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?
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
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?
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%)
Briefly, describe the vaginal contraceptive method.
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-bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained 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 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.
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 cervix or vaginal vault
- different sizes
- must be used with spermicide and elft 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%
