LARC Flashcards
What 5 methods constitute natural family planning?
1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding
Describe basal body temp methods
Taken before rising in morning
Increase in body temp > 0.2oC
Sustained for 3 days after at least 6 days of lower temp
Describe cervical mucus method
Thick and sticky post ovulation mucous
for at least 3 days after thinner, watery, “stretchy” mucous
Describe cervical position when fertile/when less fertile
When fertile….
Cervix is high in vagina, soft and open
When less fertile….
Cervix is low in vagina firm and closed
Standard days method - which days are most fertile in a 28day cycle?
Days 8 to 18 are most fertile
What 3 criteria is needed for breastfeeding to act as a contraceptive?
1) exclusively breast feeding
2) less than 6/12 post natal
3) amenorrhoeic
What are the 4 UKMEC categories?
1 No restriction for the use of the contraceptive method
2 Where the advantages of using the method generally outweigh the theoretical or proven risks
3 A condition where the theoretical or proven risks generally outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable
4 A condition which represents an unacceptable risk if the contraceptive method is used
How is failure rate of contraception worked out?
Pearl index:
-no. of contraceptive failure per 100 users per year
What LARC methods exist?
Injectable contraceptive: depo provera IM (medroxyprogesterone acetate)
What vLARC methods exist?
IUD
IUS
Implant
Depo provera:
- how does this work
- how is it given
- what other effects on the uterus does it have?
- failure rate?
- what is important to examine before starting a pt. on the depo?
- when can a depo be started?
- what are the side effects?
Primary action: inhibit ovulation
Given every 13 weeks
Will last 14 weeks
Other effects:
Effect on cervical mucus
Effect on endometrium
Failure rate: pearl index 0.2
Assessment:
- Record BP and BMI before first prescription
- Check smear status if relevant
- Consider risk factors for osteoporosis: Are there multiple risk factors?
Starting the depo:
- Standard Advice = Depo can be started up to and including Day 5 of the cycle without the need for any additional contraception
- Beyond Day 5 a woman can start the depo at any other time provided she is ‘reasonably certain’ she is not pregnant and needs to use condoms/abstain for 7 days
- post TOP up to day 5
- postpatum up to day 21 with immediate cover
Side effects:
- Weight gain
- Delay in return of fertility
- Irregular bleeding
- Possible risk of osteoporosis
What are risk factors for osteoporosis?
Underweight Anorexia Prolonged steroid use XS alcohol intake Immobility Family history Smoking Low trauma fracture
Chronic conditions: Hypothyroidism Coeliac disease Rheumatoid arthritis Hyperparathyroidism Inflammatory bowel disease Chronic renal disease
What is reasonably certain that a patient isnt pregnant?
- No sex since last period
- Consistently using reliable contraception
- < 7 days since last normal period
- < 4 wks post partum (not breast feeding)
- Fully breastfeeding, amenorrhoeic and < 6m post partum
- Negative preg test AND > 3 wks since UPSI
IUD:
- what is this?
- how does it work?
- how long is this used for?
- what is the failure rate?
- when can this be fitted?
- what are the adverse effects of IUD?
T shaped device with copper and plastic
Primary mode action:
Prevention of fertilisation (toxic to egg and sperm joining)
Also, Inflammatory response in endometrium
Licenced- 5-10years
Failure rate 0.6-0.8% (1/200)
Can be fitted:
-Within in the first 7 days of a period
-Any time provide reasonably certain not pregnant
-Up to 5 days after UPSI ( for Emergency contraception)
OR
-Up to 5 days after predicted date of ovulation
-Either within 48 hrs or > 4 weeks post partum
-Immediately post TOP ( if products of conception seen)
Adverse effects:
- Heavy , prolonged menses
- Pain, infection PID increased in first 20 days
- Perforation 1-2/1000
- Expulsion 1/20, most in first 3/12
- Higher post 2nd trim abortion, post natal
- Ectopic risk?? 0.08 per 100 women yrs (low but if do become pregnant, risk is 9-50%)
IUS:
- what are the different types?
- How does it work?
- when can an IUS be fitted?
- adverse effects of IUS?
Mirena: 52mg levonorgestrel
Jaydess: 13.5mg levonorgestrel
Primary mode of action:
- Effect on implantation: endometrium rendered unfavorable for implantation
- Also effect on cervical mucous and pre-fertilisation effects
Failure rate: 0.2% (1/500)
Can be fitted:
- Within the first 7 days of a period
- Any time provide reasonably certain not pregnant
- NOT used for EC
- If fitted out with first 7/7- use condoms for first 7/7
- Either with in 48 hrs or > 4 weeks post partum
- Immediately post TOP ( if products conception seen) up to day 7
Adverse effects: -Lighter, less frequent bleeding -Pain, infection PID increased in first 20 days -Perforation 1-2/1000 -Expulsion- same as IUD -Ectopic risk?? …….Overall 0.02 per 100 women yrs Maybe higher with lower dose version?? (0.1) -failure
