Week 7: Contraception and sexual health Flashcards
short term contraception
- Combined pill
- Progesterone only pill
Long term contraception
- IUD
- IUS
- Implant
- Injection
POP MOA
- Only contains progestogen
- Thickens cervical mucus
- Stops ovulation
correct use of POP
- >99% effective if taken properly
- Pill taken every day with no breaks between pills
- Should be taken at a similar time every day
- Traditional POP- within 3 hours
- Desogestrel – 12 hours late
- No breaks between packs
POP contraceptive protection starts
Starting: protection straight away if within 5 days of period, otherwise take for 7 days
benefits of POP
- If you cannot be prescribed oestrogen
- Periods may stop
POP rules on missed doses, D and V
- If less then 3/12 hours , then take late pill asap
- If >3/12 hours, then take pill asap, take the next pill at usually times, use extra contraception for next 2 days
- If sick within 2 hours- take another pill, if over >3/12 hours use condoms for 2 days
COCP MOA
- Pill containing oestrogen and progestogen
- 3 MOA
- Stopping ovulation
- Making cervical mucus thicker
- Preventing thickening of the endometrium
contraindication of COCP
- >35
- Smoker
- Overweight
- Certain medicines
- Previous blood clots / family history of blood clots
- Breast cancer
- Migraines with aura is an absolute contraindications
correct use of COCP
- Take 1 every day for 21 days and then have a 7 day break (although can decide not to take a break)
- Take pill at around same time everyday
- When taken correctly 99% effective at preventing pregnancy
starting the COCP
- If you start the combined pill on the 1st day of your period ( day 1 of menstrual cycle) – protection from pregnancy starts straight away
- Starting after the 5th day of your cycle- need to take pill for 7 days
side effects of COCP
- Mood swings
- Nausea
- Breast tenderness
- Headaches
- Small risk of
- Blood clots
- Breast and cervical cancer
- Doesn’t protect against STI
benefits of COCP
- Reduces risk of ovarian, uterine and colon cancer
- Reduce acne
- Bleed is lighter and less painful
COCP rules on misses doses, diarrhoea/vomiting
- If you vomit within 3 hours of taking combined pill- take another pill straight and away and the next pill at usual time. If you continue to vomit – use other contraception
- Very severe diarrhoea – use additional contraception when recovering
- If more than 24s hour missed, take 2 at a time
types of intrauterine conctraception
- IUD- Copper-bearing intrauterine device (Cu-IUD)
- IUS - Levonorgestrel- releasing intrauterine system (LNG- IUS)
IUD MOA
- Copper-bearing intrauterine device (Cu-IUD)
- Releases copper into the womb
- Alters cervical mucus
- Spermicide
- Stops implantation
indication of IUC
- Most people with a womb can use an IUD
- emergency contraception
contraindication of IUD
- If you think you may be pregnant
- STI
- Unexplained bleeding between periods or after sex
correct use of IUD
- 99%% effective
- Last for 5 to 10 years
- Insertion
- Can be inserted during menstrual cycle
- Cervix position checked
- STI checks
- Checking its still in place by feeling for 2 thin threads that hang down from your womb into the top of your vagina
- Can be taken out at any time and possible to get pregnant
important side effects of IUD
- Periods can be heavier, longer and more painful in first 3-6 months
- Small risk of infection e.g. PID in first 20 days
- Small risk of rejection or rupture
- Does not protect against STI
- Ectopic pregnancy
benefits of IUD
- For women who can remember to take the pill
- Works straight away
- No hormonal side effects
- Doesn’t effect fertility
- Doesn’t increase risk of cervical, uterine or ovarian cancer
IUS MOA
- Levonorgestrel- releasing intrauterine system (LNG- IUS)
- Releases progestogen into the womb
- Thickens cervical mucus
- Thins lining of the womb
- Can prevent ovulation
indication of IUS
- Can be used in those who cannot take COCP
- Menorrhagia
contraindication of IUS
- Current or past breast cancer
- Cervical cancer
- Untreated STI
correct use of IUS
- 99% effective, lasts for 3- 5 years
- If fitted in first 7 days od cycle- protected straight away
- If after 7 days- condoms for 7 days
- Can have local anaesthetic to help with pain
- Checking its still in place by feeling for 2 thin threads that hang down from your womb into the top of your vagina
- Can be taken out at any time and possible to get pregnant
important side effects of IUS
- Mood swings
- Skin problems
- Breast tenderness
- Risk of infection
- Ectopic pregnancy
- Doesn’t protect against STI
benefits of IUS
- For women who can remember to take the pill
- No impact on fertility
- Makes periods lighter, shorter or stop
the implant MOA
- Implant releases a steady amount of progestogen into bloodstream, which stops ovulation
- Also thickens cervical mucus
- Thins lining of the womb
indication of implant
- Can be used in women cant use contraception that contains oestrogen
contraindication of the implant
- If you are pregnant
- Don’t want your periods to change
- Take medication that affects the implant
- Medicines for HIV, epilepsy and tb
- Unexplained bleeding in between periods or after sex
- Breast cancer
- Medicines for HIV, epilepsy and tb
correct use of implant
- >99% effective
- Last for 3 years
- If fitted within first 5 days of menstrual cycle- protected immediately
important side effects of implant
- Bruising and swelling when first implanted
- Headaches, nausea, breast tenderness and mood swings for first few months
- Acne
- Doesn’t protect against STI
benefits of implant
- For women who can remember to take the pill
- Fertility returns to normal very quickly
- amenorrhoea
the injection
depo-provera mostly given in uk
injection MOA
- Progestogen is steadily released into bloodstream and prevents ovulation
- Also thickens cervical mucus and thins endometrium
indication of injection
- Can be used in women cant use contraception that contains oestrogen
contraindication of the injection
- If pregnant
- If you don’t want periods to change
- Want to have a baby in the next year
- Unexplained bleeding
- Risk of osteoporosis
- Due to suppression of oestrogen
correct use of injection
- 99% effective
- Lasts for 12 weeks
- Injection in bottom
- Can be self administered
important side effects of injection
- Wight gain
- Headaches
- Mood swings
- Breast tenderness
- Irregular bleeding
- Hair loss
- Decreased sex drive
- Can take up to a year for fertility to return to normal after injection wears off
- Doesn’t protect against STI
benefits of injection
- For women who can remember to take the pill
- Not affected by other medicines
- May reduce heavy, painful periods
women who have a past history of breast cancer should
not be on hormonal contraception
- only appropriate long term contraception is IUD
vasectomy
Is a surgical procedure to cut or seal the tubes that carry a man’s sperm to permanently prevent pregnancy.
- >99% effective
- Permanent- very difficult to reverse and not on the NHS
- Doesn’t affect sex drive
- Counselling before operation
- Safer and simpler to female sterilisation
- Often only done in those >30
how a vasectomy works
- Stopping sperm getting into semen by cutting the vas deferens (removing a small section and then the ends are closed by tying them or sealing them using heat
- 2 types of vasectomy
- Scalpel (surgical)- conventional
- Non-scalpel
- Need to use contraception for 8-12 weeks after operation because sperm will still be in the tubes
- Up to 2 semen test done after operation to make sperm have gone
- At 12 weeks sample of semen tested for sperm
sterilisation
Female sterilisation is an operation to permanently prevent pregnancy. The fallopian tubes are blocked or sealed to prevent the eggs reaching the sperm and becoming fertilised.
- >99% effective
- Does not affect hormone levels and you still have periods
- Reversal is not available on the NHS
- Counselling before operation
how sterilisation works
- Fallopian tubes sealed preventing eggs travelling down to be fertilised
- Eggs will still be released from the ovaries as normal, but they’ll be absorbed naturally into the woman’s body.
- Methods:
- Applying clips
- Applying rings
- Tying, cutting and removing
- If blocking tubes hasn’t work, tubes can be removed- salpingectomy
- Often done under general anaesghetic
advice after sterilisation
- If you have had tubal occlusion, use additional contraception until first period to protect yourself from pregnancy
Adverse outcomes for sterilisation
- Internal bleeding
- Infection
- Damage to other organs
- May not work and increased risk of ectopic pregnancy
- Non reversible
- Doesn’t protect against STI
Fertility awareness method
Involves monitoring and recording fertility indicators throughout the cycle
e.g. cervical secretions, changes in your cervix, basal body temp
when you ar emost fertile
- cervical secretions are wetter, transparent, slippery and most stretchy
- basal body temp increases slightly after ovulation (36.1 to 36.4 whereas after ovulation it rises between 36.4 – 37)
advantages of fertility awareness method
- no hormones involves
- can be up 99% effective if followed very carefully
disadvantages of fertility awareness method
- time consuming, unreliable, no STI protection
post-cotial contraception
Two types of emergency contraception
- Emergency contraceptive pill – levonelle or ellaOne
- The IUD
indication of post-coital contraception
Indication: unprotected sex, forgot to taker regular contraceptive, late having implant or injection
emergency contraceptive pill: MOA of levonelle
within 3 days (72hours) of unprotected sex
- Contains levonorgestrel a synthetic version of progesterone
- Stops or delays ovulation
emergency contraceptive pill: MOA of ellaOne
within 5 days (120 hours)
- contains ulipristal acetate- stops progesterone working normally
- stops or delays ovulation
Indications and contraindications morning after pill
- most women can take it (levonelle is even safe to take whilst breast feeling)
- contraindications
- e.g. medicine for epilepsy, HIV or TB
side effects of morning after pill
- Headache
- Tummy pain
- Change to next period
- Feeing or being sick (get medical attention if you’re sick within 2hours of taking levonelle or 3 hours of taking ellaOne
the IUD as a post-coital contraception
- Can be fitted up to 5 days after unprotected sex or up to 5 days after the earliest time you could have ovulated
- More effective than the pill
Presentation of menorrhagia
- need to change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than is recommended
- need to use 2 types of sanitary product together, such as a pad and a tampon
- have periods lasting more than 7 days
- pass blood clots larger than about 2.5cm (the size of a 10p coin)
- bleed through to your clothes or bedding
- avoid daily activities, like exercise, or take time off work because of your periods
- feel tired or short of breath a lot
