Fertility Control Flashcards
Contraception: Age Range:
- menache to menopause
- <18s:
- menopause -> retrospective
diagnosis - trans men + non-binary assigned
female at birth: if no
hysterectomy/bilateral
oophorectomy, with risk of
pregnancy
Female Physiology
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Female Physiology
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A surge in LH leads to final egg maturation and release.
The follicle left after ovulation transforms to the corpus luteum.
The corpus luteum produces both oestrogen and progesterone which negatively feedback on FSH and LH.
If pregnancy does not occur, the corpus luteum degenerates and circulating hormone levels decline.
Sustained higher levels of oestrogen and or progesterone negatively feedback on production of FSH and or LH and in turn decrease the stimulation and or release of developing follicles.
Female Contraceptive Hormones: Oestrogen: Effect:
- suppresses ovulation
Female Contraceptive Hormones: Progesterone: Effect:
- suppress ovulation
- reduces cilia activity in the
fallopian tube - increases volume + thickens
cervical mucous - thinning of endometrium
*progesterone creates a
hormonally driven barrier
Overview of Hormonal Contraceptives:
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Exogenous Contraception: CHC:
- combined hormonal
contraceptives - oestrogen and progesterone
- effective immediately D1-5 else 7
days
Exogenous Contraception: CHC: Efficacy:
- highly user dependent
- 99%-91%
Affected by:
- diarrohoea and vomiting
- weight
- drug interactions
Exogenous Contraception: CHC: Modes of Administration:
- pill
- patch
- vaginal ring
Exogenous Contraception: CHC: Benefits:
- reduces risk of ovarian,
colorectal and endometrial
cancer - predictable bleeding patterns
- reduced menstrual bleeding and
pain - management of PCOS,
endometriosis, premenstrual
syndrome and acne - reduced menopausal symptoms
- maintains bone density in
perimenopausal under 50 - rapid return to fertility
Exogenous Contraception: CHC: Risks:
- breast tenderness
- weight gain
- bloating
- libido changes
- irregular bleeding
- increased risk of breast and
cervical cancer - risk of venous and arterial
thromboembolism: 3x - risk of thromboembolism lower
than during pregnancy and
post-partum period
CHC: Questions to ask:
- factors increasing thrombotic
events: age, weight, smoking,
clotting disorder - not in breastfeeding women until
after 6 weeks
Exogenous Contraception: CHC: Administration:
- standard 21 days followed by
hormone free interval (HFI) of 7
days - tailored regimens also suitable
Exogenous Contraception: Progesterone-only Contraceptives:
- mode of action varies according
to mode of administration - alters cervical mucous and
endometrial thickening - some inhibit ovulation as
primary MoA - all are suitable for breastfeeding
women
Exogenous Contraception: Progesterone-only Contraceptive: Modes of Administration:
- pill (mini pill/POP)
- injection
- implant
- interuterine system (IUS)
Exogenous Contraception: Progesterone-only Contraceptive: Benefits:
- suitable for most, whereas
oestrogen can be
contraindicated - not associated with
thromboembolic events - reduced menstrual bleeding and
pain - management of gynaec conditions
Exogenous Contraception: Progesterone-only Contraceptive: Risks:
- bloating
- headaches
- mood changes
- irregular bleeding
Progesterone-only Contraceptive: Pill:
- daily intake at same time with no
HFI - some affect ovulation
- efficacy: 99-91%
- affected by: diarrhoea, vomiting,
drug interactions - effective immediately D1-5, else
2 days to become effective - suitable whilst breastfeeding
Progesterone-only Contraceptive: Injection:
- LARC: Long-acting reversible
contraception - inhibits ovulation, alters cervical
mucous, endometrium - every 12 -13 weeks via IM
- 99-91%
- not affected by enzyme inducing
drugs or weight - effective immediately D1-5, else
7 days - *decreased bone mineral density
- *delayed fertility for upto 1 year
Progesterone-only Contraceptive: Implant:
- LARC: Long-acting reversible
contraception - inhibits ovulation, alters cervical
mucous and endometrium - subdermal injection every 3
years - efficacy >99%
- affected by enzyme inducing
drugs - effective immediately D1-5, else
7 days - suitable immediately after
delivery - rapid return to fertility
- local reactions/risk of migration
Progesterone-only Contraceptive: IUS:
- LARC: Long-acting reversible
contraception - inhibits ovulation in 25%, affects
cervical mucous and endometrial
thickness - foreign body effect
- efficacy>99%
- effective for 8 years/until no
longer required if inserted in
>45yrs - 48 hrs after delivery
- part of HRT for 4 years
- rapid return to fertility
- risk of perforation, migration and
infection - increased risk of ectopic
pregnancy but overall risk
decreased due to lower
pregnancy risk
Progesterone-only: Emergency Contraception:
- second line to IUD
Levonorgestrel:
- delay/prevents follicular rupture and
ovulation
- licensed within 72 hours, efficacy reduces
with time
- body weight>70kh/BMI>26 recommend
double dose or another agent
Ulipristal acetate:
- selective progesterone receptor modulator
- delays ovulation by up to 5 days, including
after the start of LH surge
- first line hormonal emergency
contraceptive
- licensed for use within 120 hours
Lactational Amenorrhea Method (LAM):
- ovarian activity can resume by 21 days
- suckling suppresses resumption of ovarian
activity - breastfeeding as a contraceptive requires:
- less than 6months post partum
- amenorrheic
- fully breastfed - efficacy >98%
- one of many post natal contraceptive
options - important to discuss contraception
antenatally, offer early postpartum
contraception and STI protection; not to
wait until postnatal checks typically done 6
weeks after delivery - postpartum contraception including LAM
should be initiated immediately if
medically eligible
LAM
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Condoms:
- male and female condoms
- latex and polyurethane
- protects against STIs
- 98%-85% efficacy
- no contraindications
- can split, come off or be damaged with oil
based lubricants
IUDs:
- intrauterine devices
- LARC: Long-acting reversible contraception
- copper coil
- affects cervical mucus and foreign body
effect - > 99%
- effective immediately
- first choice for emergency contraception
- 5-10 years
- rapid return to fertility
- risk of perforation, migration and infection
- increased risk of ectopic pregnancy, overall
decreased risk due to unlikely pregnancy
IUDs are hormonal contraceptive devices?
Non-hormonal contraceptive devices
non-hormonal emergency contraception
reversible
Male Contraception:
- condoms
- male sterilisation: bilateral cut/seal of vas
deferens - efficacy >99%
- not effective immediate
- 45% reversal succes <10 years later
Male Physiology
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Male Hormonal Contraception:
- maintenance of androgen dependent
function - testosterone is effective at suppressing
sperm concentration - GnRH antagonists are effective in
suppressing spermatogenesis - testosterone only side effects: acne,
altered libido, night sweats, increased
weight and mood changes - combination regimes allow a reduction in
testosterone and associated side effects
Comparative Efficacy:
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Potential mechanisms for male contraception:
- condoms/sterilisation
- testosterone only regimens
- GnRH antagonists
- androgen must be part of the
contraceptive regime
