Fertility control Flashcards
What is the most common method of contraception in the UK for women aged 16-49?
sterilisation
What percentage of women in the UK do not use contraception despite being sexually active and no wish to get pregnant?
12%
examples of combined contraception
pills, patch and vaginal ring
examples of progesterone only methods of contraception
pills, injectable and implant
Give some aims of an ideal contraceptive
100% effective
does not relate to intercourse and is convenient
100% reliable, free of adverse side effects and protection against STIs
non-contraceptive benefits
low maintenance and no ongoing medical input
What type of contraceptives have the most adverse effects?
containing oestrogen
Closest contraception regime to 100% effective?
vasectomy then implant
What is the only contraceptive method which is not reversible?
sterilisation
Only contraceptive which is related to intercourse
condoms
2 methods of tracking the failure rates
pearl index and life table analysis
pearl index
number of contraceptive failures per 100 women - years of exposure
total months or cycles of exposure from initiation of product to end of cycle
life table analysis
contraceptive failure rate over specified time frame
cumulative failure rate for any specific length of exposure
pearl index of COC
0.3-4 per HWY
2 ingredients of COC
ethinyl estradiol
synthetic progesterone - progestogen
dose of EE in the COC
20-35 mcg –> 50 if on liver enzyme inducers
2nd gen COC
levonorgestrel and norethisterone
3rd gen COC
gestodene and desogestrel
How is the COC taken?
21 days with a 7 day free period
some new evidence for tricycling/continual use
3 modes of action of COC
prevents ovulation
prevents implantation by providing inadequate (thin) endometrium
progesterone alters cervical mucus to inhibit sperm penetration
How long does COC take to work?
7 days —> USE CONDOMS
Non contraceptive benefits of COC
- regular, less painful, less heavy bleeding
- help with anaemia
- reduced functional ovarian cysts, benign breast disease, osteoporosis, RA, colon cancer
- decreased endometrial and ovarian cancer
- improve acne
Risks of COC
VTE
focal migraine –> ischaemic stroke
breast cancer - small and returns to normal in 10 yrs
cervical cancer? doubles with 10 year use
Increased risk factors for VTE
postnatally in 21 days major surgery and immobility thrombophilias FH in under 45's BMI>30 underlying vascular disease
Progesterone only pill - name and method of taking
desogestrel
12 hour window but usually taken in 3 hours
no pill free interval
pearl index of progesterone only pill
0.3-3.1
Why might there be a lower failure rate of POP in older women?
less fertile?
less sexually active?
methods of action of POP
cervical mucus
max effect after 48 hours of ingestion
effect lost if > 3 hours late
ovulation
What is DepoProvera?
aqueous solution of progesterone crystals
How is DepoProvera given?
im injection in upper outer quadrant of buttock every 12 weeks
–> new subcut can be done at home
3 modes of action of DepoProvera
prevents ovulation
alters cervical mucus
prevents implantation - inadequate endometrium
positives of DepoProvera
good for forgetful pill takers
oestrogen free
70% amenorrhoeic
4 negatives of DepoProvera
delay in return to fertility
reversible reduction in bone density
weight gain
problematic bleeding
Describe the subdermal implant
4cm x 2mm –> 68mg of progestogen in EVA
lasts 3 years
Primary action of subdermal implant
inhibit ovulation
secondary action of subdermal implant
effect on cervical mucus - inhibit sperm entering upper reproductive tract
LARC
long acting reversible contraception: 5-10 years
copper coil
toxic to sperm so can be used as emergency contraception
lasts 5-10 years
Emergency contraception - 2 pills and one other option **
copper IUD is best - within 120 hours
levonelle: 1500 micrograms levonorgestrel within 72 hours
Ella one - ulipristal acetate 30mg within 120 hours
Method of female sterilisation
laparascopic - tube ligation using flishie clips
1 in 500 lifetime risk of failure
What is a vasectomy?
permanent division of vas deferens under LA
Describe the vasectomy
1 in 2000 failure - irreversible
pain due to sperm granuloma
no change in testosterone and semen of same colour and volume
no evidence of prostate and testicular cancer
Target for terminations
70% under 9 weeks
Is medical or surgical abortions more common in Grampian?
medical
After what gestation must a woman be referred to England for abortion?
20 weeks
Reasons for abortion
less than 24 weeks
pregnancy will cause greater harm to physical or mental health of the women and/or other children
social
medical eg anomaly, maternal health
Home abortion - what is taken home?
misoprostol
Clinic consultation for home abortion
methods of termination
prolonged bleeding after TOP and counselling
contraception
FBC/group&screen/rubella/scan/chlamydia and gonorrhoea self obtained swab/STI bloods
certificate A signed
2 medications in medical abortion
mifepristone
misoprostol
mifepristone mode of action
switches off pregnancy hormones keeping uterus from contracting and allowing pregnancy to grow
misoprostol mode of action
initiates uterine contractions
opens cervix and expels pregnancy
complications of abortion
failure haemorrhage infection prolonged bleeding psychological uterine perforation cervical trauma
Conscientous objection
medical staff allowed to object being part of abortion but must ensure woman can still access and receive the correct care
