L09: Contraception And HRT Flashcards
What are the 3 main methods contraception aims to prevent pregnancy
1) Preventing ovulation
2) preventing fertilisation
3) preventing implantation of a fertilised egg
Does contraception include abortifacients
No
What happens to fertility as you age
Decrease
Is contraception 100% effective
No
What is the pearl index
Failure rate per 100 woman years of exposure
What is the typical use
Failure rate when used in real life e.g when patients forget to take the pill
What is the perfect use
The failure rate when method is consistent and correct at all time
What are the 2 broad categories of types of contraception
Methods with no user failure
Methods with user failure
What are the methods with no use failure
Intrauterine device IUD- copper
Intrauterine system- levonorgestrel hormonal coil
Implant: under the skin
Sterilisation (male and female)
What are the methods with user failure
Barrier: condones, diaphragm and cap
Hormonal: combined pill, patch, ring, POP injectable
Natural family planning and lactational ammenorhhea
Emergency contraception
What is the first of day of menstrual cycle
Day 1
What is the last day of menstrual cycle
Day 28
What happens to progesterone levels in the second half of menstrual cycle if there is pregnancy
Increases
What does the LH surge stimulate
Ovulation to kick off
What happen to oestrogen in the second half the cycle if there is pregnancy
Increases
What is new hormone is produced by the placenta that causes oestrogen and progesterone to rise
HCG
What are the barrier methods in males known as
Condom
Where is a condom places
Over an erect penis
What is the advantages of using a male condom
Protection against STI and HIV
What are barrier methods for females known as
Female condom
Diaphragm
Caps
Where is a female condom placed
Into the vagina which covers the lining of the vagina and partially the vulva
What is the advantage of using a female condom
STI and HIV protection
What do diaphragms and cap cover
Cervix
What has to be done to the diaphragm and cap after sexual intercourse
Left in for 6 hours after sex
What are the disadvantages of diaphragms and caps
Does not offer protection for STI and HIV
What can be used with diaphragm and caps
Spermicide
What are the risk of using a spermicide an diaphragm/cap
Increased risk of HIV transmission
What are the long acting reversible contraception methods
Intra uterine system- hormonal coil
Intra uterine device- copper coil
Implant
Progesterone only injection (POP)
What are the advantages of using long acting reversible contraception
Does not require memory
Is reversible
Administration is required less than once per cycle
What is the intra-uterine system
A coil that had levonorgestrel at the body
What hormone is levonorgestrel
Progesterone
What is the action of intra-uterine system
Thins endometrium
Thickens cervical mucus
Inhibit ovulation
What are the benefits of intra-uterine system
Reduce menstrual bleeding
Reduced painful bleeding
Reduce pain from endormetriosis
What are the disadvantages of intra-uterine system
Requires pelvic examination
Can lead to irregular bleeding up to 9 months
No STI protection
Benign ovarian cysts
Coils can become expelled: so patient has to feel for string
What are the contraindications of intra uterine system
Pregnancy
Post partum sepsis
Cardiac arrhythmias
What are the 4 types of intra-uterine system coils dependent on
Dosage of levonorgestrel
What is the intra uterine device
A t shaped coil that is made of copper
What is the mode of action of intra-uterine devices
The foreign body in the uterus prevents implantation
Copper is toxic to the egg and sperm
What are the advantage of intra uterine device i.e copper
Effective
Can be used as emergency contraception
Doesn’t involve hormones which some women will be sensitive to
What are the disadvantages of intra-uterine device
Requires pelvic examination May increase menstrual bleeding Painful periods No STI protection Risk of ectopic pregnancy if pregnancy occurs
What are the contraindication of intra uterine device
Same as IUS
What are implants
A device that sits under the skin in the harm
What hormone does implants contain
Etonogestrel
What is the duration of use of implants
3 years
What is the mode of action of implants
Inhibit ovulation
Thicken cervical mucus
What hormone is etonogestrel
Progesterone
What are the advantages of implants
Reduces heavy bleeding
Reduces painful bleeding
May reduce endometrial cancer
What are the disadvantages of implants
No protection for STI
Hormonal side effects
Irregular bleeding
Affected by enzyme inducer medication
What are the mode of action of progesterone only injectable
Inhibit ovulation
Thickens cervical mucus
Thins endometrium
What are the advantages of injectable
Reducing bleeding and pains
Reduces sickle cell crises if sickle cell disease
What are the disadvantages of injectable
No STI protection Irregular bleeding Delayed fertility up to 1 year Hormonal side effects Decreases bone mineral density (for 55+)
What hormones does combined hormonal contraceptive pill contain
Oestrogen
Progesterone
What forms can combined hormonal contraception be found in
Pill
Patch
Vaginal ring
What is the mode of action of combined hormonal contraception
Prevent ovulation
Thicken cervical mucus
Thin endometrium
What are the benefits of combined hormonal contraception
Gives regular bleeeding, lighter and less painful
Reduces pre-menstrual symptoms
Reduces ovarian cancer risk
Improve acne
What are the disadvantages of combined hormonal contraception.
Venous or arterial thrombosis Heart attack Breast cancer Cervical cancer Hypertension No STI protection
What is the effectives of combined hormonal contraception affected by
Enzyme inducers
What is the standard use regime to use combine hormonal contraception
Use 21 days with 7 days break (where you get the withdrawal bleed)
What is the combined hormonal contraception patch called
Evra
How many patches do you use for 1 week for 3 weeks
1
What is the brand for combined vaginal ring known as
Nuvaring
What is the oestrogen in the combined hormonal contraception called
Ethinyl estradiol
What is the progesteron only pill (pop)
A pill that contain progesterone only
What is the mode of action of pop
Prevent ovulation
Thin endometrium
Thicken cervical mucus
How long does it take for a pop to be effective
2 days
What are the benefits of pop
Can be used in breastfeeding
What drugs can pop not be used with
Enzyme induce drug
What are the disadvantages of pop
Hormonal side effects
No STI protection
Change periods
Memory dependent
What are the 2 natural family planing methods
Fertility awareness method
Lactational ammenorhhea
What is fertility awareness method about
Working out when you are the most fertile by looking at the indicators
What are the main fertility indicators
Basal body temperature
Cervical secretions
Length of menstrual cycle
When can you only use the fertility awareness methods
If you have a regular period
What are the disadvantages of fertility awareness method
Time consuming
Events such as illness can change indicators such as body temperature
What is lactational ammenorhhea for
Post partum women
What are the criteria’s needed for lactational amennorhea
Baby less than 6 months old
Women has remained ammenorhoic
Need to be regularly breastfeeding : every 4 hours and 6 hours at night
Have to breast feeding only : should not involve bottles
How many of the criteria’s should be met
All
What are the 2 types of sterilisation
Male sterilisation
Female sterilisation
What does male sterilisation involve
Cut and tie the vas deferens
What does the female sterilisation involve
Clipping the Fallopian tube
What are the disadvantages of sterilisation
Risk of regret as it is permanent
What is required for people wanting sterilisation
Counselling so they know the disadvantages
What are the 2 main categories of emergency contraception
Copper iud
Hormonal
What are the 2 hormonal pills used in emergency contraception
Levonorgestrel Ulipristal acetate (Ella one)
When can levonorgestrel be used
Up to 96 hours
When can ulipristal acetate (Ella one) be used
5 days
What is the definition of menopause for patients over the age of 45
Ammenorhhea for at least 12 months with no other cause
What is the definition of menopause for people under the age of 45
Amennorhea for at least 24 months with no other cause
Which hormonal emergency contraception is the most effective
Ella one
Why do we have symptoms in menopause as a result of
Low oestrogen
Low progesterone
What are the menopausal symptoms
Loss of libido Mood change Hot flushes Vaginal dryness Fatigue
What are the long term effects of oestrogen deficiency
Increased risk of mi
Osteoporosis
What treatment is offered to women with menopause symptoms
Hormonal replacement therapy
What are the types of hormonal replacement therapy
Combine (oestrogen and progesterone)
Oestrogen only
Who can receive eostrogen only
Woman with no uterus
What are the risk of hormonal replacement therapy
Increased risk of breast cancer
How does using spermicide increase the risk of STI
Spermicide can irritate the vagina and make it easier for STD germs to enter the body
Up to how many days can copper IUD be inserted after unprotected sexual intercourse
5 days after UPSI
Up to how many days can you insert the copper IUD after the earliest estimated ovulation
5 days therefore if the average cycle is 28 days at 14 days ovulation occurs, + 5 days= 19 day. Therefore at day 19 it can be inserted.
