Fertility Control Flashcards
What is the most used contraceptive in the UK?
Combined hormonal contraception 25%
What is the pearl index?
Number of pregnancies per 100 women - years
Total months or cycles of exposure from initiation of the product to the end of the study
What is LARC?
Long acting reversible contraception
When can sex cause pregnancy?
If 26-32 day of cycle and not on hormonal contraception
Ovulate 12-18 day and egg survives 24 hrs and sperm survive less than 4 days
So highest chance on day 8-19
Describe the combined hormonal contraception
Pill, patch and vaginal ring
Combination of 2 hormones - ethinyl estradiol and synthetic progesterone
Stops ovulation and affects cervical mucus and endometrium
What is the regime of the combined hormonal contraception?
Standard regime - 21 days with a hormone free week
Tailored - tricycling or continuous use
Pill taken daily, Patch (EVRA) is changed weekly and ring is changed every 3 weeks
What are the non-contraceptive benefits of combined hormonal methods?
Regulates and reduces bleeding
Stops ovulation
Reduces functional ovarian cysts
Reduction in ovarian and endometrial cancer
Improves acne/ hirsutism
Reduction in benign breast disease, RA, colon cancer and osteoporosis
What are some side effects of combined hormonal methods?
Breast tenderness, nausea, headache and irregular bleeding in first 3 months
Mood and weight gain
What are the serious risks of the combined hormonal methods?
Increased risk of DVT or PE, arterial thrombosis - MI/ ischaemic stroke, cervical cancer and breast cancer
When should combined hormonal methods be avoided in risk if venous thrombosis?
If BMI > 34, previous VTE, 1st degree relative VTE under 45, reduced mobility and thrombophilia
When should combined hormonal methods be avoided in risk of arterial thrombosis?
Smokers >35, personal history, focal migraine, age > 50 and hypertension of 140/90
When should combined hormonal methods be avoided?
If active gall bladder disease or previous liver tumour
Avoid if previous breast cancer - BRCA
What is the increase risk of VTE on combined hormonal methods?
Increases three-fold
Describe the progesterone only pill (POP or mini pill)
Take it same time every day without pill free interval
Not good if have GI upset
Desogestrel pill
LNG NET pills
Oestrogen free
Describe the desogestrel pill
12 hour window period
Nearly all cycles anovulant and also affects mucus
Most users are bleed free after4-6 months
Describe LNG NET pills
3 hour window period
1/3 anovulant 2/3 rely on cervical mucus effect
1/3 are bleed free, 1/3 irregular and 1/3 regular periods
What are the progestogenic side effects?
Appetite increase, hair loss/ gain, mood change, bloating or fluid retention, headache and acne
When should progesterone only pill be avoided?
If current breast cancer or liver tumour past/ present
Describe the injectable progesterone ‘the jag’
Solution of medroxyprogesterone acetate dose every 3 weeks
1ml deep IM injection into upper quadrant of buttock - Depoprovera
0.6 SC injection in abdomen or thigh - Sayana press
How does the injectable progesterone work?
Prevents ovulation
Alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation
What are the positives of injectable progestogen?
Only need to remember every 12-14 weeks
70% of women amenorrhoeic after 3 doses
Oestrogen free so few contraindications
What are the negatives of injectable progestogen?
Delay in return to fertility - average 9 months
Reversible reduction in bone density
Problematic bleeding esp first 2 doses
Weight gain 2/3 of women (2-3kg)
What is ‘the rod’?
Subdermal progestogen implant Nexplanon
Describe the progestogen implant
Inhibition of ovulation and effect on cervical mucus
Can last 3 years and no user input needed
No effect on weight
What are the negatives of the progestogen implant?
60% are almost bleed free but 30% have prolonged/ frequent bleeding
Can cause mood change more often than the other progestogen only methods
What are the positives of intrauterine contraception?
Little user input after fitting - neither woman or partner are aware of device
Can be fitted at any age and parity
Side effects immediately reversible once removed
What are the risks of the intrauterine contraception?
Small risk of infection in first 3 weeks
1:1000 risk perforation
5:100 risk expulsion
If conceives then may be ectopic
Not suitable if pelvic infection or distorted endometrial cavity
What is the mode of action of the copper IUD?
Toxic to sperm - stops sperm reaching egg and may sometimes work by preventing implantation of fertilised egg
What are some features of the copper IUD?
Hormone free
May make periods heavier/ crampier
Can last 5-10 years on type
Not a contraindication to MRI
Describe the levonorgestrel IUS
Affects cervical mucus and endometrium - stops fertilisation of egg and some women may still ovulate
Slow release progestogen on stem
Reduces menstrual bleeding after 4 months of irregular bleeding
Low circulating progestogen
What are types of Levonorgestrel IUS?
Mirena
Kyleena and Jaydess
Describe the Mirena IUS
5 year contraception
Most women bleed free after 12 months
Equivalent systemic dose to 3 POP/ week
Licensed to treat heavy menstrual bleeding and can act as progestogenic part of HRT
Describe the Kyleena and Jaydees IUS
Less progestogen so even less chance of side effects but less likely to be bleed free
Smaller frame and insertion tube
3 year contraception only
What is the most effective option of emergency contraception?
Copper IUD - fit before implantation - within 120 hrs UPSI ant time cycle or by day 19 of 28 day cycle
What are other options of emergency contraception?
Levonorgestrel pill - take within 72 hrs
Ulipristal pill - take within 120 hrs (has more contraindications like breast feeding and enzyme inducing drugs)
When should contraception be started?
In first 5 days of cycle - immediate cover
Can start at other time of cycle if no risk of pregnancy (need condoms for 7 days)
When can women get pregnant after delivery and breast feeding?
21 days after delivery and 5 days after miscarriage or abortion
Breast feeding is contraception only in first 6 months + feeding evert 4 hrs + amenorrhoeic
Breast feeding women can use any type of contraception
What are drug interaction of contraception?
Enzyme inducing drugs like carbamazepine, topiramate, rifampicin
Incresae metabolism of progestogen and oestrogen and reduce effectiveness of combined pill/ patch/ ring, implant and POP
Not injection, copper IUD and levonorgestrel IUS
What are the negatives of female sterilisation?
Risks of GA and laparoscopy
Irreversible
Failure rate is 1 in 200 lifetime risk - ectopic
No effect on periods/ hormones
Describe female sterilisation
Laparoscopic sterilisation - Filshie clips applied across tube to block lumen
Okay for MRI
May do salpingectomy at planned caesarean section
Describe a vasectomy
Vas deferens divided and ends cauterised small incision midline scrotum
Local anaesthetic
Takes 4-5 months to be effective - 2 sperm samples sent
What are the positives and risks of vasectomy?
Failure rate is 1 in 2000
Irreversibility
Less than 1 in 100 risk of long term testicular pain
No effects on testosterone and sexual function
What contraception was most used before need of abortion?
Condoms mainly then UPSI, pills and LARC
What is involved in the clinic consultation before abortion?
Medical history, circumstances and scan needed
Discuss methods of abortion and contraception for after
STI bloods are offered
Vaginal swab
What are the long term effects of abortion?
Safer than a full term delivery
No effect on future fertility unless infection or on cancer risks
Emotional effects
Describe cervical priming in termination of pregnancy
Misoprostol 3 hrs preop helps dilation and reduces risk of perforation/ haemorrhage
GA or LA cervical block
Transcervical - 6-0mm suction catheter
Risks of GA and perforation
Describe Mifepristone oral antiprogestogen tablet
36-48hrs later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
Average 4-6 hrs to pass pregnancy
Some may need surgery for incomplete abortion
