Fertility Control Flashcards
Methods of natural contraception…
- Rhythm method: estimating fertility window based on previous cycles - abstaining from sex during this period
- Billings method: identifying most fertile period by cervical mucosity and avoiding sex/ using barrier contraception during it
- Persona device and fertility apps can be used to identify correct time
- Withdrawal method
- Lactational amenorrhoea -most common method
Advantages and disadvantages of natural contraception…
Advantages:
- Natural therefore no side effects from medication
- Can also be used to plan pregnancy
Disadvantages:
- Not very reliable - heavily user dependent
- Need to keep daily records with Billings method
What are the different modes of combined hormonal contraceptive?
- EVRA patch = transdermal patch is used with 3 weeks on and 1 week off pattern
- NUVA ring = flexible, transparent ring which is in-situ for 21 days and removed for 7 days
What is the mode of action of combined hormonal contraception?
- Prevents ovulation
- Thickens cervical mucus in the neck of the womb
- Thins uterus lining - harder to implant
Advantages and disadvantages of combined hormonal contraception…
Advantages:
- Over 99% effective in providing contraception
- Convenient - do not have to think about taking a pill
- Reversible - normal fertility returns when stopping
- Periods become more regular and lighter
Disadvantages:
- Not suitable if very overweight or smoker > 35y/o
- Low risk of VTE, breast cancer
- Side effects= headaches, nausea, breast tenderness
Different types of combined pill…
- 21-day pills: take pill once a day, every day around the same time for 21 days, then 7 days with no pill - withdrawal bleed may occur
- Everyday pill: one pill taken each day for 28 days with no break between packs - (7 placebo pills)
Starting the combined pill at different points in the cycle…
- Ideally start COC on the first day of period - provides protection straight away and no other contraception is required
- COC started within first 5 days of the period - will still provide protection straight away and no further contraception required
- COC started after 5 days - will need to use barrier contraception for first 7 days of the pill
Contraindications for using COC…
- Pregnancy
- Smoker > 35 y/o
- Very overweight
- Previous VTE history
- Severe migraine with aura
- IHD or stroke
Use of COC after childbirth…
- Non-breastfeeding mothers should commence COC on day 21 after childbirth - if starting after day 21, need to use additional contraception for 7 days
- Breastfeeding mothers should wait 6 weeks after childbirth, and use barrier contraception in the meantime
What to do if you miss COC pill..
1 missed pill- at any point in cycle:
- Take the missed pill immediately, even if it means taking 2 pills in a day, then continue as normal
2 or more pills missed:
- Take last missed pill immediately, even if it means taking 2 pills in a day, leave any other missed pills an continue taking one daily as normal
- Use condoms / abstain until you have taken pill for consecutive 7 days
Advantages and disadvantages of taking COC…
Advantages:
- Does not interrupt sex
- Can make periods more regular and lighter
- Reduced risk of endometrial and ovarian cnacer
Disadvantages:
- S/Es= headache, nausea, mood swings
- Increases BP
- Increased risk of VTE and breast cancer
Advantages and disadvantages of POP…
Advantages:
- Over 99% effective
- Can be taken by women who cannot use COC (smokers>35y/o, hypertensives, breastfeeding mothers)
- Helps with painful periods
Disadvantages:
- Must take at same time everyday - within 2 hour window
- May cause functional ovarian cysts
- Hormonal problems: mood swings, weight gain, headaches
How often is the contraceptive injection given?
Depo-provera = 13 weeks Norethisterone = 8 weeks
Advantages and disadvantages of injection…
Advantages:
- Provides protection for long period of time
- May reduce heavy, painful bleeds
Disadvantages:
- Not easily reversible - side effects will last whole time of the injection
- Return of fertility may be delayed once injection has stopped
How is the implant administered and how long is it effective for?
Nexplanon = subdermal implant that is inserted under the skin during a small procedure .
Lasts for 3 years, after which the implant will need to be removed, and possibly replaced.
Advantages and disadvantages of implant…
Advantages:
- Very effective - providing protection for 3 years
- Fertility returns to normal soon after implant is removed
Disadvantages:
- Menstrual irregularities - may be heavier, more irregular than normal
- Requires procedure to take implant out - may be difficult
How does the Mirena work?
Mirena = levonergestrel (synthetic progesterone) releasing device
T-shaped plastic device that acts as a steroid reservoir, inserted into uterus
Provides contraception for up to 5 years
Advantages and disadvantages of Mirena…
Advantages:
- Provides contraception for up to 5 years
- Can be removed earlier if required
- Periods become shorter and lighter
Disadvantages:
- Irregular bleeding for first 6 months
- Chance of infection - should not be given if already have pelvic infection
- Some people get ovarian cysts
How does the copper coil work?
- Copper intrauterine device that becomes effective as soon as it is put in place
- Provokes a foreign body-type reaction, and the copper is spermicidal
Advantages and disadvantages of copper coil…
Advantages:
- Can be used for up to 5 days after unprotected sex
- Works for 5-10 years - providing long term protection
- Begins to provide protection instantly
Disadvantages:
- Periods may be heavier or longer
- Risk of pelvic infection
- Risk of malposition or uterine perforation
What are the different types of emergency contraception?
Levonergestrel (Levonelle):
- 1.5mg single dose
- Must be taken up to 72 hours from unprotected sexual intercourse
- Hormonal contraception can be started immediately after
Ulipristal (ella One):
- 30mg single dose
- Must be taken up to 120 hours (5 days) from unprotected sexual intercourse
- Barrier contraception should be used for 5 days after ella One, before restarting hormonal contraception
IUD :
- Must be inserted within 5 days of unprotected sexual intercourse
- Provides 99% effectiveness regardless of when in the cycle it was used
- Can be kept in to provide long term contraception
What is the upper limit of gestation, which is legally allowed for TOP?
24 weeks gestation
What are the recommended investigations before TOP procedure?
- USS to assess the pregnancy
- STI screen
- Rhesus status - give anti-D if negative
- VTE risk assessment
- Discuss future contraceptive methods - can insert IUCD during procedure
Different methods of TOP…
Method used depends on gestation of the foetus:
MEDICAL (0-13+6 weeks)
<9 weeks = 200mg PO Mifepristone + 800mcg vaginal Misoprostol 24 -48 hours later
9-13+6 weeks = 200mg PO Mifepristone + 800mcg vaginal Misoprostol 36-48 hours later, followed by 3 hourly 400mg vaginal misoprostol - up to maximum of 4 doses
SURGICAL (0-24 weeks)
<14 weeks = Vacuum aspiration
14-24 weeks = dilatation and evacuation
