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 coils
- 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
No contraceptive has all of them.
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 pill)?
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 Combined Oral Contraception Pill (COCP)?
Oestrogens act:
- on the anterior pituitary and hypothalamus causing NF –> don’t pump out GnRH —> pathway
- directly on the ovary
- on the endometrium
How do progestogens act in Combined Oral Contraception Pill (COCP)?
Progestogens act:
- on the anterior pituitary and hypothalamus through NF.
- 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 - increases risk of stroke)
NEOPLASTIC (tumour):
- no increase risk of developing breast or cervix cancer.
- Small increase in risk of developing liver cancer
GASTROINTESTINAL:
COH-insulin metabolism (makes you more insulin resistant, can’t have it if you have diabetes), does not make you gain weight, Crohns Disease
HEPATIC:
hormone metabolisms, congenital nonhaemolytic jaundices, gall stones
DERMATOLOGICAL:
chloasma, acne, erythma multiforme
PSYCHOLOGICAL:
mood swings, depression, reduces Libido
What are the rules for using COCP?
- Start 1st packet 1st day of a menstrual period
- Take 21 pills and stop for 7 day break (PFI)
- Restart each new packet on 8th day (same)
- Do not start new packets late
- If late or missed pills in 1st 7 days, condoms
- If missed pills in last 7 days no PFI
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: Progestogen Only Pills (POPs) - Desogestrelle (Cerelle) - norethisterone - ethynodiol diacetate - levonorgestrel - norgestrel
INJECTIBLES:
- depo provera (MPA) (12-weekly)
- noristerat (NET)
Why is Cerelle better than older Progestogen Only Pills (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.
