Contraceptives Flashcards
What broad methods of contraceptives do we have?
- Barrier methods
- Hormonal contraceptives
- Long Acting Reversible Contraceptives (LARC)
- Emergency contraception
- Permanent contraception
What options are within the barrier methods?
- Condoms
- Diaphragms
- Caps
What options are within the hormonal methods of contraception?
- COCP
- POP
- Provera injection (deppo)
- Implant
What options do we have for LARC?
- Mirena coil (IUS)
- Copper coil (IUD)
What options are there for emergency contraception?
- Levonorgestrel 1500mg (Levonelle)
- Ulipristal Acetate (Ellaone)
- Copper Coil
What is UPSI?
Unprotected Sexual Intercourse
Up to how long after UPSI can Levonelle be taken?
72 hours
Up to how long after UPSI can EllaOne be taken effectivley?
120 hours
How does Levonelle work?
It contains an hormone similar to progesterone which delays ovulation
How does EllaOne work?
It delays ovulation and disrupts the production of progesterone (which would disrupt the stability of the endometrium).
When can the copper coil be fitted during an individuals’ cycle?
From day 1 of the cycle and up to 5 days after the expected day of ovulation (i.e if ovulation was on day 14, the last day for an IUD insertion would be day 19).
What are the 5 points of the Fraser Guidelines that means an individual under the age of 16 can consent to contraceptive or sexual health advice?
- The young person understands the practitioners’ advice
- The young person cannot be persuaded to inform their parents , or will not allow the practitioner to, that contraceptive advice has been sought
- The young person is likely to begin or to continue having intercourse without contraceptive protection
- Unless he or she receives advice or treatment their physical or mental health is likely to suffer (or both)
- The young person’s best interest requires the practitioner to give treatment or advice without parental consent
What advice must be given to a female taking emergency contraception?
If they vomit they must return to have another tablet
Take a pregnancy test if her period is >3 days late
How long can the IUD (copper coil) be in situ for?
10 years
What is the COCP?
Combined Oral Contraceptive Pill
This contains oestrogen and progestogen
How effective is the COCP?
99% with perfect use
91% with typical use
What is ‘perfect use’ of a contraceptive?
The method is used correctly every time
What is ‘Typical use’ of a contraception?
What is seen in terms of failures by women using the method and accepting that the method has not been used perfectly every time.
What patient characteristics make it unlikely that someone will be prescribed the pill?
I. Smokers who are >35 II. 35< and stopped smoking <1 year ago III. overweight or obese (BMI >30) IV. Take certain medicines V. You're breastfeeding a baby <6 weeks old
What conditions make it unlikely that someone will be allowed to take the COCP?
I. Thrombosis (or if immediate family had thrombosis <45 years old)
II. Heart disease or stroke
III. SLE
IV. Heart abnormality or circulation disease (HTN)
V. Migraine aura
VI. Breast cancer (or a BRCA gene)
VII. Liver or gallbladder disease (active)
VIII. Diabetes with complications
IX. Immobile for long periods (or wheelchair user)
X. You’re at high altitude (>4500m) for more than a week
What age can the COCP be taken up until?
50
What are the advantages of taking the COCP (list 4)?
- Usually makes bleeding regular, lighter and less painful
- Gives you the choice to not have a ‘regular bleed’
- May help with premenstrual symptoms
- Reduces the risk of cancer of the ovary, uterus and colon
- Improves acne in some
- Reduce menopausal symptoms
- May reduce the risk of recurrent endometriosis after surgery
- Helps with PCOS symptoms
What are the disadvantages of using COCP (list 3)?
- Temporary side effects (headache, nausea, breast tenderness, mood swings)
- May increase BP
- No STI protection
- Breakthrough bleeding may occur (or spotting)
What are the risks of taking the COCP? (list 3)
- VTE - DVT, PE, MI or stroke possible
- Breast cancer risk slightly increases
- Cervical cancer risk slightly increases with prolonged use
How does the COCP work?
- Thickens the mucus plug at the cervix
- Thins the endometrium
How long does the user of a COCP need to use condoms for when starting treatment?
7 days
What advice would you give to an individual who has missed; ONE COCP?
Take the missed pill straight away and continue taking the rest of the pack as normal.
What advice would you give to an individual who has missed; TWO OR MORE PILLS?
Take the most recent pill you have missed straight away and leave any of the pills you missed before then. Use condoms or abstain from sex for the next 7 days. If you have had sex in the previous 7 days you need to seek emergency contraception.
What is the effectiveness of condom use?
Perfect - 98%
Typical - 82%
What are the advantages of using condoms?
- Only need to use them when having sex
- Helps protect both parties against STIs
- No serious side effects
- They come in a variety of shapes and sizes
- They’re readily available
What are the disadvantages of condoms?
- It can split or come off
- Some people are sensitive to latex
- It’s important to pull out after ejaculation, before the penis goes soft, so the condom remains on
How long does the contraceptive implant work for?
3 years
How effective is the contraceptive implant?
99% effective (more effective than sterilisation)
When may a contraceptive implant not be suitable for someone?
- If they think they are already pregnant
- If they do not want their periods to change
- If they take certain medicines
What past medical history may make an individual ineligible for the contraceptive implant?
- Breast cancer
- Unexplained vaginal bleeding
- Heart disease or stroke
- Serious liver pathology
What are the advantages of the contraceptive implant?
- It may work for 3 years
- May reduce heavy, painful periods
- Can use when breastfeeding
- Fertility unaffected when contraception is discontinued
- May improve acne in some
What are the disadvantages of using the contraceptive implant?
- Periods may change in an unacceptable way
- Side effects include headaches, breast tenderness and mood changes
- Acne may develop or worsen
- Won’t work if enzyme-inducing drugs are taken
- Small surgical procedure to put it in and remove
- Doesn’t protect you from STIs
How does a contraceptive implant work?
- Thickened cervical mucus plug
- Thinned endometrium
What is the most common contraceptive injection given in England?
Deppo-Provera
How regularly does the depo injection need to be given?
Every 3 months (12 weeks)
The injection protects the user from pregnancy for 13 weeks
What is the effectiveness of the contraceptive injection?
Perfect use - 99%
Typical use - 94%
When may the contraceptive injection not be suitable for a patient?
- If they are already pregnant
- If the patient does not want their periods to change
- If they want a baby within the next year
- If they have breast cancer
- If they have unexplained PVB
- If they have arterial disease or stroke hx
- If they have severe liver disease
- Risk factors for osteoporosis present
How long can the depo injection be carried on for?
Up until the age of 50
If someone continues to use the injection long term, what must they expect?
The must expect an osteoporosis risk factor check every 2 years
What are the advantages of the injection?
- Don’t have to think about contraception for 3 months at a time
- Not affected by other medications
- May reduce heavy, painful periods and hep with PMT symptoms
- Can be used when breastfeeding
- Good method if oestrogen’s aren’t tolerated
What are the disadvantages of using depo injections?
- Periods may change in a way that is not suitable for the patient
- Irregular PVB may continue for months after stopping the injection
- Some people report weight gain
- The injection works for 13 (or 8 in some) weeks, so cannot be reversed once it has been administered, therefore if the patient experiences any side effects in that time they cannot be reversed.
- There can be a delay of up to 12 months for periods and fertility to return after the injections are stopped
- No STI protection
- Some side effects include spots, hair loss, decreased libido, mood swings and headaches
What are the risks of using the depo injection?
- osteoporosis risk
- There may be an increased risk of breast cancer
- Allergic reaction is possible, but rare
- Small risk of reaction locally as it is an injection
How does the contraceptive injection work?
- Stop the ovaries from releasing an egg monthly
- Thickens cervical mucus
- Thins the endometrium
What can happen to the patients’ periods when they are given the contraceptive injection?
They can either;
- stop completely (most common)
- become infrequent with some spotting between regular bleeds
- become heavier and last longer
How quickly after giving birth can someone resume the use of the contraceptive injection?
Straight away
How soon after birth must the injection be administered in order to prevent against further pregnancy?
Up to 21 days postpartum
If any later than this, additional methods of contraception or abstinence must be followed for at least 7 days to prevent further pregnancy
What can be a consequence of having the contraceptive injection before 6 weeks postpartum?
Increased risk of heavier, irregular bleeding
What is an intrauterine device (IUD)?
A small, flexible plastic and copper device that is put into the uterus. It is also called the copper coil. 2 small, thin threads hang through the cervix.
How long does an IUD last?
5-10 years (depending on the type fitted)
How effective is the IUD (copper coil)?
> 99% effective
When may the IUD be unsuitable for someone?
- If they are already pregnant
- Have an untreated STI/PID
- Have uterine or cervix problems
- Have unexplained PVB
What are the advantages of the IUD?
- It works as soon as it is put in
- It is a LARC (5-10 without contraceptive worries)
- Can be used when breastfeeding
- Not affected by other medicines
- Fertility is unaffected
What are the disadvantages of the IUD?
- Periods may be heavier, longer or more painful
- You’ll need an internal examination on fitting of the coil
- No STI protection
- IUD increases risk of pelvic infection if an infection is left untreated after insertion
What risks should the patient be made aware of when having an IUD/IUS fitted?
i. Small chance of infection during the first 20 days after the IUD is in situ
ii. The IUD can be expelled by the uterus via uterine contraction
iii. The IUD can become displaced
iv. The IUD can perforate the uterus or cervix on fitting
v. There is an increased risk of ectopic pregnancy if you were to become pregnant with the IUD in situ
How does an IUD work?
- It stops the sperm and egg from surviving
- Increases the cervical mucus plug
- May also prevent a fertilised egg from implanting in the endometrium (this is why there is an increased risk for ectopic pregnancy)
What is an intrauterine system (IUS)?
A small plastic device that is inserted into the uterus that released progestogen
How long does the IUS work for?
3-5 years
What is a common IUS fitted in the UK?
The Mirena coil
How effective is the IUS?
99%
Which patients may be advised not to have a mirena coil if they ask for one?
- Those who think they may be pregnant
- If they are <4 weeks postnatal
- If they have any STI or pelvic infection symptoms/signs and are untreated
- Have breast cancer or have had breast cancer
- Have uterine or cervix problems
- Serious liver pathology
- Unexplained PVB
- Arterial disease or history or heart disease or stroke
What are the advantages of the IUS?
- Doesn’t need to be remembered to be taken
- Periods become much lighter and shorter and sometimes less painful (they can stop after 1 year)
- It lasts for 3-5 years, depending on the type (mirena is 5 years so commonly used)
- Can be used when breastfeeding
- Fertility is unaffected when the coil is removed
- Can be used if oestrogen intolerant
- Not affected by other medicines
When can the mirena also be used as a protective agent?
When there is a patient using HRT. The mirena provides progestogen as an endometrial protective agent and prevents there be an increase risk for endometrial malignancy.
What are the disadvantages for the IUS?
- Side effects include; acne, headaches, breast tenderness
- Fluid-filled cysts on the ovaries can cause pain if they develop
- Internal examination is required before insertion
- Doesn’t protect from STIs
