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Reproductive system > Lecture 13- Contraception > Flashcards

Lecture 13- Contraception Flashcards

1
Q

Definition:

A

any method to prevent pregnancy

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2
Q

Various methods of contraception (3)

A
  • Blocking sperm transport to avoid fertilisation of oocyte
  • Disruption of HPG axis- interfere with ovulation
  • Inhibit implantation of conceptus into endometrium
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3
Q

Categories of contraception

A
  • Natural
  • Barrier
  • Hormone control
    • short or long acting reversible
  • Prevention of implantation- IUD/IUS
  • Sterilisation
  • Emergency contraception
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4
Q

Barrier method

A
  • Provides physical +/- chemical barrier to stop sperm entering cervix
    • Male/female condoms
    • Diaphragms/cervical caps
    • Spermicides
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5
Q
  • Barrier method Advantages
A
  • Reliable
  • STI protection
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6
Q
  • Barrier method Disad
    *
A
  • Disrupts intercourse
  • Risk of dislodging
  • Allergy/ sensitivity to latex
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7
Q

Natural methods

A
  • abstincence
  • withdrawal
  • fertility awaness methods
  • lactational amenorrhoea method
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8
Q

abstinence advantages vs disad

A
  • Advantage- 100% effective
  • Disad
    • Not option for most
    • Unprepared if sexually active
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9
Q

coitus interruptus means

A

withdrawal method

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10
Q
A
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11
Q
  • Withdrawal- coitus interruptus advantages vs disadvantages
A
  • Advantages
    • No device or hormones
  • Disad
    • Unreliable
    • Pre-ejaculate
    • No STI protection
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12
Q

how does​ Fertility awareness methods work

*

A
  • Monitoring and recording fertility indicators throughout menstrual cycle:
    • Cervical secretions and changes in cervix
    • Body temp
    • Length of menstrual cycle- calendar method
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13
Q

Fertility awareness methods advantages and disadvantages

A
  • Advantages
    • No hormones/contraindications
  • Disad
    • Time consuming
    • Unreliable
    • No STI protection
    • Not suitable for all
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14
Q
  • Lactational amenorrhoea method
    • Breastfeeding after childbirth to avoid pregnancy
    • Delays return of ovulation
    • Can be used effectively for 6 month postnatally
      • Exclusive breastfeeding
      • Complete amenorrhea
A
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15
Q

Lactational amenorrhoea method​ advantages and disadvantages

A
  • Advantages
    • No hormones/contraindications
  • Disad
    • Unreliable after 6 months
    • No STI protection
    • Not suitable for all
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16
Q

Hormonal control works by

*

A
  • Interrupts HPG axis, prevents Ovulation, may effect endometrial lining
    • Short or long acting reversible contraception (LARC)
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17
Q

types of hormonal control

A
  • Combined oestrogen and progesterone- COCP, patch, ring
  • Progesterone only pill (POP)
  • LARC- progesterone depot and implant
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18
Q

role of progesterone

A

at high levels

  • enhances negative feedback of oestrogen hence
    • pre-ovulation- reduces FSH and LH
    • inhibtis positive feedback fo high oestrogen –> no LH surge –p> No ovulation

at low levels

  • does not inhibit LH surge–> can still obvulate
  • will thicken cervical mucus
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19
Q

COCP

A
  • Pill containing
    • Synthetic oestrogen and progesterone
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20
Q

how is the COCP (combine oestrogen and progesterone) taken

A
  • Usually taken 21 days with a 7 day break or 21 days + 7 placebo pills
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21
Q

main action of COCP

A
  • prevent ovulation – negative feedback of oestrogen and progesterone on LH surge
  • Secondary action- reduce endometrial receptivity to implantation
    • Thickens cervical mucus
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22
Q

advantages of COCP

A
  • Advantages
    • Reliable if used correctly 99%
    • Relieve menstrual disorders
    • Decrease risk of ovarian and endometrial cancer
    • Decrease acne severity in some
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23
Q

COCP disadvantages

A
  • Disad
    • User dependent
    • No STI protection
    • Medication interaction
    • Contraindications
      • Raised BMI
      • Migraine and aura
      • Breast cancer
    • Side effects
      • Menstrual irregularities
      • Breast tenderness
      • Mood disturbances
    • Increased risk of CV disease, stroke, VTE, breast cancer and cervical cancer
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24
Q

POP

A

progesterone only pill

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25
Q

what is POP

A

low dose progesterone

26
Q

main action of POP

A

thickens cervical mucous–> preventing entry of sperm

other action:

  • Reduced cilia activity in fallopian tubes
  • Ovulation not prevented
27
Q

How is POP taken

A

daily no break

28
Q

advantages of POP

A
  • Advantages
    • Reliable if used properly 99%
    • Can be used if COCP contraindicated
29
Q
  • Disad of POP
A
  • No STI protection
  • Strict timing- user dependent
  • Menstrual irregularities
  • Risk of ectopic pregnancy
30
Q

Progesterone injection

A

High dose progesterone- LARC e.g. depo-provera

31
Q

main action of progesterone injection

A
  • Inhibit ovulation, thicken cervical mucus, thin endometrial lining
32
Q

how is the progesterone injection delivered

A
  • Given intramuscularly every 12 weeks
33
Q
A
34
Q
  • Advantages of progesterone injection
A
  • Reliable
  • No known medication interactions
  • Can be used if oestrogen contraindicated and raised BMI
35
Q
  • Disadvantages of progesterone injection
A
  • No STI protection
  • Not rapidly reversible
  • Menstrual irregularities
  • Hard to get appointment
36
Q

Progesterone implant

A
  • Small subcutaneous tube inserted in the arm
  • High dose progesterone – LARC
37
Q
  • Main action of progesterone implant
A

Inhibit ovulation, thicken cervical mucus, thins endometrial lining

38
Q
  • Advantages of progesterone implant
A
  • Reliable
  • 3 years lasting
  • Can be used if oestrogen contraindicated and raised BMI
  • Fertility returns faster than injection
39
Q
  • Disad of progesterone implant
A
  • No STI protection
  • Menstrual irregularities
  • Complications with insertion and removal
40
Q

coil works by

A

inhibiting implantation

41
Q

types of coil

A

Intrauterine system (IUS)

Intrauterine device (IUD)

42
Q

Intrauterine system (IUS)

A

progesterone releasing coil- local

e.g. mirena

43
Q

Intrauterine system (IUS) main action

A

prevent implantation and reduces endometrial proliferation, thickens cervical mucus

ovulation usually continues

44
Q

intrauterine device- IUD

A

copper containing coil

45
Q

intrauterine device main and secondary actions

A

main action- copper is toxic to ovum and sperm preventing fertilisation

secondary action- cervical mucus changes, endometrial inflammatory reactions inhibits implantation

46
Q

Advantages of the coil

A
  • Convenient
  • 99% effective
  • LARC- 3-10 years
  • IUS for treatment of menorrhagia
47
Q

Disadvantages of the coil

A
  • No STI protection
  • Complications with insertion-perforation
  • Menstrual irregularities
  • Displacement/expulsion may occur
48
Q

sterilisation men

A

vasectomy

49
Q
  • Vasectomy
A
  • Vas deferens snipped or tied to prevent sperm entering ejaculate
  • Under local anaesthetic
  • Must do post-vasectomy semen analysis -12 weeks post
  • Failure rate 1 in 2000 men
50
Q

sterilisation female

A

tubal ligation

51
Q

Tubal ligation

A
  • Fallopian tube occluded to prevent ovum transport
  • Under local/ GA
  • Failure rate 1 in 200- 500 depending on method
52
Q

advantages and disadvantages of sterilisation methods (vasectomy and tubul ligation)

A
  • Advantages- permanent
  • Disad
    • No STI protection
    • Regret
    • Not easily reversed
    • No available under NHS
53
Q

emergency contraception used when

A

following unprotected sexual intercourse (UPSI) or contraceptive failure

54
Q

types of emergency contraception

A

levonorgestrel

ulipristal acetate

copper iud

55
Q

Levonorgestrel

A

morning after pill- high dose progestogen (artificial progesterone) - inhibits ovulation

56
Q

ulipristal acetate

A

selective progesterone receptor modulator- inhibits/delays ovulation

57
Q

choice of emergency contraception depends on

A

several factors

  • time

always think STI and safeguarding

58
Q

if UPSI within 72hours

A

levonorgestrel

  • maximum effect if taken within the first 12 hours
  • double dose in obese
59
Q

if UPSI +72h up to 120 hours

A

ulipristal (effectiveness may be reduced if patient has been taking progestogen) or copper IUD (most effective emergency contraception- can be left in situ for up to 10 years)

60
Q

contraceptive methods that dont depend on you remebering to take or use them

A
  • contraceptive implant
  • intrauterine device (IUD)
  • Intrauterine system (IUS)
  • contraceptive injection
  • sterilisation
61
Q

contraceptive methods that you have to think about regulalry or use each time you have sex

A
  • condom
  • diaphragm/ cap with spermicide
  • external condom
  • POP
  • COC
    Contraceptive patch
  • contraceptive vaginal ring
  • fertility awareness method
62
Q

summary of contraceptive methods- look in notes and read through pls and thanks :))))

A

Reproductive system (28 decks)

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