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Reproduction, Development and Aging COPY > Lecture 18: Avoiding Pregnancy Contraception > Flashcards

Lecture 18: Avoiding Pregnancy Contraception Flashcards

1
Q

What is the legal age of consent?

A

16 but studies show that up to 30% of NZ teenagers have had sex before 15

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2
Q

What is contraception?

A

A method of preventing pregnancy via interference with ovulation, fertilisation or implantation

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3
Q

Around what day after fertilisation does the egg implant?

A

Day ~8

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4
Q

How do you calculate the date of ovulation

A

Count backwards from the period

Day 14 in 28 day cycle

Day 16 in 30 day cycle

Day 12 in 26 day cycle

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5
Q

What are the characterisitics of the “perfect” contraceptive

A

1) 100% effective
2) 100% convinient
3) 100% safe
4) 100% reversible
5) Maintenance free
6) Non contraceptive benefits
7) Inexpensive
8) Acceptable to the user

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6
Q

What is the UK MEC?

A

Medicine eligibility criteria

Evidence based guidance for providers of contraception

MEC 1: No restriction on use

MEC 2: Advantages of use of method generally outweight the disadvantages

MEC 3: Disadvantages of use generally outweigh the advantages

MEC 4: Do not use under any circumstances

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7
Q

What are the stats of effectiveness of different types of contraception?

A
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8
Q

What is the difference between perfect use and typical use?

A

Perfect use = never miss an appointment, always take on time etc.

Typical use = What people usually use

Bit disparity. The perfect use is very different to perfect use

IUD and implant are the only ones that have similar rates between perfect and typical use.

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9
Q

Describe the Combined oral contraceptive pill

How do they work? (4)

A

1) Suppress ovulation ** main action

2) Reduce sperm transport in upper genital tract (fallopian tube)
3) C_hange endometrium_ making implantation less likely
4) Thicken cervical mucus (preventing sperm penetration)

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10
Q

What are the advantages and disadvantages of the Combined oral contraceptive pill?

A

Advantages

  • Available everywhere
  • Trusted
  • Everyone knows about it
  • Can stop whenever you want
  • Has non-contraceptive benefits (e.g. reduces ovarian cancer and endometrial cancer)

Disadvantages

  • 9% failure rate
  • Complicated to take (mis-pill rules are complex)
  • Lots of reasons why people can’t take it (especially older patients who smoke or BMI
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11
Q

How does the Combined oral contraceptive pill work?

A

The estrogen in the pill overrides the hormone cycle needed in an ovulation (e.g. no LH surge)

The combined oral contraceptive pill (usually just called the pill) contains both oestrogen and progestogen.

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12
Q

If someone comes in asking for the Combined oral contraceptive pill, what should you ask them?

A

If they suffer from focal migrains

History

Smoking

Weight

Epileptic

BP

Why now?

Already sexually active? Have they used other contraception?

Menstrual cycle

STI risk assessment

Stress advanges, dicuss any preconceptions

Missed pill instructions

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13
Q

What happens during the pill-free interval?

A

In the pill-free interval (the 7 days), the estrogen is being withdrawn and FSH increases

The LH surge is triggered- Ovulate

The most risky time to miss a pill is during the first week after the 7-day break. If you miss a pill in this time and have had sex, you have a higher risk of getting pregnant and may want to consider the emergency contraceptive pill.

If you miss a pill during days 7 to 14, you are less likely to get pregnant. Seek help if you are worried about missing a pill.

If you miss a pill in the third week, you are unlikely to get pregnant, but you must skip the 7-day break and go straight to the first active pill in the next packet

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14
Q

When people start the pill (OCP) are they protected straight away?

A

D1-5 of cycle, they are protected straight away

If they start later in the cycle (and reasonably sure they’re not pregnant- no sex since the last cycle)- they need to take 7-day precautions

(no interaction with antibiotics- expect rifampicin, which is rarely encountered)

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15
Q

How does the POP pill work?

A

Progesterone only pill

Take every day

Mainly works by thickening the cervical mucus.

This effect is maximal 48 hours after starting the POP

Funded POP has only a small window of opportunity- relying on the cervical mucus effect

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16
Q

When would we use POP?

A

Progesterone only pill

Useful if unable to take OCP or if they’re breastfeeding

Funded POP has only a small window of opportunity- relying on the cervical mucus effect

Cerazette has a much lower failure rate due to its suppression of ovulation and a 12-hour window but it’s unfunded

17
Q

Describe LARC

Definition

Benefit

NZ related issues

A

Long acting reversible contraception

Definition: requires administration less than once per month

Benefits: cost effective even after 1 year of use

NZ related issues: training and accessibility (including cost)

18
Q

Describe DEPO

(advantages, disadvantages)

A

Depo Provera is a contraceptive injection containing progestogen. It is commonly referred to as “the injection” or “DP”.

Progestogen is similar to one of the hormones produced naturally by a woman’s ovaries. The injection is given every 12 weeks.

  • 12 weekly injection
  • Prolonged amenorrhoea, weight gain
  • Delayed return of fertility
  • Oestrogen free- fewer restrictions than the OCP
19
Q

How does the DEPO work?

A

Depo Provera is a contraceptive injection containing progestogen. It is commonly referred to as “the injection” or “DP”.

Progestogen is similar to one of the hormones produced naturally by a woman’s ovaries. The injection is given every 12 weeks.

Supresses hormones responsible for ovulation

Thickens cervical mucus to block sperm

20
Q

What is Jadelle?

A

The implant or “the rods” are a type of long-acting reversible contraception (LARC).

Implanted into inner aspect of upper arm

Lasts 5 years

Some problems with bleeding (14%) but high satisfaction rate

21
Q

How does the jadelle work?

A

1) Prevents ovulation
2) Alters endometrium (makes it thin so nothing can implant)
3) Thickens cerval mucus

22
Q

Describe copper IUD

A

The IUD is a type of long-acting reversible contraception (LARC) that goes in your uterus.

An IUD is a small, T-shaped object that goes inside your uterus.

  • There are two types of IUDs:
    • Copper IUD - contains copper, a type of metal
    • Hormonal IUD – contains the hormone progestogen (Mirena or Jaydess)

Lasts 10 years

Can cause periods to be heavier and/or more painful

Cheap

23
Q

How do IUD-copper work?

A

An IUD is a small, T-shaped object that goes inside your uterus.

  • Inserted via the cervix to sit in the uterus
  • The copper is directly spermatoxic so fertilisation does not take place
  • It also creates an _inflammatory reactio_n in the endometrium so that implantation does not work
  • Very very effective
  • Can be used as post-coidal contraception
  • No need to swab pre-fit: take a sexual history and assess the risk
  • Gold standard for emergency contraception
24
Q

Describe Mirena IUS

A

It is an IUD which releases a progestogen hormone to stop conception and help reduce heavy periods.

A significant advantage of Mirena is that it usually reduces blood loss during menstruation by up to 75 percent

Not funded in NZ as contraception

25
Q

How does the mirena work?

A

1) Make endometrium thinner
2) Creates unfavourable environment for the sperm in the uterus and the fallopian tubes so fertilisation is prevented
3) Makes cervical mucus thicker so that sperm passage is obstructed

26
Q

What are the indications for Mirena?

A

1) Heavy menstrual beleeding
2) Contraception
3) Endometrial protection with HRT (Hormone replacement therapy)

Also used to decrease dysmeorrhoea, m_ild endometriosis,_ and endometrial hyperplasia

27
Q

Describe the emergency contraception

A

Licenced up to 72 hours following UPSI

Efficacy decreases with time (85% at 72 hours)

Main action is to postpone/prevent ovulation. Postpones ovulation for 5 days (how long sperm lasts) by which time no active sperm in the genital tract

At/after ovulation, effect is no better than placebo. (so find out their menstural cycle)

IUD-copper is a better option.

28
Q

Describe Cooper IUD as an emergency contraception

A

Copper IUD can be used up to _5 days after ovulation (_D19 of a 28 day cycle)

(because implantation occurs at day 8, so we know that as long as we can say that it’s within 5 days, you are not terminating a pregnancy)

Weight is not a factor

Anti implantation and (primarily) anti fertilisation effects

Provide on-going contraception

Reproduction, Development and Aging COPY (32 decks)

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