Female hormonal contraception 1 & 2 Flashcards
Features of a perfect contraceptive
100% reliable, 100% safe, non-user dependent, unrelated to coitus, visible to women, no ongoing medical input, completely reversible within 24 hrs, no discomfort
Different types of contraceptives:
Methods which require ongoing action by the individual = oral contraception, vaginal contraception, barrier methods, fertility awareness, coitus interruptus, oral emergency contraception
Methods which prevent conception by default = IUD, progesterone implant/IUS/injection, fe/male sterilisation
Combined oral contraception
Contains oestrogen & progestogens
Oestrogen: EthinylOestradiol (synthetic oestrogen)
Progestogens:
Older: Norethisterone (Norethindrone) and Levonorgestrel
Newer: Desogestrel, Gestodene and Norgestimate (Norgestromin)
Latest: Drospirenone (derived from Spironolactone)
How does a combined oral contraceptive work?
Oestrogens act on ant pit and hypothalamus, and on endometrium
Progestogens act on ant pit and hypothalamus, on endometrium, fallopian tubes and cervical mucus
Basic principles of combined oral contraceptives:
Causes: supra-physiological levels, ‘pseudo-pregnancy’, suppression of the HPO axis
In reality: pharmacokinetics are highly variable- individual serum levels may vary, suppression may not be absolute, follicular activity possible in some and breakthrough bleeding in some
Benefits of COC (combined oral contraceptive)
reliable, safe, unrelated to coitus, woman in control, rapidly reversible, halve ca ovary, halve ca endometrium, helps endometriosis, premenstrual syndrome, dysmenorrhoea, menorrhagia, can stop periods if taken continuously
Risks associated with COC
CVS: arterial (progestogen, HBP, smoking), venous (oestrogen-VTE-clotting disorders- DVT, PE, migraine)
Neoplastic: breast, cervix, liver
GIT: COH/insulin metabolism, weight gain (?)
Hepatic: hormone metabolisms, congenital non-haemolytic jaundices, gall stones
Dermatological: chloasma, acne, erythema multiforme
Psychological: mood swings, depression, libido
Contraindications
breast cancer, undiagnosed genital bleeding, pregnancy, <3 weeks post-partum, breast feeding, hypertension, PH thrombosis, migraine with aura, active liver disease, thrombophilia, systemic lupus erythematosus, thrombotic thrombocytopenic purpura, smoking >15 and age >35
Relative contraindications: BMI>35, migraine w/o aura, hypertension, diabetes, hyperprolactinoma
Pill rules for COC
Start 1st packet 1st day of menstrual cycle
Take 21 pills and stop for a 7-day break (PFI)
Restart new packet on 8th day (same)
Do not start new packets late
If late or missed pills in 1st 7 days = condoms
If missed pills in the final 7 days, don’t take a break/PFI
Combined vaginal contraceptive
Same as COCP, except vaginal delivery (ring) for 21 days. Remove for 7 days
Advantage = don’t have to take every day, but disadvantage = don’t have to take every day
Progesterone only methods
Default methods: implants, hormone releasing IUCD
User dependent methods: POPS (desogestrel), injectables
How they work: progestogens act on ant pit and hypothalamus (neg FB), on the endometrium, on the fallopian tubes and on cervical mucus
Basic principles of progesterone only methods
Delivery method is user choice
Systemic side effects (e.g., headache, bloating, acne) depend upon systemic absorption
Effect on cervical mucus and endometrium highly variable
Effect on HPO suppression is less reliable- some women ovulate
Irregular bleeding is potential issue for ALL methods
Basic principles of progesterone only methods
Delivery method is user choice
Systemic side effects (e.g., headache, bloating, acne) depend upon systemic absorption
Effect on cervical mucus and endometrium highly variable
Effect on HPO suppression is less reliable- some women ovulate
Irregular bleeding is potential issue for ALL methods
IUCDs
Copper bearing intrauterine contraceptive devices are inserted into the uterus by trained practitioners and may be left in situ long term
Can be copper bearing or hormone bearing
