Sexual and Reproductive Health 1 Flashcards
What are different natural method of family planning?
lactation - major contraceptive role in the world
rhythm method - avoids fertile period around ovulation
withdrawal - removal of penis before ejaculation
What are the drawbacks of natural contraception methods?
less reliable
offers no protection against STIs
only suitable for monogamous women who would not be concerned by pregnancy
What are the different barrier methods of contraception?
male condom
female condom
diaphragms and caps
What are the advantages of the male condom?
best protection against disease including HIV
What are the cons of barrier methods of contraception?
can affect sex
may split or burst
diaphragms have to be fitted before intercourse and remain in place for 6+ hours
What are the chemical fertility control methods?
spermicides
used in conjunction with barrier methods in form of jelly, cream or pessary
not very effective
How does the combined oral contraceptive pill work?
Negative feedback effect on gonadotrophin release, inihibiting ovulation
Thin endometrium + thicken cervical mucus
Single tablet every day for 3 weeks and then stopped for 1 week (vaginal bleeding)
Most contain synthetic oestrogen ethinyloestradiol or natural oestrogen oestradiol
valerate (metabolised in body to naturally occurring oestradiol)
What are the common side effects of the combined oral contraceptive pill?
depression bleeding acne breast discomfort weight gain reduced libido nausea headaches bleeding occasionally HTN increased mucus
What are the rare major complications of the COCP?
Venous thrombosis and MI are most important
Risk increased with smoking, increased age and obesity
What are the advantages of the COCP?
contraception
more regular, less painful and lighter menstruation
protection against simple ovarian cysts, benign breast cysts, fibroids and endometriosis
improve hirsutism and acne
reduction in ovarian, endometrial and bowel cancer
How should someone starting the pill be counselled?
advise of major complications and benefits
advise to stop smoking
advise to see if doctor if major complications
advise poor absorption with abx and sickness
stress importance of follow up and BP measurement
What is the combined transdermal patch?
transdermal adhesive patch that releases oestrogen and progesterone
new patch applied for 3 weeks in a row and then one week patch free
similar SEs to COCP
How is the progesterone only pill/mini pill used?
taken continuously without a break
must be taken in a 3 hour window at the same time daily
makes cervical mucus hostile to sperm and inhibits ovulation in 50%
What are the SEs of POP?
vaginal spotting weight gain mastalgia premenstrual symptoms functional ovarian cysts
What the advantages of the POP?
can use when breast feeding
rapid return to fertility
used when COCP contraindicated
What is the nuvaring?
vagina ring
releases oestrogen and progesterone
ring inserted into vagina and worn for 3 weeks and removed for 7 days#
lower systemic SEs
What is Depo-Provera?
administered IM every 3 months
What are the disadvantages with using Depo-Provera?
causes irregular bleeding in first 3 weeks but followed by amenorrhoea
other progesterone SEs
prolonged amenorrhoea after cessation so warn women if they are considering pregnancy
bone density decreases over first 2-3 years use but regained after stopping
What is Nexplanion?
subdermal implant
lasts 3 years
How do Depo-Provera and Nexplanion prevent pregnancy?
prevent ovulation
thicken cervical mucus
thin endometrium
What are the pros of the implant?
nexplanion
no user failure
immediate return to fertility
What are the cons of the implant?
nexplanion
50% irregular bleeding
procedure to remove
What is female sterilisation?
interruption of fallopian tubes so sperm and egg cannot meet
clips can be applied laproscopically to occlude them
Usually done under GA
How should you counsel a woman for female sterilisation?
woman and man must be certain
discuss alternative contraception
reversible not possible and not guaranteed with clips
risks of surgery
What does male sterilisation involve?
ligation and removal of small segment of the vas deferens
performed under LA
not sterile until two confirmed semen analysis have confirmed azoospermia
What are the complications of male sterilisation?
failure
post operative haematomas and infection
chronic pain
How does an IUD/IUS work as contraception?
device put into uterine cavity
copper or progesterone
thin strings pulled through cervix
What are the benefits of IUD?
safe effective and reversible
menstrual loss reduced
can be used as emergency contraception
What are the complications of an IUD?
pain or cervical shock
can be expelled in the first month
perforation of the uterine wall can occur
threads can be cut too short and US scan needs to be performed
heavier and more painful menstruation can occur
risk of infection
How should women be counselled before IUD insertion?
advise of major risks
advise to inform doctor if bleeds intermenstrually, pelvic pain or vaginal
discharge or poss pregnant
advise to check strings after each period
How does the copper coil (IUD) work as contraception?
by preventing fertilisation
copper ion is toxic to sperm
blocks implantation
How does the hormone containing IUS work?
contains progesterone which is slowly released over 5 years local contraceptive effect reduces menstrual loss and pain systemic SE are low fertility returned after removal
What are the disadvantages of the copper coil?
heavy or painful periods
