Sexual health Flashcards
What is the main mechanism of LARC contraception?
prevent ovulation by suppressing FSH and LH
What is the mechanism of action of emergency contraception?
delays ovulation
What are the other less used mechanisms of contraception?
- prevention of fertilisation eg condoms, diaphragm and spermicide
- prevention of implantation by hormonal methods by creating a hostile endometrium
Why is LARC good?
user failure rate is nearly equal to the method failure rate as it doesn’t rely on remembering to take something or do something
What are the features of IUDs and IUSs?
- IUD is an intrauterine device
- IUS is an intrauterine system which has hormones too
- long lasting, effective but are invasive to insert
- prevent fertilisation and also implantation
What are the features of the copper IUD?
- last up to 10y
- non-hormonal so periods tend to get worse
- prevents fertilisation primarily but also implantation
- as emergency contraception it prevents implantation primarily
What are the features of the hormonal IUS?
works for heavy periods or pain eg with endometriosis, can cause irregular bleeding to start with to thin lining and then periods will most likely stop
What are the features of the rod/Nexplanon?
- most effective
- lasts three years
- causes prolonged bleeding which is extremely unpredictable
- takes 7 days to work after implantation
What are the main guidelines used for contraception choices?
UKMEC is the eligibility for contraception guidelines
- Always useable
- Broadly useable
- Counsel/caution
- Do not use
What is covered in combined hormonal contraception?
pill
patch
ring
these stop ovulation
What is the effectiveness of the pill impaired by?
- impaired GI absorption
- increased metabolism eg drug interaction or liver enzyme induction
- forgetting to take pill
What are the risks involved with CHC?
- venous thrombosis (prescribe more effective pill with lowest increased risk and educate on DVT)
- systemic hypertension (must be under 140/90)
- arterial disease/MI, migraine with aura (increases risk of stroke so contraindication for pill)
- age >35y
- breast cancer (small additional risk which returns to baseline after stopping for 10y)
- cervical cancer risk
What are the benefits of CHC?
- reduces the risk of ovarian and endometrial cancer so no overall risk of cancer
- less PMS
- treatment for PCOS
- improves skin
- less bleeding
- fewer functional ovarian cysts
What are the side-effects of CHC?
nausea
bleeding
breast tenderness
spots
What are the features of the POP pill?
- Cerelle (desogestrel) is the most commonly used
- inhibits ovulation
- risks = limited and the only contraindication is current breast cancer
- missed POP guidance is simpler and within 12h missed is okay
What are the features of depo?
- depo provera is the implant given by doctor
- sayana press is self-administered
- lowers oestradiol and suppresses FSH and stops menstrual cycle
What are the side-effects of the depo?
- nausea
- weight gain is common as appetite increases
- spots
- bleeding (amenorrhea eventually)
- headaches
- !!has an effect on bone mass due to effect on oestradiol so this maybe shouldn’t be used in teenagers!!
What are the less effective types of contraception?
- diaphragm
- natural family planning
- female sterilisation
What is the process of male sterilisation?
- needs counselling as there is a lot of regret involved
- complications with the surgery
- very effective with semen sample afterwards to verify
What is patient notification?
contact tracing process for STIs to stop community outbreaks which is cost effective and reduces morbidity and mortality from the early diagnoses
What is pre-exposure prophylaxis?
- taken before sex and is highly effective in high risk patients to prevent HIV infection
- given to MSM who have condomless anal sex often and people who have had a rectal bacterial STIs
When is post-exposure prophylaxis given?
after sex for either HIV with antiretrovirals or Hepatitis B vaccine
What are the two types of clause for abortion?
- 7 clauses for abortion
- 5 that need to be signed by 2 doctors for a specific indication
- 2 which are emergency and only need 1 doctor signature
What are the two time limits for abortion?
- can be done up to 24 weeks for any reason
- after 24 it is for foetal abnormalities or if there is a severe risk to mother’s life
