fibroids
21
Q
Condoms advantages
A
Male: - man in control - protects against STIs - no serious health risks - easily available (free at family planning clinics) Female: - woman in control - protests against STIs - can be put in advance and left inside after erection lost - not dependant on male erection to work
22
Q
Condoms disadvantages
A
Male: - last minute use - needs to be taught - may cause allergies - may cause psycho sexual difficulties - higher failure rate among some couples - oily preparations not rubber Female: - obtrusive - messy - expensive - rustles during sex - uncertain failure rate
23
Q
Caps
A
Diaphragm caps:
- made of latex
- fit across vagina
- sizes 55-95cm in 5cm jumps
- must be used with spermicide and left in at least 6 hours after sexual intercourse
Suction (cervical) caps:
- made of plastic
- suction to cervix or vaginal vault
- different sizes
- must be used with spermicide and left in 6 hours or more
24
Q
Caps advantages
A
Diaphragm caps:
- woman in control
- can be put in in advance
- offers protection against cervical dysplasia
- perceived as natural
Suction caps:
- suitable for women with poor pelvic muscles
- no problems with rubber allergies
- very unobtrusive
- woman in control
25
Q
Caps disadvantages
A
Diaphragm caps: - needs to be taught - messy - higher failure rates than most other methods - higher UTI higher Candiasis
Suction caps:
- needs an accessible and suitable cervix
- higher failure rate than diaphragm
- not easy to find experienced teacher
26
Q
Fertility awareness
A
- prediction of ovulation (14/7 before period)
- sperm can survive 5 days in female tract
- ova can survive 24 hours
- ova are fertilised in the Fallopian tube and take days to reach the uterus and implant
- cervical mucus is receptive to sperm around time of ovulation
- use periodic abstinence or alternative contraception to avoid pregnancy
- time intercourse to pre-ovulatory phase to conceive
27
Q
Natural family planning
A
- temperature
- rhythm
- cervix position
- cervical mucus
- persona
- lactational amenorrhoea (LAM)
28
Q
Fertility awareness: advantages and disadvantages
A
Advantages:
- non medical
- can be used in 3rd world
- allowed by catholic church
- can result in closeness of understanding between partners
Disadvantages:
- failure rate heavily user dependant
- requires skilled teaching
- may require cooperation between partners
- may involve sexual activity
- can cause strain
29
Q
Emergency contraception
A
Postcoital pills:
- up to 72 hours after unprotected sexual intercourse (UPSI)
- Schering PC4 (prevents 3 out of 4 pregnancies which would have occurred)
- Levonelle and ellaOne (ulipristal)(prevents 7 out of 8 pregnancies)
Copper bearing IUCDs:
- up to 5 days after presumed ovulation or 5 days after one single episode of UPSI at any time of the cycle
- failure extremely rare
30
Q
Postcoital pills dosage
A
- Levonelle consists of 2 tablets each containing 750 microgram of Levonorgestrel
- 1.5mg is one dose
31
Q
Postcoital pills
A
Schering PC4:
- lower failure rate in 1st 24 hours
- causes nausea and vomiting in many women
- contraindicated during focal migraine attack
Levonelle 2:
- lower failure rate in 1st 24 hours
- very little nausea
- only contraindicated in women taking very potent liver enzyme medication (anti TB)
ellaOne:
- ulipristal acetate
- new selective progestagen receptor modulation (SPeRM)
- up to 120 hours
- RR 0.58 pregnancy vs Levonelle
- possible slightly higher side effect profile (GI symptoms mainly)
32
Q
Postcoital pills effectiveness
A
Schering PC4:
- up to 24hrs 77%
- 25-48hrs 36%
- 49-72hrs 31%
Levonelle 2:
- up to 24 hrs 95%
- 25-48 hrs 85%
- 49-72 hrs 58%
33
Q
Postcoital contraception
A
PC4 and Levonelle 2:
- act by postponing ovulation is 1st part of cycle (so beware)
- act by preventing implantation in 2nd part of cycle
Copper IUCDs:
- copper kills sperm in 1st part pf cycle
- device prevents implantation in 2nd part of cycle
34
Q
Contraception efficacy
A
- COCP: <1/100 woman years
- Depo: <1/100 woman years
- IUCD: <1/100 woman years
- Implants: <1/100 woman years
- IUS: <1/100 woman years
- POP: 1/100 woman years
- Condoms (male): 2/100 woman years
- Condoms (female): 5/100 woman years
- Diaph/caps: 4-8/100 woman years
- Female sterilisation: 1/200 failure rate
- Male sterilisation: 1/2000 failure rate
35
Q
Contraceptive efficacy (real use)
A
- COCP: 8/100 woman years
- POP: 8/100 woman years
- Condoms: 10-15/100 woman years
If it involves user input error, the risks of failure are much higher
36
Q
Glossary
A
- Combined oral contraceptives - This form of birth control suppresses ovulation (the monthly release of an egg from the ovaries) by the combined actions of the hormones oestrogen and progestogen.
- Progestogen only methods – Progestogen-only pill; Progestogen-only implant; Progestogen-only injectables. Progestin-only methods have several effects in the body that help prevent pregnancy: The mucus in the cervix thickens, making it difficult for sperm to enter the uterus and fertilize an egg; they stop ovulation, but they do not do so consistently.
- Emergency contraception - Forms of contraception, especially contraceptive pills, that are effective if administered within a specified period of time after sexual intercourse.
- Intra-uterine devices - A contraceptive device fitted inside the uterus and physically preventing the implantation of fertilized ova.
- Pearl index - The number of contraceptive failures per 100 women-years of exposure, and uses as the denominator the total months or cycles of exposure from the initiation of the product to the end of the study or the discontinuation of the product.
