Endo-Repro L30 Contraception Flashcards
Hormonal contraception
- Contraceptive pills → Combined pill, progestin0only pill, post-coital pill
- Patch
- Injectable
- Implants
- Intrauterine systems (mirena)
- Vaginal ring (Nuvaring)
- Male pill
Combined oral contraceptive pill (COCP): Definition
Mix of estrogen and progestogen
Combined oral contraceptive pill (COCP): Mechanism of action (2)
1st prevention ovulation • Remove normal cycle, withdrawal bleed has minimal medical significance 2nd Cervical mucus • Thick (progesterone) →Fallopian tubes →Endometrium
Combined oral contraceptive pill (COCP):Advantages
Effective and easy to use Convenient Not intercourse related Reversible Periods (lighter, timed or no periods)
Combined oral contraceptive pill (COCP):Reduction in
PMS
Ovarian cysts and cancer
Benign breast disease
Combined oral contraceptive pill (COCP): Disadvantages
Forget-ability
Needs planning
Combined oral contraceptive pill (COCP): Side effects
Nausea and vomiting Irregular bleeding Tiredness change Change in sex drive Weight gain? Sore breasts
Combined oral contraceptive pill (COCP): Risk factor for
VTE
Arterial disease
History of focal migraines
Contraceptive patches and vaginal ring →
same as COCP except wear or insert for 3 weeks then have one week off.
Progesterone only pill → General principles
Low dose of progestogen through out cycle
Progesterone only pill → Mechanism of action
1. Cervical mucus • Thick (progesterone 2. Fallopian tubes 3. Endometrium 4. Prevents ovulation: • Cerazette
Progesterone only pill → Progestogen action on fallopian tubes
It is a smooth muscle relaxant and therefore cant contract to move egg.
Progesterone only pill → Advantages
- Effective and easy to use
- Convient
- Not intercourse related
- Reversible
Progesterone only pill →Can use if
>35 yrs Smoker Obese During lactation/breast feeding High BP or Migraine/DM
Progesterone only pill →Disadvantages
Forget ability →
• 3hrs with standard POP
• 12 hrs with Cerazette
Progesterone only pill → Side effects
- Irregular bleeding
- Functional ovarian cysts
- Headaches, weight, spots, breast tenderness
Post-coital (Emergency) contraceptive: Examples
Levonelle
EllaOne
Emergency IUD
Levonelle
Is a tablet containing a hormone called progestogen. 1 pill (within 72 hours)
Ellaone
A tablet containing ullipristal (progestogen receptor blocker) 1 pilll (120 hours)
Emergency IUD
Is a small plastic and copper device that is fitted in your uterus up to five days (120 hours) after unprotected sex or within five days of the earliest time you could have released an egg.
Mechanism of action Levonelle
Levonorgestrel (levonelle)
• Progestogen hormone
• Prevents/delays ovulation if given early in the cycle – seems to prevent follicular rupture or cause luteal dysfunction
• Disrupts egg transport
Advantages Levonelle
- Allows a mistake to be corrected.
- No prescription needed
- No affect if one does become/is pregnant
Side effects Levonelle
- Nausea, vomiting, headache
- Menstrual disturbance
- May not work
Mechanism of action Ella one
Ullipristal acetate is a progestrogen receptor modulator
Prevents/de;ays ovulation if given early in the cycle
No current evidence on disruption of embryp-endometrial interface.
Advantages ellaone
- Allows a mistake to be corrected.
* No affect if one does become/is pregnant
Side effects ellaone
- Nausea, vomiting, headache
- Menstrual disturbance
- May not work
Mechanism of action cooper IUD
Disrupts egg transport and implantation (conception is at time of implantation not fertilisation
Consider with copper IUD
Antibiotics
Advantages copper IUD
Allows a mistake to be corrected
Can be inserted up to 120 hours after the first episode of unprotected sex intercourse (UPSI) or within 5 days of the earliest expected date of ovulation.
Side effects of copper IUD
Menstrual disturbance
May not work
Intrauterine Devices (IUD) → copper/plastic Mechanism of action
- Cause mild inflammatory response
- Cause toxic environment reducing survival of gametes and embryo
- Disrupt inflammation (may inhibit endometrial enzymes)
Intrauterine Devices (IUD) → copper/plastic Advantages
Work long-term, and are highly effective
Non-intercourse related
No user error
Intrauterine Devices (IUD) → copper/plastic Disadvantages
Have to be fitted by an expert
Heavier periods
May be expelled or displaced
Increased risk of ectopic pregnancy
IUS (Mirena): Mechanism of action
- Increases the thickness of cervical mucus
- Thinning of the endometrium (prevents implantation)
- Preventing ovulation
IUS (Mirena): Advantages Mirena
Effective
Not user/intercourse dependent
Local hormone action
IUS (Mirena): Mirena reduces
Periods (Heavy menstrual bleeding)
Risk endometrial cancer
IUS (Mirena):Side effects Mirena
Irregular bleeding
Oestrogen contraindications/cautions:
- Pregnancy
- Focal migraines
- VTE
- Breast cancer
Non-hormonal methods:
- Intrauterine devices (coil)
- Barrier methods
a. Condoms
b. Diaphragms
c. Caps - Spermicides
- Natural methods
- Sterilisation