Lecture 11: Contraception Flashcards
What are the types of contraception?
- Barrier Methods
- Chemical Methods
- Hormonal Methods
- Device; inert + medicated
- Surgical sterilisation
- ‘natural’ methods
What are three examples of the barrier method?
Condoms
Femadon
Cap/diaphragm
Write some shorts notes about condoms;
Condoms;
- protect against pregnancy and STIs
- Cheap and readily accessible
- Easy storage
- Correct use is essential i.e not re-used
Write some short notes about femadons;
Femadon;
- expensive
- single use
- questionable protection against sti
Write some short notes on cap/diaphragm;
Cap diaphragm;
- can leave in place 24-48hrs
- can use in conjunction with spermicide
- Must be fitted
- Questionable STI protection
Write some short notes on the chemical method of contraception
Spermicide agents
- nonoxynol-9 is a surfactant (detergent)
It disrupts the acrosomal membrane
What are the hormonal methods of contraception?
The pill
i. e
- Combined oral contraceptive (COC)
- Progesterone only pill (POP)
Write some short notes about the types of COC;
21 or 24 day
Mono, bi or triphasic
What are the good effects of the COC
- Effective
- Convenience, not-intercourse related
- Reversible
- Reduced incidence of disease
- Improvement of menstural cycle disorderd
What disease incidence does COC reduce?
- Endometrial cancer (50%)
- Ovarian cancer (50%)
Both these effects last 15 years once COC stops
What menstural cycle disorders does the COC improve?
- Cysts of ovary
- PID
- benign prostate disease
- Endometriosis
- Benign retention
- Acne
Describe the COC and breast cancer risk;
Appears to be a slight increase in risk of breast cancer in women who use COC and this is greater in those who start as young teenagers
Risk returns to normal 10 years after stopping the pill
What are other hormone relates factors that increase risk of breast cancer?
- Beginning mensturation at an early age
- experiencing menopause at a late age
- Later age at first pregnancy
- Not having children at all
What are the absolute contraindications of COC?
Past or present circulatory disease
- intravascular thrombosis
- IHD or angina
- hyperlipidemia
(reasons why you shouldnt be on the pill)
What may COC cause?
Venous thromboembolism
risk; 1 in 30,000
What does the COC do?
Surpress FSH and LH release
What may mean you are not protected from pregnancy if you take the pill?
May not be protected from pregnancy if you;
- Miss 2 hormone pills or take them more than 12 hrs after the normal time
- vomit within 3 hrs of taking two hormone pills or have continued vomiting
- severe diarrhoea
- Are taking other medications e.g antibiotics, laxatives, grapefruit
What are the forms of progesterone contraception?
- POP
- Injection (depo provera)
- Implants (jadelle)
- IUD
What is the action of progesterone contraception?
- Make cervical mucous impenetrable to sperm.
- Changes endometrial lining and prevents implantation
- Blocks ovulation (anvoulation, insufficient luteal phase)
Describe sperm penetration after POP
A few hours post POP ingestion, sperm penetration (through cervical mucous) is significantly reduced. at around 22-24 hrs penetration rapidly increase thus POP must be taken every 24 hrs!!
Why use POP?
Oestrogen (COC) contraindication;
- Thromoembolic disease / hypertension
- Smokers
- over 35
- Lactation
In which subset of the population is the POP more effective in?
Older women, failure rate is lower
This is because they are more capable of taking the pill same time every day
Does the POP affect breast feeding?
- No effect on milk supply
- No difference in infant growth
- 1 pill dose passed to babe in four years of lactation
Write some short notes on the depo provera;
- Injection first five days every 8-12 weeks
- Highly effective (0-1% failure)
- Forgettable as independent of intercourse
What are the down sides to the depo?
- Not immediately reversible
- Bleeding, amenorrhoe and weight gain
What sorts of bleeding can the depo create?
- Amenorrhoe
- 30% by 3 months
- 60% by 12 months
- 68% by 24 months
- Irregular spotting
- <12% by 12 months
Heavy prolonged bleeding
- 1-2%
Describe depo and weight gain
- Some studies do indicate weight gain, but they often have problems with methodology. i.e lac of placebo or weight measurement prior to trial
- A long term prospective study showed no significant wieght gian in 50 depo vs 50 IUD users
What is a jadelle implant?
Jadelle;
- Two thin felxible rods
- 75mg of LNG per rod
- Norplant and jadelle have almost identical clinical performance
What is the method of action for implants?
- Induces cervical mucous thickening
- may suppress ovulation
- Steady release of progestins
- Rapidly reversible
What are the failure rates and symptoms of side effects for implants?
<1% failure in first year
<1.6% failure within five years
Side effects;
- Bleeding, amenorrhoea, acne, headache
What is an IUD?
Copper wire
- toxic to sperm
- changes uterine environment
- prevents fertilisation and blocks implantation
Write some short notes on IUD
- Failure rates vary, 0.4 per 100 women
- Forgettable and no link with intercourse
- Duration can exceed ten years
- Association with infections, pain, bleeding
What a type of IUD that has hormonal features?
Mirena LNG IUD
- Effects locla, cervical mucous and endometrium
- Systemic LNG 50% that of POP
- Return of fertility rapidly
What are the types of sterilisation?
Tubal ligation
Vasectomy
Write some short notes on tubal ligation;
- Sutures, clips/rings, cauterisation
- Prevent egg from reaching uterus
- Easy compliance
- Permanent
- Major surgery
Write some short notes on vasectomy;
Vasectomy;
- Vas deferns are cut
- Prevent sperm in ejaculate
- simple and easy access
- minor surgery
- inexpensive
- safe and effective
What are the natural methods?
- Abstinence
- Withdrawal
- Timed intercourse
for contraception or fertility- Basal body temperature
- Cervical mucous
How does breast feeding infleunce fertility?
- The prolactin produced in lactation can suppress FSH and LH secretion
- Not a great contraceptive
