Fertility Control Flashcards
What is method failure ?
Pregnancy despite correct use of the method by user
What is user failure ?
Pregnancy because method not used correctly by user.
What is long acting reversible contraception (LARC) ?
Minimizes user input so minimizes user failure ?
When is a normal female 26-32 day cycle (not on hormonal Rx) most likely to ovulate ?
Ovulate day 12-18 (2 weeks before next period)
How any days/hours does an egg survive ?
24 hours
How long does a sperm cell survive ?
Less than 4 days
When is the highest chance of pregnancy if a woman is on a 26-32 day regular cycle ?
Day 8-19 but sperm survival and ovulation are variable so natural methods can fail.
In what forms does the combi-pill come in ?
Pill
Patch
Vaginal ring
The combi-pill (contraceptive pill) is a combination of which 2 hormones ?
Athinyl estradiol (EE) Synthetic progesterone (progestogen)
What do the hormones in the combi-pill do ?
Stop ovulation and affect cervical mucous
What is the standard regime for the combination contraception?
21 days with a hormone free week.
One pill taken daily/Patch changed weekly/Ring changed every 3 weeks.
What are the non-contraceptive benefits of the combi-therapy for contraception?
Regulate /reduce heavy bleeding.
Stop ovulation.
Reduction in ovarian cysts.
Improve acne/hirsutism.
What are some of the troublesome side effects of the combi-therapy for contraception ?
Breast tenderness
Nausea
Headache
Irregular bleeding for first 3 months
What are some of the serious risks associated with CHC ?
Increased risk of DVT/PE
Increased risk of arterial thrombosis
Who would you avoid prescribing CHC for?
If BMI >34
Previous VTE
Thrombophillia
Reduced mobility
Hx MI or stroke
Smoker >55
Focal migraine
Hypertension
If active gallbladder disease
Increased cancer risk
What hormone is used in the mini-pill ?
Progestogen only (POP)
What is the routine for the POP mini-pill ?
Pill taken at the same time every day without a pill free interval
What is the mechanism of action of the POP ?
Anovulant
Affects mucous
Bleed free
What are the side effects of the POP ?
Appetite increase Hair loss/gain Mood change Bloating/fluid retention Headache Acne
No increase of venous or arterial thrombus.
What is the routine for the depot contraception injection ?
Aqueous solution of progestogen.
150mg/ml deep IM injection every 13 weeks.
What are some of the cons of the depot contraception injection ?
Delay in return to fertility.
Reversible reduction to bone density.
Problematic bleeding.
Weight gain (The only contraceptive method with a causal effect on weight gain)
What kind of hormone is found in ‘The rod’ ?
Subdermal progestogen implant (Nexplanon)
How much progestogen is found inside the rod ?
68mg of progestogen in a matrix of ethinylvinylacetate (EVA)
What is the mechanism of action of the rod ?
Inhibition of ovulation and effects cervical mucous.
What are the 2 main forms of intra-uterine contraception ?
Copper IUD and Levonorgestrel IUS
What is the mode of action in a copper IUD?
Copper is toxic to sperm - stops sperm reaching the egg. Hormone free.
How many years does a copper IUD last ?
5-10 years
What is the mode of action of Levonorgestrel IUS ?
Affects cervical mucous and endometrium - most women still ovulate but it stops fertilisation of egg and prevents implantation of fertilised egg.
How does the hormones present in the levongestrel IUS compare to that of the combi-pill and the POP ?
IUS has low circulating progestogen levels compared to pill/implant/injection .
What are the 2 types of Levongestrel IUS ?
Mirena
Kyleena
What are the 3 main types of emergency contraception ?
Copper IUD
Levonelle Pill
Ellaone Pill
What is the time frame for use of the copper IUD as emergency contraception ?
Fit before implantation i.e. 120 hours UPSI any time in cycle or by day 19 of 28 days cycle.
What is the time frame for the levonelle emergency contraceptive pill ?
Take within 72 hours
What is the time frame for the ellaone emergency contraceptive pill ?
Take within 120 hours
When can a women become pregnant after delivery ?
21 days after delivery
What occurs in female sterilization ?
Clips across tubes to block tube lumen
What occurs in a vasectomy ?
Vas deferens divided and cauterised.
What are the 2 forms of pregnancy termination ?
Surgical and medical
Between what weeks can a surgical termination of pregnancy be carried out ?
5-12 weeks
Between what weeks can a medical termination of pregnancy be carried out ?
5-24 weeks
What is the process of a surgical termination of pregnancy ?
- Cervical priming misoprostol 3 hours pre-op help dilation and reduces risk of perforation/hemorrhage.
- GA or LA cervical block
- Trans-cervical
What is the process of a medical termination of pregnancy ?
- Mifepristone PO anti-progestogen tablet.
- 36-48 hours later, Misoprostol initiates uterione contraction which opens cervix and expels pregnancy.
- Average 4-6 hours to pass pregnancy under 12 weeks.
- Mifepristone helps misoprostol work better
