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Y2S2 > TBL 3 Contraception > Flashcards

TBL 3 Contraception Flashcards

1
Q

Name the 7 types of hormonal contraceptives:

A

Combined oral contraceptive (COC)
Progesterone only oral contraceptive (POP)
Transdermal combination transdermal patch
Combined contraceptive vaginal ring
Progesterone only contraceptive injection
Progesterone only contraceptive implant
Intrauterine system (IUS)

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2
Q

Name 6 types of non-hormonal contraceptives:

A

Male condom
Female condom
Diaphragm/ cap +spermicide
Intrauterine device (IUD)
Female/ male sterilisation
Natural family planning

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3
Q

What hormones does the combined oral contraceptive contain and give examples of these hormones:

A

Oestrogen- ethinylestradiol, estradiol
Progesterone:
2nd gen levonorgestrol, norethisterone, norgestimate
3rd gen desogestrel, gestodene
4th gen drospirenone

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4
Q

What is the dose of the oestrogen hormone in the COC?

A

Low= 20mcg
Standard 30-35mcg

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5
Q

What are the three types of COC’s and describe the difference:

A

Monophasic- same amount of hormone
Biphasic- changes the level of progesterone halfway through the cycle, oestrogen stays the same
Triphasic- changes the levels of progesterone and oestrogen 3 times during the cycle

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6
Q

What is the mode of action of COC’s?

A

Inhibition of ovulation- suppress release of FSH and LH
Thicken cervical mucus
Reduce endometrial receptiveness

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7
Q

What are the advantages of COC’s?

A

Highly effective and reversible
Convenient
May reduce menstrual pain/ blood loss
May protect against pelvic and inflammatory disease
May protect against osteoporosis
Reduce risk of ovarian and endometrial cancer (50% up to 10 years)

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8
Q

What are the disadvantages of COC’s?

A

Breakthrough bleeding, breast tenderness, acne
Weight gain and fluid retention
Venous thromboembolism (VTE)
Stroke
Breast cancer
Cervical cancer
No protection against STDs

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9
Q

What can increase your chance of a Venous thromboembolism if taking COC’s?

A

Risk is lower with low dose oestrogen
Increase risk in obese
Increase risk in family history
Increase risk with surgery
Increased risk with long haul flights

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10
Q

What are contraindications of the COC?

A

Current past history of VTE, stroke, or heart disease
Active liver disease
Breast feeding
Surgery
Family history of VTE
Obesity (avoid if >35)
Long term immobilisation
Smoking
>35 years (avoid in over 50)
DM (avoid if any complications)
Hypertension
Migraine without aura (avoid with aura)

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11
Q

What are the steps involved when taking COCs and surgery?

A

Surgery increases VTE
Stop COC’s 4 weeks before major surgery, surgery to legs or which involves prolongued immobilisation
Restart at first menuses at least 2 weeks after full mobilisation
Depot progesterone only injection as alternative
Doesnt apply to minor surgery
If emergency surgery, use compression hosiery and thromboprophylaxis (heparin)

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12
Q

What hormone is in the POP and name some:

A

Low dose progesterone
Norethisterone
Etynodiol diacetate
Desogestrol
Levonorgestrol
Norgestro

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13
Q

What is the mode of action for POP?

A

Delay ovum transport
Thicken cervical mucus
Reduce endometrial receptiveness
Inhibition of ovulation (in 60%, not main MoA)
Bioavailability 70%

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14
Q

What are the advantages of the POP?

A

Reliable and reversible without the oestrogen
Can be used while breast feeding
Can be used by women with cautions with the oestrogen e.g older women, heavy smokers, dm, migraine, major surgery

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15
Q

What are the disadvantages of the POP?

A

Menstrual irregularities
Must be taken at the same time of day (within 3 hours)
Ovarian cysts (30% increase)
Breast cancer
No protection against STDs

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16
Q

What are the steps involved when taking POPs and surgery?

A

All progesterone contraceptives are okay to take during any surgery including to the legs and for long periods of immobilisation

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17
Q

Name and describe some COC interactions:

A

Antiepiletics, can decrease oestrogen and progesterone, use alternative contraceptives, or if necessary to double dose
Rifampicin & Rifabutin (enzyme inducers), use alternative form of contraception, continue after 28 days of stopping
St Johns wort- avoid
Lamotrigine

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18
Q

Name and describe some POP interactions:

A

Rifampicin & Rifabutin (enzyme inducers), use alternative form of contraception, continue after 28 days of stopping

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19
Q

Name a POP that has a different MoA and explain:

A

Desogestrel 75mcg
Main MoA is to inhibit ovulation
Missed dose window is 12 hours rather than 3 hours

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20
Q

Describe and explain the main factors of the transdermal combination contraceptive patch:

A

Brand = Evra®
600mcg Ethinylestradiol + 6mg Norelgestromin
Patch releasing:
▪ 20mcg/24hrs ethinylestradiol
▪ 150mcg/24hrs norelgestromin
Apply 1 patch weekly for 3 weeks and then patch free week (withdrawal bleed)
Apply patch to clean, dry, hair free skin on buttock, abdomen, upper outer arm, or torso, not on breast

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21
Q

What are the advantages of the transdermal combination contraceptive patch?

A

Very effective when used correctly
Once weekly application
Easy to use
Does not interfere with sex
Absorption not affected by diarrhoea and vomiting

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22
Q

What are the disadvantages of the transdermal combination contraceptive patch?

A

Local reactions
Same risks and CIs as COCs
Withdrawal bleeding starts, on average, day later than COC and may extend into next cycle of patch use
Not recommended for women greater than 90kg
May become fully or partially detatched
Visible
No protection against STIs
Same drug interactions as COCs

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23
Q

What should happen if the transdermal combination contraceptive patch detaches?

A

1st week:
-Off >24hrs, start new cycle of patches, additional precautions for 7 days & EC if appropriate
2nd or 3rd week:
- Off up to 48hrs, apply new patch immediately & new patch next schedules change day. No additional precautions required
- Off >48hrs, start new 4 week cycle immediately with new patch, additional precautions for 7 days & EC if appropriate

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24
Q

Describe and explain the main factors in the combined contraceptive vaginal ring:

A

Brand name= NuvaRing®
Etonogestrol 11.7mg/Ethinylestradiol 2.7mg
Releasing:
15mcg/24hrs ethinylestradiol
120mcg/24hrs etonogestrol
Self insertion, stays in for 3 weeks then removed for 1 week
Store in fridge before dispensing but can stay out of the fridge for 4 months

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25
Q

What are the advantages of the combined contraceptive vaginal ring?

A

Very effective when used correctly
Once monthly insertion
Immediate contraception if inserted on first day of vaginal bleed
Doesnt interfere with sex
Isn’t affected by N&V

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26
Q

What are the disadvantages of the combined contraceptive vaginal ring?

A

Local reactions
Same risks as COCs
Risk of expulsion
No protection against STDs
Same interactions as COCs but possibly less as oestrogen misses first pass liver metabolism

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27
Q

What should you do if the combined contraceptive vaginal ring is expelled?

A

Within 3 hours, wash and reinsert
Over 3 hours (1st and 2nd week), wash and reinsert and additional contraceptive for 7 days after
over 3 hours (3rd week), discard and either take a 7 day break + additional contraception for 7 days or discard and insert new ring t start new three week cycle

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28
Q

Describe the 2 types of progesterone only contraceptive injection:

A

Medroxyprogesterone acetate (Depo-Provera®)
-150mg deep IM injection every 12 weeks
-short or long term use
Norethisterone enantate (Noristat®)
-200mg deep IM injection, can be repeated ONCE after 8 weeks
Only for short term use e.g when waiting for vasectomy to become effective

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29
Q

What is the MoA of the progesterone only contraceptive injection:

A

Inhibition of ovulation
Thicken cervical mucus
Decrease endometrial receptiveness

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30
Q

What are the advantages of the progesterone only contraceptive injection?

A

Very effective and reversible
Convenient and not related to intercourse
Can be used in breast feeding
Suitable for use before major surgery, surgery to legs or long periods of immobilisation

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31
Q

What are the disadvantages of the progesterone only contraceptive injection?

A

Menstrual irregularities
Delay in return to fertility
Administration issues- need to be HCP
Decrease in bone mineral deficiency
Increase in breast cancer
No protection against STIs
Same contraindications and risks as POPs

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32
Q

What should happen if there is a delayed injection of Medroxyprogesterone acetate (Depo-Provera®)?

A

If interval greater than 12 weeks and 5 days, exclude pregnancy before next injection and additional precautions for 14 days after injeciton

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33
Q

What are the interactions of the progesterone only contraceptive injections?

A

None

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34
Q

Describe the progesterone only sub-dermal contraceptive implant:

A

Nexplanon®
68mg Etonogestrol match-stick sized flexible rod
Contraception within one day of insertion and lasts up to 3 years
Inserted into inner aspect of upper arm, using a preloaded single-use applicator (by trained professionals only)

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35
Q

What is the MoA of the progesterone only sub-dermal contraceptive implant?

A

Inhibition of ovulation
Thicken cervical mucus
Decrease in endometrial receptiveness

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36
Q

What are the advantages of the progesterone only sub-dermal contraceptive implant?

A

Very effective and rapidly reversible on removal
Convenient and not related to intercourse
No daily/ weekly action required
Can be used in breast feeding
Suitable for use before major surgeries etc

37
Q

What are the disadvantages of the progesterone only sub-dermal contraceptive implant?

A

Menstrual irregularities (low short term dose of COCs?)
Weight gain
Acne, breast pain, headaches
Administration issues- by HCP
Decrease in bone mineral density
No protection against STIs
Local bruising and itching at site of insertion
Other risks and CIs same as oral POPs

38
Q

What are drug interactions of the progesterone only sub-dermal contraceptive implant?

A

Enzyme inducers may decrease the effectiveness of them and alternative contraception should be used, continue after 28 days of stopping

39
Q

Describe the intrauterine system (IUS):

A

Small plastic device interested into uterus
Releases 52mg progesterone (levonorgestrel)
Inserted by dr/ nurse

40
Q

Describe the MoA of the IUS:

A

Thicken cervical mucus
Reduces thickening of the endometrium
Sometimes stops ovulation

41
Q

What are the advantages of the IUS?

A

Doesnt interrupt sex
Convenient
Reversible
Stays in for up to 5 years
Lighter periods/ decrease pain
Effective as soon as put in if within first 7 days of cycle

42
Q

What are the disadvantages of the IUS?

A

Pain on insertion
Irregular periods initially
Temporary SEs, acne, breast pain
Expulsion
Infection
Perforation
Doesnt protect against STIs

43
Q

Describe female sterilisation:

A

Fallopian tubes are cut/ sealed or blocked
Usually under general anaesthetic
Ovaries still produce eggs but can’t reach sperm

44
Q

What are the advantages of female sterilisation:

A

Doesnt interrupt sex
Once worked don’t have to think about contraception again

45
Q

What are the disadvantages of female sterilisation?

A

Cant be easily reversed
Doesnt protect against STIs
Requires general anaesthetic
If fails and becomes pregnant small chance of ectopic pregnancy
Long waiting time on NHS

46
Q

Describe male sterilisation (vasectomy):

A

Vas deferens cut, sealed or blocked
Usually under local anaesthetic

47
Q

What are the advantages of male sterilisation?

A

Doesn’t interrupt sex
Quick and simple operation
Once operation worked don’t have to think about contraception again

48
Q

What are the disadvantages of male sterilisation?

A

Additional contraception required for about 8 weeks after, until semen test negative
Doesn’t protect against STDs
Reverse may be difficult
Long NHS waiting list

49
Q

Describe the intrauterine device (IUD):

A

Small plastic and copper device inserted into uterus, threads hang into cervix
Copper toxic to sperm/ ova
Impedes sperm transportation
May also block implantation
Inserted by doctor/ nurse

50
Q

What are the advantages of the IUD?

A

Doesnt interrupt sex
Reversible
Convenient
Stays in for 3-10 years
Effective as soon as put in

51
Q

What are the disadvantages of the IUD?

A

Pain on insertion
Dysmenorrhoea
Menorrhagia
Infection
Expulsion
Perforation
Doesnt protect against STDs

52
Q

Describe the diaphragm/ cap + spermicide:

A

Flexible latex or silicone device used with spermicide
Placed in vagina to cover cervix
Needs to be kept in cervix for 6 hours after sex

53
Q

What are the advantages of the diaphragm/ cap + spermicide?

A

Can be put in any time before sex - need to add more spermicide if more longe than 3 hours before
May protect against some STDs and cervical cancer
Variety of types
No major SEs
Can be used during period

54
Q

What are the disadvantages of the diaphragm/ cap + spermicide?

A

Can interrupt sex
Need spermicide
Technique for insertion
Need good pelvic floor muscles
Cystitis
Holes

55
Q

Which hormones are involved in both female and male reproductive systems and how?

A

Gonadotrophin- releasing hormone (GnRH) is produced by the hypothalamus which stimulates the anterior pituitary to release Leutinizing hormone (LH) and Follicle- stimulating hormone (FSH)

56
Q

How is LH involved in the male reproductive system?

A

LH travels to the testes via the bloodstream
LH will enter the interstitial space in between the seminiferous tubules and target the Leydig cells which stimulate testosterone release

57
Q

What is the function of testosterone in the male reproduction system?

A

Testosterone targets and stimulates the sertoli cells in the seminiferous tubules:
-maintain libido, stimulate bone and muscle growth, maintenance of secondary sex characteristics, maintenance of accessory glands and organs in the male RS

58
Q

How is FSH involved in the male reproductive system?

A

FSH travel to the testes via the bloodstream and will enter the interstitial space in between the seminiferous tubules
FSH also targets are Sertoli cells, stimulating Androgen Binding Protein (ABP) release- needs testosterone also

59
Q

How is negative feedback involved in the male reproductive system?

A

Sertoli cells produces inhibin, acts as a negative feedback which decreases production of FSH in the pituritary

60
Q

What are the two phases of the menstrual cycle?

A

Follicular phase (0-14)
Luteal phase (14-28)

61
Q

Describe the follicular phase of the menstrual cycle:

A

Before 10 days:
Follicle turns into a 1º and 2º follicle due to FSH
FSH secreted due to low oestrogen so increase in oestrogen decreases FSH
Oestrogen causes negative feedback of LH secretion so steady state of LH
After 10 days:
Oestrogen has a positive feedback, stimulate the release of LH, at high conc of oestrogen, high conc of LH
Stimulating and release of electrical is the release of the most mature 2º female follicle (egg)
After ovulating, LH will decrease

62
Q

Describe the luteal phase in the menstrual cycle:

A

After ovulating the follicle turns into a corpus luteum, it will slowly degrade and release oestrogen, inhibin and progesterone

63
Q

What is the function of inhibin in the luteal phase?

A

Negative feedback of FSH

64
Q

What is the function of progesterone in the luteal phase?

A

Negative effect of hypothalamus inhibiting release of GnRH
Also due to oestrogen decreasing so a decrease in LH and FSH
Progesterone stimulates endometrial growth when corpus luteum degrades, progesterone decreases, GnRH levels increase so new cycle because of a decrease in all of these hormones, the endometrium will shed

65
Q

What are the actions of oestrogen:

A

Rebuilding of endometrium during follicular phase
Induction of progesterone receptor (enables response to progesterone in second-half cycle)
2º sexual characteristics
Increase synthesis of bones
Increase protective HDL (cholesterol)
Increase coagulation, fibrinolytic pathways

66
Q

What are the actions of progesterone?

A

During luteal phase prepares endometrium for implantation
Thickens cervical mucus
Abrupt full at end of cycle is main determinant for onset of menstruation
Major role in suppressing menstruation and uterine contractility during pregnancy
Temp rise at ovulation (1°C) maintained by progesterone

67
Q

What is the function of prolactin?

A

Produced by the pituriatry under control of hypothalamus
Inhibited by dopamine
Stimulates milk secretion
Decreases gonadal activity by decrease in GnRH

68
Q

What is hyperprolactinaemia?

A

Galactorrhoea, menstrual abnormalities, subfertility, impotence, decrease libido

69
Q

What are the causes of hyperprolactinaemia?

A

Pituitary tumour
Drugs e.g chlorpromazine

70
Q

What is the treatment for hyperprolactinaemia?

A

Bromocriptine, cabergloine
Both dopamine agonists

71
Q

What are the symptoms of male hypergonadism?

A

Subfertility, poor libido, impotence, loss of secondary sexual hair

72
Q

What are the causes of male hypergonadism?

A

Hypopituitarism, gonadotropin deficiency, hyperprolactinaemia, drugs

73
Q

What is a treatment for hypogonadism when fertility isn’t required?

A

Testosterone and esters
Symptomatic improvement but won’t improve fertility

74
Q

What is a treatment for hypogonadism when fertility is required?

A

Gonadotrophins E.G menotrophin, LH+ FSH

75
Q

What are symptoms of female hypogonadism?

A

Subfertility, poor libido, breast reduction, loss of 2º sexual hair, dry vagina, dyspareunia, amenorrhoea

76
Q

What are the causes of hypogonadism in females?

A

Hypopituitarism, GnRH deficiency, hyperprolactinaemia, polycystic ovary disease, ovarian failure, drugs, fallopian tube defects

77
Q

What is the treatment for infertility in females?

A

Gonadotrophins
Pulsatile GnRH given as Gonadorelin analogue
Clomifene acts as an anti-oestrogen, occupies oestrogen receptors in the hypothalamus and induces gonadotrophin release by interfering with feedback mechanisms

78
Q

What is polycystic ovary syndrome?

A

Multiple small ovarian cysts + excess androgen production

79
Q

What are the symptoms of polycystic ovary syndrome?

A

Hirsutism- facial hair
Amenorrhoea and dysmenorrhoea
Acne, obesity, sub fertility, hyperinsulinaemia

80
Q

What is a treatment for polycystic ovary syndrome?

A

Hirsutism- use COCs
Cyproterone acetate 50-100mg daily, anti-androgen
Menstrual disturbance- COCs, Metformin (unlicensed)

81
Q

What is endometriosis?

A

Functioning endometrial tissue found in abnormal location e.g ovary, Fallopian tubes, vagina, rectum, colon
Endometriosis within ovary responds to cyclical changes in oestrogen and progesterone

82
Q

What are the symptoms of endometriosis?

A

Varied, difficult to diagnose
Chronic pelvic pain, dysmenorrhoea, dyspareunia, menorrhagia (heavy periods), backpain, GI symptoms, urinary symptoms, fatigue, depression, infertility

83
Q

What are the treatments for endometriosis?

A

Analgesia: NSAIDs e.g ibuprofen, naproxen, mefanamic acids or paracetamol
Progesterones
COCs
Gonadorelin analogues- Danazol 200-800mg daily, inhibits pituitary gonadotrophins
Surgery is 1st line treatment if fertility an issue

84
Q

Which drugs can cause amenorrhoea?

A

High dose corticosteroids
Danazol
Isoniazid
Sprionlactone

85
Q

Which drugs can cause hyperprolactinaemia?

A

Methyldopa
Metoclopramide
Cimetidine
Phenothiazines

86
Q

When should an emergency contraceptive be issued when on an oral contraceptive?

A

If missed more than 2 pills in the first week of starting or last week

87
Q

When should an emergency contraceptive be issued when on a transdermal patch contraceptive?

A

If off for more than 24 hours in the first week

88
Q

What does ABP do?

A

ABP promotes the synthesis of spermatozoa sperm in the lumen

Y2S2 (14 decks)

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