Lecture 13- Contraception Flashcards
1
Q
Definition:
A
any method to prevent pregnancy
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
3
Q
Categories of contraception
A
- Natural
- Barrier
- Hormone control
- short or long acting reversible
- Prevention of implantation- IUD/IUS
- Sterilisation
- Emergency contraception
4
Q
Barrier method
A
- Provides physical +/- chemical barrier to stop sperm entering cervix
- Male/female condoms
- Diaphragms/cervical caps
- Spermicides
5
Q
- Barrier method Advantages
A
- Reliable
- STI protection
6
Q
- Barrier method Disad
*
A
- Disrupts intercourse
- Risk of dislodging
- Allergy/ sensitivity to latex
7
Q
Natural methods
A
- abstincence
- withdrawal
- fertility awaness methods
- lactational amenorrhoea method
8
Q
abstinence advantages vs disad
A
- Advantage- 100% effective
- Disad
- Not option for most
- Unprepared if sexually active
9
Q
coitus interruptus means
A
withdrawal method
10
Q
A
11
Q
- Withdrawal- coitus interruptus advantages vs disadvantages
A
- Advantages
- No device or hormones
- Disad
- Unreliable
- Pre-ejaculate
- No STI protection
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
13
Q
Fertility awareness methods advantages and disadvantages
A
- Advantages
- No hormones/contraindications
- Disad
- Time consuming
- Unreliable
- No STI protection
- Not suitable for all
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
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
16
Q
Hormonal control works by
*
A
- Interrupts HPG axis, prevents Ovulation, may effect endometrial lining
- Short or long acting reversible contraception (LARC)
17
Q
types of hormonal control
A
- Combined oestrogen and progesterone- COCP, patch, ring
- Progesterone only pill (POP)
- LARC- progesterone depot and implant
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
19
Q
COCP
A
- Pill containing
- Synthetic oestrogen and progesterone
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
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
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
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
24
Q
POP
A
progesterone only pill
25
what is POP
low dose progesterone
26
main action of POP
thickens cervical mucous--\> preventing entry of sperm
other action:
* Reduced cilia activity in fallopian tubes
* Ovulation not prevented
27
How is POP taken
daily no break
28
advantages of POP
* Advantages
* Reliable if used properly 99%
* Can be used if COCP contraindicated
29
* Disad of POP
* No STI protection
* Strict timing- user dependent
* Menstrual irregularities
* Risk of ectopic pregnancy
30
**Progesterone injection**
High dose progesterone- LARC e.g. depo-provera
31
main action of progesterone injection
* Inhibit ovulation, thicken cervical mucus, thin endometrial lining
32
how is the progesterone injection delivered
* Given intramuscularly every 12 weeks
33
34
* Advantages of progesterone injection
* Reliable
* No known medication interactions
* Can be used if oestrogen contraindicated and raised BMI
35
* Disadvantages of progesterone injection
* No STI protection
* Not rapidly reversible
* Menstrual irregularities
* Hard to get appointment
36
**Progesterone implant**
* Small subcutaneous tube inserted in the arm
* High dose progesterone – LARC
37
* Main action of progesterone implant
Inhibit ovulation, thicken cervical mucus, thins endometrial lining
38
* Advantages of progesterone implant
* Reliable
* 3 years lasting
* Can be used if oestrogen contraindicated and raised BMI
* Fertility returns faster than injection
39
* Disad of progesterone implant
* No STI protection
* Menstrual irregularities
* Complications with insertion and removal
40
coil works by
inhibiting implantation
41
types of coil
Intrauterine system (IUS)
Intrauterine device (IUD)
42
Intrauterine system (IUS)
progesterone releasing coil- local
e.g. mirena
43
Intrauterine system (IUS) main action
prevent implantation and reduces endometrial proliferation, thickens cervical mucus
ovulation usually continues
44
intrauterine device- IUD
copper containing coil
45
intrauterine device main and secondary actions
main action- copper is toxic to ovum and sperm preventing fertilisation
secondary action- cervical mucus changes, endometrial inflammatory reactions inhibits implantation
46
**Advantages of the coil**
* Convenient
* 99% effective
* LARC- 3-10 years
* IUS for treatment of menorrhagia
47
**Disadvantages of the coil**
* No STI protection
* Complications with insertion-perforation
* Menstrual irregularities
* Displacement/expulsion may occur
48
sterilisation men
vasectomy
49
* **Vasectomy**
* 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
sterilisation female
tubal ligation
51
Tubal ligation
* Fallopian tube occluded to prevent ovum transport
* Under local/ GA
* Failure rate 1 in 200- 500 depending on method
52
advantages and disadvantages of sterilisation methods (vasectomy and tubul ligation)
* Advantages- permanent
* Disad
* No STI protection
* Regret
* Not easily reversed
* No available under NHS
53
emergency contraception used when
following unprotected sexual intercourse (UPSI) or contraceptive failure
54
types of emergency contraception
levonorgestrel
ulipristal acetate
copper iud
55
Levonorgestrel
morning after pill- high dose progestogen (artificial progesterone) - inhibits ovulation
56
ulipristal acetate
selective progesterone receptor modulator- inhibits/delays ovulation
57
choice of emergency contraception depends on
several factors
- time
always think STI and safeguarding
58
if UPSI within 72hours
levonorgestrel
- maximum effect if taken within the first 12 hours
- double dose in obese
59
if UPSI +72h up to 120 hours
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
contraceptive methods that dont depend on you remebering to take or use them
* contraceptive implant
* intrauterine device (IUD)
* Intrauterine system (IUS)
* contraceptive injection
* sterilisation
61
contraceptive methods that you have to think about regulalry or use each time you have sex
* condom
* diaphragm/ cap with spermicide
* external condom
* POP
* COC
Contraceptive patch
* contraceptive vaginal ring
* fertility awareness method
62
summary of contraceptive methods- look in notes and read through pls and thanks :))))
