LARC Contraception Flashcards
How many babies are born every 2 seconds on the planet?
9
How many people die every 2 seconds on the planet?
3
What are the ideal features of a perfect contraception?
Effective Availability Easy to use Safe, free from side effects Cheap Reversible Not memory reliant
What is the most common method of contraception?
Withdrawl
What 5 things are part of natural family planning?
Basal body temperature Cervical mucous Cervical position "Standard" days Breast feeding
Describe the cervical mucous post ovulation
Thick and sticky
Describe how the cervical mucous is during ovulation
Thinner, watery and stretchy
What is the cervical position when fertile?
High in the vagina, soft and open
What is the cervical position when less fertile?
Low in vagina, firm and closed
What days in the cycle are the most fertile?
In a 28 day cycle… day 8-18
What is the criteria of breast feeding as a contraception?
Exclusively breast feeding
Less than 6/12 post natal
Amenorrhoeic
How effective is breast feeding as a contraception?
98%
What do you use to assess the patient before prescribing contraception?
UKMEC 2016 - UK Medical Eligibility Criteria
What are the 4 categories of the UKMEC?
- No restriction for use of contraception method
- Where advantages outweigh negatives
- A condition where use gives more disadvantage
- A condition that presents as an unacceptable risk if contraception used
What drugs can be used as the contraceptive pill?
Medroxyprogesterone acetate
(Depo Provera)
Sayana
How does the contraceptive pill work?
Inhibits ovulation Given every 13 weeks Will last 14 days Thickens cervical mucous Effects the endometirum
What examinations are done prior to contraception prescribing?
Record BP and BMI
Check smear test status
Consider osteoporosis risk factors
When do you start Depo?
Up to and including day 5 of the cycle without need for additional contraception
What points are important to remember?
Conception most likely if UPSI on day ovulation OR preceding 24hrs
Fertile period is highly variable
What happens when Depo is started beyond day 5?
Needs to use condoms or abstain for 7 days
What criteria is taken into account when deciding if the person is really ‘reasonably certain’?
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 pregnancy test and >3 wks since UPSI
What do you do if pregnancy can’t be excluded?
Pregnancy test after 3 weeks and give depo thereafter
What are side effects of depo?
Weight gain
Delay in return to fertility
Irregular bleeding
Osteoporosis risk
Is VLARC good?
Most cost effective
Describe the LARC - IUD?
T-shaped
Non-hormonal
Contain copper and plastic but can contain silver
What is the gold standard of a copper coil?
380mm2 copper
How does the coil work?
Prevents fertilisation
Inflammatory response in endometrium
What is IUS?
T shaped device with elastomere core
52mg LNG-IUS
ALso, 13.5mg
What drug is present with IUS?
Levanorgestrel
How does IUS work?
Effects implantation
Endometrium rendered unfavourable for implantation
Also effects cervical mucous and pre-fertilisation
What are the contraindications of the IUD and IUS?
Current pelvic infection Abnormal uterine anatomy Pregnancy Sensitivity to any of constituents Gestational trophoblastic disease when b-HCG levels are high/abnormal Endometrial/cervical cancer
What examinations are performed?
PV to check uterine size and position
BP and pulse
When can an IUD be fitted?
Within first 7 days of period
Up to 5 days after UPSI for emergency contraception
Up to 5 days after predicted ovulation date
When can an IUS be fitted?
Within first 7 days of a period
Not used for emergency contraception
What are side effects of IUD?
Heavy, prolonged menses Pain/infection PD within first 20 days Perforation Expulsion Higher post 2nd trimester abortion, post natal Ectopic risk
What are side effects of IUS?
Lighter, less frequent bleeding Pain/infection in first 20 days Perforation Expulsion Ectopic risk Failure
What is the implant?
Single, non biodegradable
Subdermal rod
What does the implant contain?
68mg ENG
releases 60/70ug per day in weeks 5-6
25-30ug per day at end of 3rd year use
How does the implant work?
Inhibition of ovulation
Effects endometrium and cervical mucous
When can the implant be fitted?
Within first 5 days
Up to day 5 post 1st/2nd trimester abortion
On or before day 21 post partum
What are side effects of the implant?
Irregular bleeding Weight gain Acne Nerve damage/vascular injury Deep insertion
What are health concerns regarding the implant?
No know risk on: Bone mineral density CV risk VTE risk MI risk
What drug interactions may the implant have?
Enzyme inducers
!Always check BNF!
