REPRO: Contraception Flashcards
List some methods of contraception that require ongoing action by the individual, and others that prevent contraception by default.
REQUIRE ONGOING ACTION BY THE INDIVIDUAL:
- oral contraception
- barrier methods
- fertility awareness
- coitus interruptus
- oral emergency contraception
PREVENT CONTRACEPTION BY DEFAULT:
- IUCD/IUI/IUS
- progesterone implants
- progesterone injections
- sterilisation
What would be the (theoretical) perfect contraceptive?
- 100% reliable
- 100% safe
- non-user dependent
- unrelated to coitus
- visible to the woman
- no ongoing medical input
- completely irreversible within 24 hours
- no discomfort
What are the risks and benefits of contraceptive treatment?
BENEFITS:
- non-contraceptive
- psychosexual
- choice
- sexual health
- cost saving
- female equality
RISKS:
- cardiovascular
- neoplastic
- emotional
- infection-related
- allergic
- iatrogenic
What are the risks and benefits of no contraceptive treatment?
BENEFITS:
- non-interference
- population growth
- control of women
RISKS:
- childbirth-related
- abortion-related
- social costs
- economic costs
What is combined oral contraception comprised of?
The oestrogen is actually ethinyloestradiol, a synthetic version of oestrogen. The dose ranges from 20-50 micrograms.
Progesterone is actually progestogens, a group of compounds that resembles progesterone.
Examples of these medicines would be:
- norethisterone
- levonorgestrel
- desogestrel
- gestodene
- norgestimate
- drospirenone
How do oestrogens act in COCP?
Oestrogens act:
- on the anterior pituitary and hypothalamus
- directly on the ovary
- on the endometrium
How do progestogens act in COCP?
Progestogens act:
- on the anterior pituitary and hypothalamus
- directly on the ovary
- on the endometrium
- on the fallopian tubes
- on the cervical mucus
Expand on the benefits of COCP?
- CONTRACEPTIVE BENEFITS:
- reliable
- safe
- unrelated to coitus
- woman in control
- rapidly reversible - NON-CONTRACEPTIVE BENEFITS:
- halves risk of ovarian cancer (long-term)
- halves risk of endometrium cancer (long-term)
- helps endometriosis, menorrhagia, dysmenorrhea
Expand on the risks of COCP on each body system?
CARDIOVASCULAR:
Arterial - progestogen, HBP, smoking
Venous - Oestrogen-VTE-clotting disorders (DVT, PE, migraine)
NEOPLASTIC:
breast, cervix, liver
GASTROINTESTINAL:
COH-insulin metabolism, weight gain, Crohns Disease
HEPATIC:
hormone metabolisms, congenital nonhaemolytic jaundices, gall stones
DERMATOLOGICAL:
chloasma, acne, erythma multiforme
PSYCHOLOGICAL:
mood swings, depression, Libido
What is some medication that can interact with COCP?
- Liver enzyme-inducing drugs:
Affect the metabolism of both oestrogen and progestogen
Beware rifampicin and anti-epileptics - Broad-spectrum antibiotics
Affect enterohepatic circulation of oestrogen (40%)
What is the vaginal contraceptive method?
What are the advantages and disadvantages?
It’s the same as COCP except that there is vaginal delivery (a ring) for 21 days. You just remove it for 7 days.
Advantages: you don’t have to take it every day (easier on user)
Disadvantages: you don’t have to take it every day (may forget)
List some progestogen-only methods.
The default methods are:
IMPLANTS:
- nexoplanon
- norplant (LNG)
HORMONE_RELEASING IUCD:
- mirena IUS (LNG)
The user-dependent methods are: POPs - Desogestrelle (Cerelle) - norethisterone - ethynodiol diacetate - levonorgestrel - norgestrel
INJECTIBLES:
- depo provera (MPA) (12-weekly)
- noristerat (NET)
Why is Cerelle better than older POPs?
- it’s as effective as COCP
- no oestrogen - (breastfeeding)
- favourable side effect profile vs older POPs
- bleeding is as predictable as COCP
- you have a 12-hour window if missed (compared to 3-hour window)
Describe IUDs as a contraceptive method.
The copper devices are inserted into the uterus by practitioners and may be left in situ long-term and act by:
- destroying spermatozoa
- preventing implantation: an inflammatory reaction and prostaglandin secretion, as well as a mechanical effect
ALL IUCDs can be left for 5 years. Any device inserted after a woman’s 40th birthday could be left in until after menopause, without being replaced.
What are the names of some IUCDs?
COPPER BEARING:
- Ortho T 380: 8-12 yrs
- Multiload 375: 5 yrs
- Multiload 250: 5 yrs
- Nova T 380: 5 yrs
- Nova T 200: 5 yrs
- GyneFix (IUI): 5 yrs
HORMONE BEARING:
- Mirena (IUS): 5 yrs
- Jaydess: 3 yrs
What are some advantages and disadvantages of IUCDs?
ADVANTAGES:
- non-user dependant
- immediately and restrospectively effective
- immediately reversible
- can be used long-term
- extremely reliable
- unrelated to coitus
- free from serious medical dangers
DISADVANTAGES:
- has to be fitted by trained medical personnel
- fitting may cause pain or discomfort
- periods may become heavier and painful
- doesn’t offer protectio against infection
- threads may be felt by the male
What are some risks of IUCDs?
- miscarriage can occur if left in situ during a pregnancy
- protects less well against ectopic pregnancies
- may be expelled
- the uterus may be perforated
What are some absolute contraindications with IUCDs?
- current pelvic inflammatory disease
- suspected or known pregnancy
- unexplained vaginal bleeding
- abdormalities of the uterine cavity
Some relative contraindications:
- nulliparity
- past history of pelvic inflammatory disease
- not in mutually monogamous relationship
- menorrhagia/ dysmenorrhea
- small uterine fibroids
What are some advantages of using condoms?
MALE:
- man in control
- protects against STIs
- no serious health risks
- easily available (free at family planning clinics)
FEMALE:
- woman in control
- protects against STIs
- can be put in in advance and left inside after erection lost
- not dependant on male erection to work
What are some disadvantages of using condoms?
MALE:
- last minute use
- needs to be taught
- may cause allergies
- may cause psycho-sexual difficulties
- higher failure rates among some couples
- oily preparations rot rubber
FEMALE:
- obtrusive
- expensive
- messy
- rustles during sex
- uncertain failure rate
Describe caps as a contraceptive method.
DIAPHRAGM CAPS:
- made of latex
- fit across vagina
- sizes 55-95mm in 5cm jumps
- must be used with spermacide and left in at least 6 hours after sexual intercourse
SUCTION (CERVICAL) CUPS:
- made of plastic
- suction to the cervix or vaginal vault
- different sizes
- must be used with spermicide and left in 6 hours or more
What are some advantages of using caps as a contraceptive method?
DIAPHRAGM CAPS:
- woman in control
- can be put in in advance
- offers protection against cervical dysplasias
- percieved as ‘natural’
SUCTION CAPS:
- suitable for women with poor pelvic floor muscles
- no problems with rubber allergies
- very unobtrusive
- woman in control
What are some disadvantages of using caps as a contraceptive method?
DIAPHRAGM CAPS:
- needs to be taught
- messy
- higher failure rate than most other methods
- higher UTI chance
- higher candiasis chance
SUCTION CAPS:
- needs an accessible and suitable cervix
- higher failure rate than the diaphragm cap
- not easy to find experienced teacher
Describe fertility awareness as a contraceptive method.
It uses the prediction of ovulation, and several facts surrounding fertilisation:
- sperm can survive 5 days in the female tract
- the ova can survive 24 hours
- ova are fertilised in the fallopian tube and take 4 days to reach the uterus and implant
- cervical mucus is receptive to sperm around the time of ovulation
They use priodic abstinence/alternative contraception to avoid pregnancy. They also time intercourse to the pre-ovulatory phase to concieve.
What does natural family planning take into consideration?
- temperature
- rhythm
- cervix position
- cervical mucus
- persona
- lectational amenorrhoes (LAM)
What are some advantages and disadvantages of using fertility awareness as a contraceptive method?
ADVANTAGES:
- non-medical
- can be used in 3rd world countries
- allowed by Catholic church
- can result in closeness of understanding between partners
DISADVANTAGES: failure rate is heavily user dependant - requires skilled teaching - my require cooperation between partners - may involve limiting sexual activity - can cause strain
Describe some methods of emergency contraception.
POSTCOITAL PILLS:
- can work up to 72 hours after unprotected sexual intercourse (UPSI)
- schering PC4 - prevents 3 out of 4 pregnancies which would have occured
COPPER-CEARING IUCDs:
- up to 5 days after presumed ovulation OR 5 days after one single episode of UPSI at any time of the cycle
- failure rate is extremely rare
Compare PC4 and Levonelle 2 as postcoital pills.
PC4:
- lower failure rate in the first 24 hours
- causes nausea and comiting in many women
- contraindicated during a focal migraine attack
LEVONELLE 2:
- higher failure rate in the first 24 hours
- very little nausea
- only contraindicated in women taking very potent liver enzyme medication (eg. anti-TB)
Describe elleOne as a postcoital pill.
- it’s a new selective progesteragen receptor modulator (SPeRM)
- up to 120 hours
- RR 0.58 pregnancy vs. Levonelle
- possibly slightly higher side effect profile - GI symptoms mostly
Compare the effectiveness (statistically) of Levonelle 2 and Schering PC4.
LEVONELLE 2:
up to 24 hours - 95%
25-48 hours - 85%
49-72 hours - 58%
SCHERING PC4:
up to 24 hours - 77%
25-48 hours - 36%
49-72 hours - 31%
