Long Acting Reversible Contraception Flashcards
What are the physical reasons people have sex?
Sexual pleasure, release of sexual tension, attraction to person, stress relief, mood booster, exercise
What are the emotional reasons for having sex?
Love, commitment, sexual curiosity and novelty, nurturance, gratitude, need for affection
What are some reasons motivated by insecurity that people have sex?
To boost self-esteem/social status, to keep partner, feeling sense of duty, wanting to fit in, external pressure
What are some goal-based reasons for people wanting to have sex?
To improve social status and reputation, to enhance power, to seek revenge or cause jealousy, for financial/material gain, to make a baby
How many women get pregnant in a year when not using contraception?
85% = around 40% of pregnancies in UK are unplanned
What are the mechanisms of action of contraceptives?
Prevent ovulation, fertilisation or implantation
How do contraceptives prevent ovulation?
Work by suppressing LH and FSH (e.g most hormonal methods)
How do contraceptives prevent fertilisation?
Work by creating a mechanical/surgical barrier or by direct toxicity = condoms, diaphragms + spermicide, sterilisation, IUD, hormonal methods
How do contraceptives prevent implantation?
Works by creating hostile endometrium or direct toxicity = intrauterine and hormonal methods
What are some contraceptive methods that cause ovulation suppression?
Combined hormonal contraception, medroxyprogesterone acetate, subdermal implant, lactational amenorrhoea method, desogestrel-containing progestogen only pill, IUS (coil)
What are some contraceptives that work by thickening the cervical mucous?
IUS, medroxyprogesterone acetate, progestogen only pill, subdermal implant
What contraceptives have direct toxic effect?
IUD and spermicides
What are some methods that create a mechanical barrier to prevent pregnancy?
Condoms, diaphragm, cervical caps
What are some contraceptive methods that cause endometrial changes?
IUS, IUD, subdermal implant, medroxyprogesterone acetate, progestogen only pill, combined hormonal contraception
What are the different classifications of contraception?
Hormonal methods = ring, patch, DMPA injection, pill
Barrier methods
Intrauterine methods = IUD, IUS
Permanent methods = sterilisation
Emergency methods = emergency IUD or pill
Fertility awareness methods
What are some factors that influence choice of contraception?
Personal preference, age, mental capacity, child protection/wellbeing concerns, lifestyle, allergies, weight, BMI, blood pressure
What sexual factors should be considered when choosing a contraceptive method?
Frequency and type of sex, relationship status, pregnancy risk and future pregnancy plans
Medical, surgical and obs & gynae history
What are some child welfare concerns that may arise when seeking contraception?
Intercourse or any other sexual activity < age 13
Partner = age gap >=2 years, power imbalance, coercion
Drug/alcohol use, especially during sex
What are some things that a patient will have to weigh up the acceptability of when choosing contraceptives?
Amenorrhoea, irregular bleeding, side effects or invasive procedure
What are some non-contraceptive benefits of hormonal contraception?
Reduce period pain, heavy menstrual bleeding, irregular PV bleeding, ovulation pain, PMS, cyclical breast tenderness, ovarian cysts, endometriosis, ovarian cancer, acne/hirsutism (CHC)
What are some highly effective methods of contraception?
Subdermal implants, vasectomy, IUS, female sterilisation, IUD
How can user failure occur when using condoms?
Used too late, wrong lube, wrong technique, inconsistent use, wrong storage
How can user failure occur when using a diaphragm?
Used too late, removed too early, wrong technique, inconsistent use, no damage checks, no replacement
How can hormonal methods of contraception be used incorrectly?
Inconsistent use, late injection, wrong use or storage, late replacement when coming out, drug interactions
What are some iatrogenic reasons for user failure when using contraception?
Poor or wrong instructions, no support, no extra precaution recommended when quickstarting, drug interaction, incorrect insertion
What kind of failure rate do long acting reversible contraceptives have?
Equal user failure rate to method failure rate
How long do intrauterine contraception last for?
Between 3-10 years depending on device = have less than 1% failure rate
What are the types of intrauterine contraception?
Intrauterine device (IUD) = copper coil Intrauterine systems (IUS) = hormonal coil
How does intrauterine contraception work?
Mainly prevent fertilisation but also prevent implantation
What are the negatives of intrauterine contraceptives?
Invasive = quick but often painful insertion
Carry small risk of perforation, PID and malposition
How painful can intrauterine contraceptives be?
Pin scale is 3/10 for parous women and 5/10 for nulliparous women
How long do IUDs last for?
Up to 10 years = if inserted >= 40 years can be kept until menopause
What are some features of IUDs?
Non-hormonal
Can be used as emergency contraception
What is a possible side effect of IUDs?
Often make periods heavier, longer and more painful = especially in first 3 months, NSAIDs can help with pain
What may be the only contraceptive method that will be suitable for women post-breast cancer?
IUD
Are IUDs or IUSs more effective?
IUS
What are the 4 main types of IUS?
Mirena, Levosert, Kyleena, Jaydess
What are some features of the Mirena IUS?
Licensed to treat heavy periods, can be part of HRT and can be used for endometriosis or hyperplasia
50% amenorrhoea at 6 months
What are some features of IUS?
Spotting common in weeks-months after insertion
Systemic hormone levels very low = hormonal side effects uncommon
What does the UK MEC stand for?
UK Medical Eligibility Criteria for contraceptive use
What are the categories in the UK MEC?
1 = always useable 2 = broadly useable 3 = caution 4 = do not use
What are categories 1 and 2 described as in the UK MEC?
1 = a condition for which there is no restriction for use of contraceptive method 2 = a condition where the advantages of using the method generally outweigh the risks
What are categories 3 and 4 described as under the UK MEC?
3 = a condition where the risks generally outweigh the advantages of using the method (need expert opinion) 4 = a condition which represents unacceptable risk if the contraceptive method is used
What are the main themes in the UK MEC?
VTE risk, CVD risk, liver problems, hormone dependent tumour
What is the UK MEC to be used as?
Acts as guide = not a replacement for clinical judgement, less relevant for therapeutic use
What are some contraceptive counselling tools?
Family planning association, websites (Brooks, Contraceptive choices), contraception bedsider
