Contraceptives Flashcards
What are some generalised categories of contraceptive?
Barrier methods Combined contraceptives Progesterone only contraceptives Long-Acting Reversible Contraceptives Sterilisation Natural family planning Emergency contraception
Which factors can influence a patients’ choice of contraceptive?
Most effective Ease of use Reversibility Side effect profile Effect on menstruation Non-hormonal Previous experience Family/Friend experiences Practicality
What does the UKMEC score for contraceptives indicate?
Risk profile and suitability of various contraceptives for different patients
What does a UKMEC score of 1 indicate for a contraceptive?
No restriction for use in a particular patient
What does a UKMEC score of 4 indicate for a contraceptive?
This particular contraceptive is contra-indicated for this patient
How do barrier methods of contraception work?
Act as a barrier to prevent the sperm and ovum meeting and fertilising
What are Male Condoms?
A barrier of latex that covers the penis preventing sperm from entering the vagina
What are some advantages to male condoms?
Only used during intercourse
Reduce STI transmission
Side effects are rare
What are some disadvantages to male condoms?
Can break, split or tear during use
Application can interrupt intercourse
Technique must be correct
Latex allergies are possible
With male condoms, what is the unintended pregnancy rate?
18%
What are female condoms?
A barrier of polyurethene that goes inside the vagina to prevent sperm from passing through the cervix
What are some advantages of female condoms?
Only used in intercourse
Reduce STI transmission
Side effects are rare
What are some disadvantages of female condoms?
Can break, split or tear
Application can interrupt intercourse
Technique must be correct
Less commonly available
With female condoms, what is the unintended pregnancy rate?
21%
What is a Diaphragm/Cervical cap?
Flat silicone cap which is placed over the Cervix as a barrier to sperm
What must be used with a Diaphragm/Cervical cap?
Spermicide
What are some advantages to Diaphragm/Cervical cap?
Only used during intercourse
Can be inserted prior to intercourse
Side effects are rare
What are some disadvantages to Diaphragm/Cervical cap?
Can break, split or tear
May interrupt intercourse
Must know technique
Offer no STI protection
With the Diaphragm/Cap, what is the unintended pregnancy rate?
12%
What do Combined contraceptives contain?
Synthetic versions of Oestrogen and Progesterone
How do Combined contraceptives work?
Mimick the Luteal phase of the menstrual cycle, preventing the release of FSH and LH required for ovulation.
Also thicken cervical mucus and thin the endometrium
What are some contraindications for the use of combined contraceptives?
Migraine with aura Current Breast Ca Risk factors for VTE CV Risk factors - Hypertension, IHD Severe liver disease
What is a commonly used example of a COCP?
Microgynon 30
What do COCP contain?
Oestrogen and Progestogen that inhibit ovulation
When should COCP be taken?
21 days on then 7 off
63 days on then 7 off
Continuous use
What will a patient on COCP experience during their 7 days off?
Menstrual bleed
What are some benefits to the COCP?
No interruption to intercourse
Can be abruptly stopped
Less-strict missed pill rules
Can make periods lighter/less painful
Can reduce the risk of ovarian, endometrial and bowel Ca
Can help with endometriosis and menorrhagia
What are some limitations of the COCP?
Less effective if a pill is missed Vomiting affects usefullness Anti-epileptic medications can interract Increased VTE/Stroke risk No STI protection
What are some common side effects of the COCP?
Headaches
Nausea
Breast tenderness
Mood swings
What is the unintended pregnancy rate with COCP?
9%
How do contraceptive patches work?
Supply oestrogen and progesterone via the skin
How often should contraceptive patches be applied?
Once every 7 days. Have a break after 21 days for 7 days
What are some benefits to contraceptive patches?
Don't have to remember daily No interruption to intercourse Can be stopped at short notice Gives lighter, less painful periods Reduces risk of ovarian, endometrial and bowel Ca Not affected by vomiting and diarrhoea
What are some limitations to contraceptive patches?
Not protected if forget patch
Increased risk of VTE/Stroke
No STI protection
Can “Fall off”
What is the unintended pregnancy rate with contraceptive patches?
9%
What is a commonly used brand of Vaginal ring?
Nuvaring
What is a Vaginal Ring?
Small plastic ring placed high in the vagina that secretes oestrogen and progestogen for 21 days
What are the possible regimes with a vaginal ring?
21-7
63-7
What are some benefits of vaginal rings?
Don't need the patient to remember them No interruption to intercourse Can be stopped at any time Lighter, less painful periods Reduces risk of ovarian, endometrial and bowel Ca Not affected by vomiting and diarrhoea
What are some limitations of vaginal rings?
Increase VTE/Stroke risk
No STI protection
Affected by anti-epileptics
What is the unintended pregnancy rate with vaginal rings?
9%
What are some commonly used Progesterone-Only Pills (POPs)?
Desogestrel
Levonorgestrel
How does Desogestrel work?
Inhibits ovulation
Thickens cervical mucus
Thins endometrium
When should Desogestrel be taken?
Within the same 12 hour window every day
How does Levonorgestrel work?
Thickens cervical mucus
Thins endometrium
When should Levonorgestrel be taken?
Within the same 3 hour window every day
What are some benefits of POPs?
Suitable for patients that are contraindicated with oestrogen
No break in dosage means its easier to remember
No interruption to intercourse
Can be stopped at short notice
What are some disadvantages to POPs?
Reduced protection if a pill is missed
More-strict missed pill rule than COCP
Can cause irregular bleeding, amenorrhoea or more frequent bleeding
Vomiting and diarrhoea reduce effectiveness
No STI protection
What is the unintended pregnancy rate with POPs?
9%
What is the contraceptive injection?
A 12 weekly injection of progesterone
Where is the contraceptive injection administered?
IM, into buttocks
How does the contraceptive injection work?
Thickens cervical mucus
Thins endometrium
Inhibits ovulation
What is a commonly-used contraceptive injection?
Depo-Provera
What are some benefits to the contraceptive injection?
Suitable for patients contraindicated to oestrogen
No need to remember daily pill
No interruption to intercourse
What are some disadvantages of the contraceptive injection?
Can cause amenorrhoea, irregular bleeding or more frequent bleeding
Patient must tolerate injection
Can affect bone mineral density if used long term
No STI protection
Irreversible for 12/52
Fertility can take months to return afterwards
What is the unintended pregnancy rate with the contraceptive injection?
6%
What are Long Acting Reversible Contraceptives?
Contraceptives that are inserted into the patient and provide years of ongoing protection
What is Nexplanon a form of?
Contraceptive Implant
What is the contraceptive implant?
A small plastic rod inserted sub-dermally in the upper arm
How does the contraceptive implant work?
Slowly releases Progestogen to inhibit ovulation, thicken cervical mucus and thin the endometrium
What are some benefits of the contraceptive implant?
Lasts for 3y once inserted
Suitable for those that cannot use oestrogen
Most effective contraceptive available
No interruption to intercourse
What are some limitations of the contraceptive implant?
Can cause irregular bleeding, amenorrhoea or increased frequency of bleeding
Requires qualified practitioner to insert
Can worsen acne
No STI protection
What is the unintended pregnancy rate with the contraceptive implant?
0.05%
What is the Mirena a form of?
Hormonal Coil (Intra-Uterine system)
What is a hormonal coil?
A T-shaped rod inserted into the uterus that locally release progestogen giving thickened cervical mucus and a thinned endometrium
What are some benefits to the hormonal coil?
Last 3-5y
Suitable for those that cannot take oestrogen
Very effective
More likely to help with heavy menstruation
?Less side effects than implant
What are some limitations of the hormonal coil?
Can make menstruation irregular
Can cause acne, breast tenderness and headaches
Needs qualified practitioner to insert
Must be fitted with a speculum exam
Carries a small risk of uterine perforation
Risk of ectopic pregnancy
No STI protection
What is the unintended pregnancy rate of the hormonal coil?
0.2%
What is the Copper Coil?
T Shaped plastic and copper rods inserted into the uterus
How do Copper Coils act as contraceptives?
Create an inhospitable environment for sperm and ovum to survive in the uterus
What are some benefits of the Copper Coil contraceptive?
Last 5-10y Suitable for women that cannot use hormonal contraceptive Very effective Unaffected by other medications Can be used as emergency contraceptive
What are some limitations of the Copper Coil contraceptive?
Can lead to heavier, longer, more painful periods
Must be fitted by a qualified practitioner via a speculum exam
Risk of perforation and infection with insertion
If pregnancy occurs its more likely to be ectopic
No STI protection
What is the unintended pregnancy rate with a Copper Coil?
0.8%
When/How is Female Sterilisation usually carried out?
Under General Anaesthetic
During a Cesarian Section
What are the primary methods of female sterilisation?
Tubal Occlusion with Surgical Clips
Hysteroscopic sterilisation with fallopian implants
Salpingectomy
What are some benefits to female sterilisation?
Permanent
No interruption to intercourse
No change in hormonal levels
What are some limitations of female sterilisation?
Risks of surgery including bleeding and infection
Often have pain post-operatively
Very difficult to reverse
Pregnancy can still happen, and is more likely to be ectopic
No STI protection
What is the unintended pregnancy rate with female sterilisation?
0.5%
What is Male Sterilisation otherwise known as?
Vasectomy
What happens in a Vasectomy?
Procedure under local anaesthetic to remove a section of the vas deferens, preventing sperm from entering semen
What are some benefits of male sterilisation?
Permanent contraception
No interruption to intercourse
Less invasive than female sterilisation
What are some limitations of male sterilisation?
Risks of surgery
Some men can experience pain after surgery
Very difficult to reverse
Still need contraception untill semen has been confirmed to be sperm free
No STI protection
What is the unintended pregnancy rate with male sterilisation?
0.15%
What is Natural Family Planning/Fertility Awareness?
Intercourse is timed to the part of the cycle when ovulation is least likely
What is monitored in Fertility Awareness?
Body Temperature
Cervical secretions
What are the benefits of Fertility Awareness?
No side effects
Accepted by most faiths and cultures
What are some limitations of Fertility Awareness as a form of contraception?
Much less effective Must avoid sex/use other contraception around ovulation Needs significant patient input Fertility signs can be unreliable No STI protection
What is the unintended pregnancy rate with Fertility Awareness?
24%
When may women use Emergency Contraception?
If they’ve had Unprotected Sexual Intercourse (UPSI) or contraceptive failure
What types of emergency contraception are there?
Morning After Pills
Copper Coil
Name two examples of morning after pills
Levonelle
ellaOne
What does Levnoelle contain and how does it work?
Contains a high dose of synthetic progestogen, thought to delay ovulation until the sperm are non-viable
When must Levonelle be taken?
Within 72h of UPSI
When is Levonelle uneffective as emergency contraception?
If the LH surge has already begun
What are some benefits of Levonelle emergency contraception?
Can be taken if patient recently had POP Can start hormonal contraception same day Can be used more than once per cycle No insertion procedure necessary Easily accessible Fewer contraindications than ellaOne
What are some limitations of Levonelle emergency contraception?
No benefit if ovulation has already occurred Less effective at the end of 72h window Efficacy is affected by patient weight Least effective emergency contraception Offers no on-going contraception
What is the unintended pregnancy rate with Levonelle?
1.7-2.2%
What is the active ingredient of ellaOne?
Ulipristal Acetate
How does ellaOne act as emergency contraception?
Delays/Stops ovulation
When must ellaOne be taken?
Within 120h of UPSI
What are some benefits of ellaOne emergency contraception?
More effective than Levonelle
Easily accessible
Effective for up to 120h
Can be used more than once per cycle
What are some limitations of ellaOne emergency contraception?
Little-No benefit after ovulation
Must wait 5 days before starting hormonal contraception
Not recommended in severe asthma, hepatic dysfunction or PPIs/Antacids
No ongoing protection
What is the unintended pregnancy rate with ellaOne?
1.3-1.6%
When must the Copper Coil be inserted as emergency contraception?
Within 5 days of UPSI or 5 days of ovulation
What are some benefits of the Copper Coil as emergency contraception?
Most effective
Provides up to 10y of ongoing protection
Only emergency contraception that is effective if fitted after ovulation
Not affected by weight or other medications
What are some limitations of the Copper Coil as emergency contraception?
Needs a qualified practitioner to fit
Risks of insertion
Less convenient
Absolutely contraindicated if more than 5 days after ovulation
What is the unintended pregnancy rate with the Copper Coil emergency contraception?
<0.1%
