Long-acting Contraceptives Flashcards
What is measured for the natural family planning method of contraception?
Basal body temp Cervical mucus Cervical position Standard (fertile) days Breast feeding
What is cervical mucus like:
post-ovulation
ovulation and 3 days after?
Post-ovulation - thick and sticky
Ovulation and 3 days after - thin, watery, stretchy
What position is the cervix when the woman is:
fertile
less fertile?
Fertile - cervix is high in vagina, soft and open
Less fertile - cervix is low in vagina, firm and closed
On what days of menstrual cycle is the woman most fertile?
Days 8 - 18
What are the 3 criteria for using breast feeding for natural family planning?
Exclusively breast feeding
Less than 6 months post-natal
Amenorrhoeic
What is the pearl index for contraception?
Failure rate
i.e. the number of contraceptive failures per 100 women users per year
How is the pearl index worked out?
Number of estimated accidental pregnancies x 1200/ total number of months of exposure
What are the main types of long acting reversible contraception? and it’s pearl index?
Injectable contraceptive -
Depo provera IM
Sayana press (sub cut)
Pearl index - 0.2%
What is the mode of action of depo provera?
Inhibit ovulation
(also thickens cervical mucus
and makes endometrium thin)
How often is depo provera given?
Every 13 weeks (will last 14)
What are prior examinations that need to be done before giving depo inj?
BP
Smear status
Risk factors for osteoporosis
What are the modifiable risk factors for osteoporosis?
Underweight Prolonged steroid use Excess alcohol intake Immobility Smoking
What are the unmodifiable risk factors for osteoporosis?
Hypothyroidsm Coeliac disease Rheumatoid arthritis Hyperparathyroidism IBD Chronic renal disease
How long does it take to inhibit ovulation?
7 days
On what day of menstrual cycle should depo be started to avoid need for additional contraception?
Day 5
On what day of menstrual cycle are women most fertile?
Day 14 (ovulation) - therefore give depo on day 5 (takes 7 days to inhibit ovulation) = day 12 i.e. before the woman is most fertile/ ovulates
How long can sperm live once past the vagina?
7 days
What are the criteria to say you are ‘reasonably certain’ a woman is not pregnant?
No sex since last period
Consistently using reliable contraception
<7 days since last normal period
<4 weeks post-partum and not breastfeeding
Fully breastfeeding, amenorrhoeic and <6 months post-partum
Negative pregnancy test and >3 weeks since unprotected sexual intercourse (UPSI)
Side effects of depo?
Weight gain due to appetite stimulation
Delay in return of fertility
Irregular bleeding
Risk of oestoporosis
How long can it take for fertility to return after stopping depo injections?
18 months
What are the types of very long acting reversible contraception?
Intrauterine device
Intrauterine system
Implant (progesterone)
How does the intra-uterine device work?
Prevents fertilisation
Copper is toxic to ovum and sperm joining
How can the IUD be used as emergency contraception?
It products an inflammatory response in endometrium which is toxic for the fertilised ovum
How long can the IUD be used for?
5-10 years
What is the pearl index of IUD?
0.6-0.8% (i.e. 1/200 women will accidentally become pregnant)
When can the IUD be fitted?
Within the first 7 days of period (stopping implantation, not trying to stop ovulation)
Any time as long as reasonably certain not pregnant
Within 48hours or > 4 weeks post partum
Immediately post TOP
When can the IUD be fitted for emergency contraception?
Up to 5 days after unprotected sex
What are the SE of IUD?
Heavy, prolonged menses Pain, infection and PID risk in first 20 days Perforation Expulsion Ectopic risk
What are the contraindications for IUD?
Current pelvic infection
Abnormal uterine anatomy
Pregnancy
Sensitive to the materials - Wilson’s disease
Gestational trophoblastic disease when the bHCG levels are abnormal or persistantly elevated
Endometrial cancer
Cervical cancer awaiting treatment
What are the types of intra-uterine system?
52mg progesterone (mirena) 13.5mg (jaydess)
What is the form of progesterone used in IUS?
Levonorgestrel (LNG)
What is the Mirena IUS used for?
Contraception
Heavy periods
HRT
Why is Jaydess IUS not licensed for heavy periods or HRT?
Because it contains less hormone than mirena
What is the mode of action for IUS?
Makes endometrium unfavorable for implantation
Also thicken cervical mucus
What is the pearl index of IUS?
0.2% (1/500)
When can the IUS be fitted?
Within first 7 days of a period
Anytime if reasonably certain not pregnant
Within 48hrs or >4 weeks postpartum
Immediately post TOP
Why can’t the IUS be used for emergency contraception?
Takes 7 days to have effect
What are the SE of IUS?
Lighter, less frequent bleeding Pain, infection and PID increase in first 20 days Perforation Expulsion Possible ectopic risk Failure
What are contra-indications for IUS?
Current pelvic infection Abnormal uterine abnormality Pregnancy Gestational trophoblastic disease when bHCG levels are abnormal / persistantly elevated Endometrial cancer Cervical cancer awaiting treatment
How long is the implant licensed for?
3 years
What form of oestrogen does the implant contain?
Etonogestrel (ENG) - 68 microgram
What is the mode of action of implant?
Inhibit ovulation
What is the pearl index of implant?
0-0.1%
When can the implant be fitted without any need for additional contraception?
Within first 5 days of cycle
Up to day 5 post first/ second trimester abortion
On or before day 21 post-partum
Side effects of implant?
Irregular bleeding
Weight gain
Acne
Nerve damage or vascular damage
