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contraceptives Flashcards

1
Q

how do you do natural family planning?

A

: using calendar apps
- Using body temp
- Cervical mucous

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2
Q

what is the aim if natural family planning?

A

: prevent pregnancy by reducing risk of sperm being present during ovulation

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3
Q

what are the advantages of natural family planning?

A

No side effects
Acceptable in most faiths/ cultures

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4
Q

what are disadvantages of natural family planning?

A

Less effective form of contraception
Avoiding sex
Need other forms during ovulation
Need pt commitment during ovulation to monitor signs
Fertility signs are unreliable when breastfeeding
Fertility signs can be affected by illness and stress
Does not protect STI

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5
Q

what is the pregnancy risk of natural family planning?

A

24%

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6
Q

how does barrier methods work?

A

act as barrier to stop sperm from entering cervix and stopping sperm from fertilising
- Only methods that protect against STI

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7
Q

what are male condoms made from?

A

barriers of latex, polyisoprene or polyurethane to cover penis

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8
Q

what are advantages of male condoms?

A

Reduces STI transmission
Side effects are rare
Non- hormonal

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9
Q

what are disadvantages of male condoms?

A

Can break, split or tear
Can interrupt sex to put on condom
Should not be used with oil-lubricants  risk of bleeding
Need correct technique
Latex allergies

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10
Q

what is the pregnancy risk of condoms?

A

18% of using just this within a yr of regular sex

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11
Q

what are female condoms made from?

A

polurethane

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12
Q

what are advantages of female condoms?

A

Reduces STI transmission
Side effects are rare
Non- hormonal

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13
Q

what are disadvantages of female condoms?

A

Can break, split or tear
Can interrupt sex to put on condom
Should not be used with oil-lubricants  risk of bleeding
Need correct technique
Latex allergies
Not used as widely as male
Pregnancy risk = 21%

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14
Q

what is the diaphragm/ cervical cap?

A

: silicone cup that is placed over cervix as barrier
- Placed in like moon cup

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15
Q

what must be used with diaphragm/ cervical cup?

A

spermicide

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16
Q

what are the advantages of diaphragm/ cervical cap?

A

Only used during intercourse
Can be put in advance
Side effects are rare
Non-hormonal

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17
Q

what are disadvantages of diaphragm/ cervical cap?

A

Can break, split, tear
May interrupt sex
Pts must be comfortable self examining and taught correct technique
Must be left in place for 6hrs following intercourse – if more sex need more spermicide
Does not protect against STI
Pregnancy risk = 12%

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18
Q

what is within COCP?

A

synthetic versions of oestrogen and progesterone

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19
Q

what is the moa of COCP?

A

mimics luteal phase leading to inhibition of hypothalamic-pituitary- gonadal axis
- Prevents LH/ FSH needed for ovulation
- Reduce risk of pregnancy by thickening cervical mucus and prevent sperm passage and thickening endometrium to reduce chance of implantation

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20
Q

what are contra-indications for COCP?

A

Migraine with aura
Current breast cancer
Significant VTE eg previous VTE, thrombogenic mutations, previous stroke, SLE, AF, age >35, smoking >15
CVS Risks: HTN, history of IHD

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21
Q

what are advantages to COCP?

A

No interruption to intercourse
Can be stopped at short notice
Less strict ‘missed pill rule’ than POP
Make peroids regular, lighter and less painful
May reduce risk of ovarian, endometrial, bowel cancer
May have therapeutic benefits in gynaecological disorders including endometriosis and menorrhagia

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22
Q

what are disadvantages to COCP?

A

Less effective if poor compliance
Side effects: N+V, headaches, breast tenderness, mood swings
V+D may affect effectiveness
Certain drugs (anti-epileptics) affect effectiveness
Increases risk of VTE and stroke
Potentially increases risk of breast/ cervical cancer while on COCP
Do not protect against STIs
Pregnancy risk = 9%

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23
Q

how do you take COCP?

A

How to take: take 21days and 7days break for a withdrawal bleed
- Can use 21days and then use 4day break
- Can use up to three packs then have a break

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24
Q

why should you have a bleed every three months?

A

risk of endometrium building up and then hyperplasia - endometrial cancer

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25
name some cocp?
microgynon 30 or rigevidon
26
what does the patch do?
deliver oestrogen and progestogen through skin
27
where can the patch be applied to?
- Can be applied to any patch of skin except breast where tissue is oestrogen sensitive (back, abdo, bum)
28
how do you use the patch?
How to take: apply for 7days and then immediately change for anew one, wear for 21days then 7day patch free  would get withdrawal bleed
29
what are the advantages of the patch?
Do not need to remember daily pill No interruption to intercourse Can be stopped at short notice Make periods more regular, lighter and less painful Good if forgetful with pill
30
what are the disadvantages with the pill?
Protection may be compromised if forget to take switch Side effects: headaches, N+V, breast tenderness, mod swings Interact with anti-epileptics Potentially increase risk of breast and cervical cancer while using patch No protection from STI Pregnancy rate = 9%
31
what is the vaginal ring?
: NuvaRing is a small plastic ring self inserted high into vagina and secretes oestrogen and progesterone
32
what is the direction of use for vaginal ring?
inserted into vagina for 21dayd and then removed for 7day break before new one put in can put 3 rings in a row then break
33
what are the advantages of the ring?
Do not need to remember daily pill No interruption to intercourse Can be stopped at short notice Make peroids more regular, lighter and less painful
34
what are the disadvantages of the vaginal ring?
Side effects: headaches, N+V, headaches, breast tenderness, mood swings Certain drugs may affect protection including anti-epileptics Does not protect against STI Can become dislodged Unintended pregnancy rate = 9%
35
what is the POP?
Progestogen – only pill: taken daily without breaks, contain no oestrogen
36
what are the three types of POP?
desogestrel pop norethisterone and levonorgestrol dropirenon pop
37
how does desogestrol pop work?
inhibits ovulation and thickens mucus and thinning endometrium, should be taken at same time – 12hr window
38
how does - Norethisterone and levonorgestrel POP work?
work mainly thickening cervical mucus and thinning endometrium – 3hr window
39
how does - Drospirenon POP work?
inhibits ovulation and taken daily, however 4 pills out of 28days are hormone free  have placebos
40
what are pop advantages?
Good if oestrogen is contraindicated or those intolerant to oestrogen Daily pill – do not need to start and stop No interruption to intercourse Can be stopped at short notice if not tolerated POP safe post-partum and when breastfeeding
41
what are pop disadvantages?
Not effective if pill is forgotten More strict – missed pill than COCP May cause irregular bleeding/ amenorrhoea V+D may affect protection Certain drugs including enzyme inducers affect effectiveness No STI protection Pregnancy rate – 9%
42
what is depo injection?
Contraceptive injection: contains progesterone only and given every 12weeks
43
where is depo injection given?
either side - alternate each time upper 1/4 of bum
44
what is moa of depo injection?
systemic progesterone inhibits ovulation, thickens cervical mucus and thins endometrium
45
what are advantages of depo injection?
Good if oestrogen is contra-indicated Do not need to remember daily pill No interruption to intercourse
46
what are disadvantages to depo injection?
May cause irregular bleeding, amenorrhoea/ more frequent bleeding Can affect bone mineral density if long term No STI protection Fertility can take up to a year to return Pregnancy rate = 6%
47
what is the implant?
Contraceptive implant: small plastic rod approx. 4cm in length inserted sub dermally in upper arm
48
what is moa of implant?
slowly releases progesterone (levonorgestrel) to prevent pregnancy
49
what is the name of implant?
nexplanon
50
what are advantages of implant?
Lasts 3yrs Suitable if not allowed oestrogen Most effective form of contraception No interruption to intercourse
51
what are disadvantages to implant?
May cause irregular bleeding, amenorrhoea or more frequent bleeding Need qualified required to insert implant Can cause/ worsen acne Need procedure to insert/ remove it  risk of bruising and infection Does not protect from STIs Can be affected enzyme inducers eg carbamazepine Pregnancy rate = 0.05%
52
what is the hormonal coil?
hormonal coil containing levonorgestrel - T shape plastic rod with threads inserted into uterus and releases progesterone locally - Threads remain in vagina to allow for removal of coil
53
what is the moa of hormonal coil?
prevents pregnancy by thinning endometrium to prevent implantation and thickens cervical mucus to prevent sperm passage
54
what brands of hormonal coil are there and how long can they last?
- Mirena: used for 6yrs for contraception and 5yrs for endometrial protection - Kyleena: slightly smaller hormonal coil containing less progestogen and licensed 5yrs - Jaydess: similar size to Kyleena and licensed for 3yrs
55
what are the advantages of the hormonal coil?
Lasts 3 or 5yrs Suitable if can not take oestrogen No interruption to sex More likely to reduce heavy menstruation esp mirena Some individual report fewer side effects – local
56
what are disadvantages of hormonal coil?
Can make menstruation irregular esp in first 6mths – can cause amenorrhea Can cause acne, headache and breast tenderness Need qualified practioner to insert coil Needs speculum to fit and remove Small risk of perforation and infection with infection If pregnant – more likely to be ectopic Does not protect STI Pregnancy risk = 0.2%
57
what is the copper coil?
Copper coil: IUD – does not contain hormones, rod is coated in copper and creates inhospitable environment for sperm
58
what are advantages of copper coil?
Lasts 5-10yrs Non- hormonal method Very effective in preventing pregnancy No interruption to intercourse Does not interact with medications Can be emergency
59
what are disadvantages of copper coil?
Can cause heavier, longer and more painful menstruation Need qualified practitioner to insert Involves speculum to insert and remove Small risk of uterine perforation and infection if pregnant, likely to be ectopic Does not protect against from STI Pregnancy risk= 0.8%
60
how do you perform female sterilisation?
- Tubal occlusion with surgical clips - Salpingectomy
61
what are benefits to female sterilisation?
Permanent contraception No interruption to sex Does not affect hormonal levels Does not interact
62
what are disadvantages to female sterilisation?
Carriers risk of surgery including bleeding, infection and pain Very difficult to reverse In very rare cases can become pregnant No STI protection
63
how can male sterilisation be performed?
Male sterilisation: vasectomy is done under LA
64
how does male sterilisation work?
a: prevents pregnancy by preventing sperm from entering semen  irreversible
65
what are the advantages of male sterilisation?
Permanent contraception Does not interrupt intercourse Less invasive and lower-risk than female sterilisation
66
what are disadvantages of male sterilisation?
Carries surgical risk -bleeding and infection and infection Some men experience post-vasectomy pain Very difficult to reverse Contraception should be used until semen is confirmed to be sperm-free Does not protect from STIs Pregnancy rate= 0.15%
67
how does levonelle - emergency contraception work?
high dose of synthetic progestogen  delays ovulation so sperm would not be viable
68
when does levonelle must be taken in order for it to work?
Direction: must be taken within 72hrs of UPSI occurred – any later would not be effective
69
what are the advantages of levonelle - emergency?
Can be taken if already on POP Can start hormonal contraception on same day Can be taken more than once in cycle Can be bought OTC Fewer conta-indications than ellaONe
70
what are disadvantages of levonelle emergency?
Least effective form on emergency contraception Gets less effective as 72hrs go on Does not provide ongoing contraception Delays menstruation Pregnancy rate 1-7-2.2% even when taken right
71
what is ellaONe?
ellaOne: contains ulipristal acetate, prevents pregnancy by delaying or stopping ovulation
72
when must ellaOne be taken?
within 120hrs
73
what are advantages of ellaOne?
More effective than levonelle Can be bought OTC Can be effective for up to 120hrs after UPSI Can be used more more than once in same cycle
74
what are disadvantages of ellaONe?
Affected by pt weight and enzyme inducing medications Must wait 5days from taking ellaOne before hormonal contraception Not recommended in those with severe asthma Delays menstruation Pregnancy rate: 1.3-1.6% even when taken correctly
75

Obs&Gynae (17 decks)

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