Contraception: working around ovulation Flashcards
Sperm:
______ made per second.
____mls per ejaculate.
______ many sperm in a typical ejaculate.
1000 sperm per testicle made per second.
3-5mls per ejaculate.
350, 000 000 many sperm in a typical ejaculate.
You will ovulate ___ days before your next period starts. (why is this?)
How long can sperm and egg survive?
You will ovulate 14 days before your next period starts, as the Luteal Phase of your menstual cycle is fixed!
Sperm Survive: max 7 days
Ovary Survives: only 12-24 hours
What is the Calendar Method?
Very unreliable, working around your dates and avoiding the days you will be ovulating (Day 14 if you have a 28 day cycle)
Why is the fertile Phase Day 7-16?
Because for a 28 day cycle, she ovulates Day 14.
Ovarys can survive longer, so upto day 16.
Sperm can last in the female up to 7 days so after day 7 coitus = risk.
The more sperm around that week before, the more likely pregnancy will occur
The Temperature Method: (another natural method)
Uses the temperature rise the day post-ovulation (due to progesterone) to know when they are infertile. They’re infertile the 3rd evening of the temp rise; “3/6 rule”
3/6 Rule: where the temp rises for 3 days, above the temperature
Measure all the time throughout the day, and need to do for ~3months before you have a concept of your cycle.
You need a really good thermometer to measure small temp shifts.
She can also look at her mucus
How is mucus an indiciation of where you are in your cycle?
When the mucus is fertile, it’s spinbarkeit mucus stretches really well. Present 0.5 to 4 days prior to ovulation.
At ovulation the mucus goes “dry”.
Can pregnancy occur whilst you’re on your period?
Yes! If you have a short (eg 22 day) cycle, you’ll be ovulating around day 6-8.
Sperm could still be arroun
What is Lactational Amenorrhea>
- Demand breasting feeding day and night
- no supplementation formula “supplementing”
- No period return in 1st six months
- LAM failure rate 1-2
What are the laws around Contraception and abortion for those under 18?
Contraception: Parental consent not needed, at any age.
Make sure its consential sex and she uderstands hat she’s doing
ABortion: also doesn’t need parental consent, but make sure there’s effective couselling and support.
When would we ever break confidentiality with someone in terms of their contraception or abortion?
The 3 H’s
- Harm to yourself
- Harm to others
- THat you may Harm others
What if I feel against contraception/abortion?
You don’t have to do it, but you have to give advice OR send them to another service/practioner/family planning clinic.
DON’T bar the service from the patient!
What’s the difference in failure rates for the oral contraceptive pill; with typical use and perfect use?
TU: 5%
PU: 0.1%
Because it’s so hard to remember to take everyday! Also not all practitioners are properly trained on the rules!
Why are the failure rates for Depo provera, implants, IUD the same for both typical use and Perfect use?
WHy are they so good?
Because patient compliance doesn’t play a role in this!
You can’t “forget” to take it!
They are all very low failure rates (0-0.8%)
And very good use continuation
How is the failure rate for adolescents using the pill?
There is more technical issues with remembering to take the pill, and failure rates can be as low as 32%
What contraceptives are the most effective (in 4 tiers) ??
- Sterilisation, Implant, IUD (<2)
- Pill, Injection (3-9)
- Condoms, Fertility awareness (10-20)
- Spermicide (21-30)
Bold = effectivness by measuring pregnancies/ 100 women/ yr
What contraceptives have the best use continuation?
Draw out table
Pill: you can just stop if you think you’re having a side effect > accidental pregnany
But with IUD and implant, you have to go and see a health practitioner and discuss, and that can lead to them explain how the side effect, and either you will continue contraceptive or get given an alternative.
Many low dose COCP (Ava 30, Ava 20, Brevinor, Ginet) are funded; $5 for 6 months, but why would we fund a high dose pill such as Microgynon 50??
Some drugs; such as anti-epileptic drugs are enzyme inducers, which metabolise the pill really quickly.
So a low-dose combined pill or even the implant would not be effective enough to stop fertility. Those on these drugs would need a much higher dose, but they would be much better to go on Depo Provera (at such a high dose every 3 months that you are still covered!)
What are “The Pill Rules”?
You may NOT be protected from pregnancy if you:
- Miss 2 hormone pills, or take >12 hours after the normal time
- Vomit within 3hrs of taking 2 hormone pills or have continued vomiting
- HAve several loose bowels
If any of the above happen; follow the 7 DAY RULE!
**AB’s don’t interefere with the pill
Explain this diagram
Usually take for 3 weeks, 7 days off, and get a withdrawal bleed.
The Pill hormones: stop ovulation and ovarian hormones, and build up a small lining (what we see as our ‘period’).
Whilst taking the pill, you get good FSH suppression, during the 7 day placebo, you have no suppression, levels build, and you are most at risk the week after, aka the 1st week of retaking the pill! (here your ovaries are ‘wide awake’, so if you forget pills there’s a massive risk, and you need a 7 day of no unprotected sex).
Therefore its smart to continue taking pills and skipping the placebo! Much lower risk and would take 8 days to be at risk.
What type of emergency contraceptive is available for women with BMI >30?
Postcoital CU IUD.
- Insert in uterus within 5 days of ovulation; if egg already fertilised, takes 7days to uterus from FTube, and by then implantation will be stopped.
- Not to be confused with abortion with is post-implantation
What is a contraceptive?
How does Depo Provera Work?
How does the P4 only pill work?
How doe the IU work?
What is a contraceptive? Stops sperm and egg meeting
How does Depo Provera Work? High dose IM injection, same a combined pill, stops ovulation, get every 3 months
How does the low dose P4 only pill work? Thickens the cervical mucus, stops sperm getting into uterus (FR higher then COCP)
How doe the IU work? Copper is toxic to sperm (spermicide), so they die before meeting the egg. FR <1%, can be in for 10 years, and DOESN’T increase Pelvic Inflammatory Disease (but don’t put in if there’s clamydia).
Can younger girls use an IUD? NICE Guidelines; IUD can be used by women at any age, as long as they as told of the STI risk .
What’s a Nuva Ring
- Works by stopping ovulation (eostrogen and progesterone)
- Ethinyl estradiol/etonogestrol
- 0.015/0.120mg/day
- Ring only in for 3weeks (with one week out (or not) then new week
- Not funded, $$$ ($30 per/month), not popular
