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Physiology 2 > REPRO: Contraception > Flashcards

REPRO: Contraception Flashcards

1
Q

List some methods of contraception that require ongoing action by the individual, and others that prevent contraception by default.

A

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
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2
Q

What would be the (theoretical) perfect contraceptive?

A
  • 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
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3
Q

What are the risks and benefits of contraceptive treatment?

A

BENEFITS:

  • non-contraceptive
  • psychosexual
  • choice
  • sexual health
  • cost saving
  • female equality

RISKS:

  • cardiovascular
  • neoplastic
  • emotional
  • infection-related
  • allergic
  • iatrogenic
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4
Q

What are the risks and benefits of no contraceptive treatment?

A

BENEFITS:

  • non-interference
  • population growth
  • control of women

RISKS:

  • childbirth-related
  • abortion-related
  • social costs
  • economic costs
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5
Q

What is combined oral contraception comprised of?

A

It is a combination of oestrogen and progesterone.

The oestrogen is actually ethinyloestradiol, a synthetic version of oestrogen. The dose ranges from 20-50 micrograms, but most have it at 30-35 micrograms.

The progesterone is actually progestogens, a group of compounds that resembles progesterone.

Examples of these medicines would be:

  • norethisterone
  • levonorgestrel
  • desogestrel
  • gestodene
  • norgestimate
  • drospirenone
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6
Q

How do oestrogens act in COCP?

A

It is given in supraphysiological doses

Oestrogens act:

  • on the anterior pituitary and hypothalamus
  • directly on the ovary
  • on the endometrium
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7
Q

How do progestogens act in COCP?

A

It is given in supraphysiological doses

Progestogens act:

  • on the anterior pituitary and hypothalamus
  • directly on the ovary
  • on the endometrium
  • on the fallopian tubes
  • on the cervical mucus
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8
Q

Expand on the benefits of COCP?

A
  1. CONTRACEPTIVE BENEFITS:
    - reliable
    - safe
    - unrelated to coitus
    - woman in control
    - rapidly reversible
  2. NON-CONTRACEPTIVE BENEFITS:
    - halves risk of ovarian cancer (long-term)
    - halves risk of endometrium cancer (long-term)
    - helps endometriosis, menorrhagia, dysmenorrhea
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9
Q

Expand on the risks of COCP?

A

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

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10
Q

What is some medication that can interact with COCP?

A
  1. Liver enzyme-inducing drugs:
    Affect the metabolism of both oestrogen and progestogen
    Beware rifampicin and anti-epileptics
  2. Broad-spectrum antibiotics
    Affect enterohepatic circulation of oestrogen (40%)
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11
Q

Briefly, describe the vaginal contraceptive method.

A

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)

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12
Q

List some progestogen-only methods.

A

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)
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13
Q

Why is Cerelle better than older POPs?

A
  • 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)
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14
Q

Describe IUDs as a contraceptive method.

A

The copper-bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and may be left in situ long-term and act by:

  1. destroying spermatozoa
  2. preventing implantation: an inflammatory reaction and prostaglandin secretion, as well as a mechanical effect

ALL IUCDs can be left in situ for 5 years, whatever the maker’s inserts say. Any device inserted after a woman’s 40th birthday could be left in until after menopause, if the woman wishes, without being replaced.

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15
Q

What are the names of some IUCDs?

A

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
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16
Q

What are some advantages and disadvantages of IUCDs?

A

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
17
Q

What are some risks of IUCDs?

A
  • miscarriage can occur if left in situ during a pregnancy
  • protects less well against ectopic pregnancies
  • may be expelled
  • the uterus may be perforated
18
Q

What are some absolute contraindications with IUCDs?

A
  • 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
19
Q

What are some advantages of using condoms?

A

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
20
Q

What are some disadvantages of using condoms?

A

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
21
Q

Describe caps as a contraceptive method.

A

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 cervix or vaginal vault
  • different sizes
  • must be used with spermicide and elft in 6 hours or more
22
Q

What are some advantages of using caps as a contraceptive method?

A

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
23
Q

What are some disadvantages of using caps as a contraceptive method?

A

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
24
Q

Describe fertility awareness as a contraceptive method.

A

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.

25
Q

What does natural family planning take into consideration?

A
  • temperature
  • rhythm
  • cervix position
  • cervical mucus
  • persona
  • lectational amenorrhoes (LAM)
26
Q

What are some advantages and disadvantages of using fertility awareness as a contraceptive method?

A

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
27
Q

Describe some methods of emergency contraception.

A

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-BEARING 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
28
Q

Compare PC4 and Levonelle 2 as postcoital pills.

A

PC4:

  • lower failure rate in the first 24 hours
  • causes nausea and vomiting 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)
29
Q

Describe elleOne as a postcoital pill.

A
  • 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
30
Q

Compare the effectiveness (statistically) of Levonelle 2 and Schering PC4.

A

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%

Physiology 2 (35 decks)

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