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