Week 2 - A - Contraception (LARC, Non-LARC, UKMEC) Flashcards
What are the two permanent (irreversible) methods of contraception?
This would be female sterilisation and male sterilisation
How is sterilisation carried out in a male and female?
Female - tubal ligation
Male - vasectomy
What is the population growth of the world per second?
2 new people per second (estimated 4 people are born every second and 2 people die every second)
What are the ideal features of perfect contraception?
100% effective 100% safe Cheap Reversible Free from side effects and easy to use
What is the most commonly used method of contraception worldwide?
- Condoms
- The pill
- Withdrawal
- Male and female sterilisation
- Implant
- Coils
- Diaphragm
- Withdrawal is the most commonly used method of contraception
What does the withdrawal method of contraception involve? Is the withdrawal method of contraception effective?
Withdrawal method of contraception is when the male ‘pulls out’ when he is about to ejaculate
It is not an effective method of contraception
Understanding the hypothalamic - pituitary - ovarian is axis is important when considering contraception What does the hypothalamus produce which acts on which part of the pituitary gland? What does the pituitary produce to cause the ovaries to produce what?
The hypothalmus produces gonadotrophin releasing hormone (GnRH) which acts on the anterior pituitary gland to cause the production of lutienizing and follicle stimulating hormone (LH and FSH)
These stimulate the ovaries to produce oestrogen and progesterone
What does the secretion of oestrogen and progesterone mean for the hypothalamus and pituitary gland?
What happens to the LH levels when oestrogen levels increase? (oestrogen levels increase as the follicle(granulosa cell) grows)
Oestrogen and progesterone have a negative feedback on the pituitary and hypothalamus
Oestrogen levels increase as the follicle size grows and begin to have a positive feedback on the LH and FSH levels causing the LH surge which induces ovulation
How long before ovulation does the LH surge increase?
24-36 hours
You can either stop the ovary from working- highly reliable method because no egg Also block the fallopian tube- or use a method that slows the transport of the gg in the fallopian tube so by the time it reaches the uterus its dead You can affect the lining of the uterus to stop it from implanting. Where does fertilisation of the egg usually occur?
Fertilisation of the egg usually occurs in the ampulla of the uterine tube
How long does sperm live in the female genital tract? 1. 1 day 2. 3 days 3. 5 days 4. 10 days
- Sperm tends to live 5 days
How long does the ovum tend to survive in the female genitl tract? 1) 24 hours 2) 48 hrs 3) 72 hrs 4) 96 hrs
- Tends to survive for 24 hours
Natural family planning works by observing and recording your body’s different natural signs or fertility indicators on each day of your menstrual cycle. How effective is natural family planning as a contraception mehtod? (ie identifying the bodies natural fertility indicators to alert you of when not to have sex - can then use this method to have a baby when you are ready)
Natural family planning is 99% effective if carried out properly at preventing pregnancy occurring
Natural family planning can help to avoid or plan a pregnancy - as stated before 99% effective at avoiding pregnancy if used effectively Is this allowed in all religions? What religion is contraception not allowed in?
Natural family planning is allowed in all religions
Contraception is not allowed in the Catholic church
Natural familiy planning involves 5 different things: Basal body temperture Cervical mucous Cervical position “Standard” days Breast feeding What is involved in basal body temperature? (when is temp taken, how big a rise in temp and for how long) What does the rise in basal body temperature indicate?
Basal body temperature is taken before rising in the morning
A rise in the basal body temp by 0.2degrees sustained for 3 days after previous 6 days of lower temperature indicates ovulation
What is different about the cervical mucous when looking for ovulation? What is different about the cervical position? (regarding when fertile and non-fertile)
Cervical mucous
Thick and sticky post ovulation mucous for at least 3 days of thinner watery cervical mucous
Cervical position
When fertile - cervix is high in vagina and open
When non-fertile - cervix is low in vagina and closed
Why is better to have unportected sex just before ovulation?
This is when the cervical mucous is thin and watery and therefore easier for the sperm to swim through
That is why after ovulation the cervical mucous is thicker and therefore more difficult for fertilisation to occur
In a standard 28 day menstrual cycle, which days are most fertile in a female? Which day is ovulation in a standard 28 day cycle?
Days 8-18 are most fertile in a standard 28 day cycle
day 14 would be the day of ovulation
Breast feeding is the final form of natural family plannin - lactational amenorrhea What are the three criteria that are required for lactaional amenorrhea? (one of the criteria is how long post pregnancy can the breast feeding as contraception be relied upon)
Exclusive breast feeding
Can only be for up to 6months post - natal
Patient must be amenorrheic
How successful is lactational amenorrhea as a form of contraception? How does it work?
Lactational amenorrea is 98% successful
Prolactin is an inhibitor of the pulsatile release of GnRH and therefore as the gonadaotropic hormone cannot be released, neither can LH/FSH and the patient remains infertile
What are the five methods of natural family planning?
- Basal body temperature increase by 0.2degrees for 3days of 6days lower temp = ovulation
- Cervical mucous - thick and sticky mucous post ovulation after at least 3 days thin watery mucous
- Cervical position - hgih in vagina and open - fertile, low in vagina and closed - non-fertile
- “Standard” days - standard 28 day cycle, 8-18 days
- Breast feeding - lactational amenorrhea for up to 6 months post natal on exlcusive breast feeding
There are many different types of contraception What do LARC and non-LARC stand for?
LARC - long acting reversible contraception
Non-LARC - non- long acting reversible contraception
How effective are the :
- Combined contraceptive pill
- Progesterone only pill
- Cpper IUD
- Progesterone only
- IUS
- Porgesterone depot injection
- Progesterone only implant
All 99% effective is used properly
What is LARC defined as? What are the four different types?
LARC is defined as contraceptive methods required less than once per cylce or month
- Copper IUD (Intrauterine device)
- Progesterone only IUS (Intrauterine system)
- Progesterone only injectable contraceptive (depo injection)
- Progesterone only implant (implant)
Combined hormonal contraception comes in pills, patches and vaginal rings What are the different intrauterine systems?
Have the Mirena (longer acting (5years) and the Jaydess (3 years) intrauterine systems
What is the action of the combined hormonal contraceptive?
Primarily inhibits ovulation
Has effects on cervical mucous and endometrium
What is the primary function of the progesterone only pill? What are its other functions?
Primary function is to inhibit ovulation
Also effects the cervical mucous, fallopian tube transport and the endometrium
When prescribing combined hormonal contraception and progesterone only pill, important to consider absorption and metabolism What effects can having diarrhoea and vomiting do? What effect can having serious enzyme inducers do?
Diarrhoea and vomiting - reduces absorption rates
Enzyme inducers will cause the pills to be metabolised quicker
What is the side effects of the implant? What hormone is the implant? How long does the implant last?
Can cause irregular bleeding
Progesterone only and lasts for 3 years
What is the mode of action of the implant?
The implant inhibits ovulation
What is the mode of action of the depot injection? How long does it last and how often is it given?
Its primary action is to inhibit ovulation
It is given every 13 weeks and lasts for 14 weeks
Given as a subcutaneous injection
Apparently is good for the breast milk
Due to compliance, instead of the contraceptive depot injection being 99% effective, how effective is it usually?
Usually only 94% effective (ie 6 out of 100 people in a year will become pregnant)
What is the mode of action of the intrauterine system?
The mode of action is to release progesterone to prevent the implantation of an egg
Also thickens the cervical mucous to prevent sperm reaching an egg
What is the primary mode of action of the intrauterine device? Is this hormonal?
It prevents fertilisation of the egg as the copper is toxic to the sperm
Not hormonal, relies upon copper
How long can the IUD stay in for? Does IUD or IUS make periods heavier?
IUD can stay in for 5-10 years
IUD tends to make periods heavier
IUS tends to make periods lighter
What conditions is copper-iud associated with?
May be associated with an ectopic pregnancy and pelvic inflammatory disease
Blockers include condoms, femidoms and diaphragms How do blockers work?
Blockers block the sperm from getting to the female genital tract
What are the two non reversible methods of contraception?
Male sterilization - vasectomy
Female sterilisation - tubal ligation
How effective are condoms as contraception?
Condoms are only 98% effective is used properly
What out of all the methods of contraception is proven to be the safest method of contraception? How longdoes it work for?
Progesterone only implant
Works for 3 years
What is the primary method of action of: Progesterone only implant? Progesterone only depot injection? Progesterone only intrauterine system (IUS)? Copper intrauterine device (IUD)? Combined hormonal contraceptive? Progesterone only pill? Barrier methods? How long does each last?
All main mode of action - inhibition of ovulationn
- * Progesterone only implant - 3 years
- * Progesterone only depot injection - 13 weekly depot (actually lasts 14 weeks however)
- * Combined hormonal contraceptive - take for 3 weeks and stop taking for one week
- * Progesterone only pill - take daily
- IUS - main effect is to prevent implantation - 3 to 5 years
- IUD - toxic to sperm which prevents fertilisation - 5-10 years
- Barrier methods - stops sperm reaching egg
What is the UKMEC?
This is the UK medical eligibility criteria for contraceptive use
There are 4 UKMEC categories - these categories are in relevance to whether or not contraception should be prescribed WHat is UKMEC category 1?
This states that there are no restrictions for the use of the contraception method
What is UKMEC category 2? What is UKMEC category 3?
UKMEC category 2 - The advantages of the using the method generally outweight the proven risks
UKMEC 3 - the risk of using the method generally outweighs the benefits - needs expert clinical judgement/referral
What is the UKMEC 4 category?
This is where a condition represents an unacceptable risk if the contraceptive method is used
There is a thorough history taken from a patient before prescribing contraception History: Medical conditions (past and present) Family history of medical conditions (past and present) Drug history Potential interactions Recheck annually What should be recorded before first prescription?
Record BP and BMI before first prescription
It is difficult to know if somebody is definitely not pregnant and therefore you have to be reasonably certain How long after the last incidence of UPSI (unprotected sexual intercourse) should the pregnancy test be carried out to rule out a pregnancy?
Negative preg test
AND > 3 wks since UPSI
