Intro to Contraception Flashcards
What is Contraception?
Any method used to prevent a pregnancy
Can range from Blocking Sperm transport to Interrupting HPG axis to prevent ovulation and/or implantation
What are the 6 categories of Contraception
- Natural
- Hormonal (Short and long acting reversible)
- Barrier
- Prevention of implantation/ The Coil (IUD/ IUS)
- Sterilisation
- Emergency contraception
List 4 types of Natural Contraception
- Abstinence
- Withdrawal/ Coitus Interruptus
- Fertility awareness
- Lactational Amenorrhea
What is the only reliable method of contraception?
Abstinence
Describe the Fertility Awareness method of Natural contraception
- Avoiding intercourse around ovulation
Monitoring and recording fertility indicators;
- Basal body temperature
- Cervical mucus
(Unreliable, requires education, no STI cover)
Describe the Lactational Amenorrhea method of Natural contraception
How long is this effective for?
What are 3 disadvantages?
- Suckling response lowers GnRH release due to high PRL levels, thus lactation delays ovulation onset
- 6 months
- Relies upon exclusive breastfeeding
- No STI cover
- Unreliable
Barrier contraception prevents sperm entering cervix.
Give 3 examples
Give 3 disadvantages
- Male condoms
- Female condoms
- Diaphragms/ Cervical caps
(May involve spermicide use)
- Disrupts intercourse
- Risk of dislodging (Cap becomes loose)
- Allergy to latex
What are the 2 types of Hormonal Contraception?
Gives 2 examples of each type
Short acting reversible;
- POP (Progesterone Only Pill)
- COCP (Combined Oral Contraceptive Pill)
Long acting reversible;
- Progesterone injection
- Progesterone implant
Describe mechanism of the POP as a Short-acting reversible method of Hormonal contraception
How often is it taken and what effect does it have on period control?
- Low progesterone dose
- Not enough to inhibit ovulation, but thickens Cervical mucus
- Taken daily with no breaks, no effect on controlling periods
Why does usage of the POP pose a higher risk of Ectopic Pregnancy?
Does not inhibit ovulation and reduces function of Cilia-> Increased chance of ectopic pregnancy
Describe mechanism of the COCP as a Short-acting reversible method of Hormonal contraception
(Contains both Oestrogen and Progesterone)
How is it taken?
- Primary aim: Makes hypothalamus think it is in Luteal Phase, preventing Ovulation
- Secondary aims: Reduce endometrial receptivity, thicken cervical mucus
- Taken for 21 days with a 7 day break OR 21 days with 7 placebo pills
List 4 advantages of using COCP
- Reliable (Up to 99%)
- Can alleviate menstrual symptoms (Menorrhagia, Dysmenorrhea, Irregular periods)
- Reduce acne severity in some people
- Reduce risk of endometrial + ovarian cancer
How does COCP reduce the risk of ovarian and endometrial cancer
- Reduced number of times ovulation occurs
- Reduced endometrium proliferation
What are 5 disadvantages of using the COCP
- Interaction with other medications
- Increased risk of breast cancer
- Side effects (Breast tenderness, mood disturbance)
- User dependant
- Contraindications in those at risk of MI, Stroke (Oestrogen is thromboembolic, so must be stopped before surgery)
What do you tell a patient if they have missed 1 pill or stated a pack 1 day late?
- Take the last pill you missed even if it means taking 2 in one day
- Take the rest of the pack normally
- Do not need to use extra contracteption
What do you tell a patient if they have missed 2 pills or stated a pack 2 days late?
What if there are less than 7 pills left at the end of the pack?
- Take the last pill you missed, even if this means taking 2 pills in a day
- Leave any earlier missed pills
- Take the rest of the pack normally and use extra contraception
- Start the next pack the next day with no breaks
Compare Short and Long acting reversible contraception in terms of reliability on user
Unlike SARC, LARC is not reliable on user as they have a longer lasting effect so don’t need to remember to take a pill every day
Describe the Progesterone Injection
High IM dose of Progesterone every 12 weeks;
- Prevents ovulation
- Thickens cervical mucus
- Thins endometrial lining
Give 2 advantages and 3 disadvantages of the Progesterone Injection
- No known interactions with other medications
- Can be used if COCP is contraindicated
- Not rapidly reversible
- Delay in fertility returning
- Injection may be unpleasant
Describe the Progesterone Implant
How long does it last?
Small Subcutaneous tube inserted into arm, releases high progesterone;
- Thins endometrial lining
- Thickens cervical mucus
- Prevents ovulation
Can last up to 3 years
Give 2 advantages and 2 disadvantages of the Progesterone Implant
- Can be used if COCP is contraindicated
- Fertility returns faster than with injection
- Complications with insertion and removal
- Can cause menstrual irregularities (Amenorrhoea, Heavy periods, Spotting/ irregular bleeding)
Prevention of implantation using the coil is a long term, reversible method.
What are 2 types of intrauterine coil contraception?
Intrauterine System and Intrauterine Device (IUS and IUD)
Describe the IUS
How is ovulation affected?
In what patients is this method useful?
Coil releases progesterone locally;
- Prevents implantation
- Thins endometrial lining to prevent proliferation
- Thickens cervical mucus
- Ovulation usually continues
- Useful in patients with menorrhagia (as it thins endometrial lining)
Describe the IUD
Is it effective in those with menorrhagia?
Coil made of copper;
- Physical barrier to implantation
- Toxic to sperm and ova
- No, as it doesn’t contain progesterone to thin endometrial lining
What are the 3 disadvantages of using an IUD
- Can be difficult to insert
- Can displace/ cause perforation
- No STI protection
Sterilisation is generally irreversible.
What are 2 types
- Vasectomy
- Tubal ligation/ clipping
Describe a Vasectomy
- Vas Deferens snipped/ tied to prevent sperm entering ejaculate
- Samples must be provided afterwards to ensure effectiveness
Describe Tubal Ligation
- Fallopian tubes clipped to prevent Ovum entering uterus
- Slightly higher failure rate than vasectomy
What are 2 occasions Emergency contraception can be used
What are 3 types?
After Contraceptive Failure or UPSI (Unprotected Sexual Intercourse)
- Morning after pill/ Levonorgestrel
- Ulipristal acetate
- Copper IUD
Up to how many hours after UPSI can the ‘morning after pill’ be used?
Up to 72 hours, but most effective within 12 hours
Up to how many hours after UPSI can Ulipristal Acetate be used?
120 hours (5 days)
Up to how many hours after UPSI can a Copper IUD be used?
This is the most effective form of emergency contraceptive
120 hours (5 days)
