WH: Contraception Flashcards
How much does contraception cost in the uk ?
all forms of contraception are free in the UK on the NHS
briefly describe what UKMEC means ? high/low ?
UKMEC 1: no restriction in use (minimal risk)
UKMEC 4: unacceptable risk (contraindicated)
Name some methods of contraception ? (9)
- Natural family planning (rhythm method)
- barrier methods (condom)
- Combined contraceptive pills
- Progesterone only pills
- Coils (copper, mirena)
- prgesterogen infection
- Progesterone implant
- Surgery (sterilisation, vasectomy)
- emergency contraception
Px has great cancer: what contraception should be avoided ?
avoid any hormonal contraception + go for Cooper coil or barrier
Px has cervical or endometrial cancer: what contraception should be avoided ?
avoid intrauterine system (mirena coil)
patient has Wilsons disease. what contraception should be avoided ?
avoid the copper coil
how does HRT impact chance of pregnancy ?
it does not prevent pregnancy
how many days after birth is a woman fertile ?
no considered fertile until 21 days after birth
what is lactational amenorrhoea ? how effective ? what is required for it to be effective ?
breastfeeding leads to lack of periods
- 98% effective for up to 6 months after birth
- must be completely breast feeding and completely amenorrhoiec
what contraception soul be avoided in breast feeding ?
avoid COCP until 6 weeks after birth
(but POP or implant can be started anytime)
How do barrier methods of contraception work ? what else does this protect against ?
provide a physical barrier to see entering uterus + causing pregnancy
- protects from pregnancy and infection
what products should be avoided with condom use ? (can cause damage to them)
oil based lubricant can damage latex => tear
name some barrier methods of contraception ?
- Condoms
- Diaphragms
- Dental dams
describe instruction for diaphragm contraception ? used in combo with what ?
silicone cup that fits over cervix => prevent some entry
- woman fits it before sex, leave in for 6 hours sex
- used with spermicide gel
Which hormones are in the COCP ? how effective is it ?
combo of oestrogen + progesterone
- 99% effective with perfect use (91% typical)
what are the 3 mechanism of action by which the COCP prevents pregnancy ?
- Prevent ovulation (primary mechanism)
- Progesterone thickens cervical mucus
- Progesterone inhibits proliferation of the endometrium (decrease change of successful implantation)
Describe the hormonal changes that means the COCP prevents ovulation ?
high oestrogen + high progesterone => -ve feedback on hypothalamus + AP => low GnRH + low LH + low FSH => no ovulation
(prevent LH surge)
what happens with COCP is stopped ?
uterus lining breakdown + shed => withdrawal bleed
(also rapid fertility return afters topping)
COCP SE ? (8)
- Unsceduled bleeding
- Breast pain + tenderness
- Mood changes + depression
- Headaches
- Hypertension
- VTE
- Breast + cervical cancer
- MI + stroke
COCP contraindications ? what UKMEC level would this be ? (4)
makes the pill a UKMEC 4
- uncontrolled hypertension (>160/100)
- Migraine with aura
- VTE Hx
- 35+ and smoking 15+ a day
- Major surgery with prolonged immobility
- breast cancer
advice on starting COCP: when does protection against pregnancy start ?
start on day 1 (up until day 5): offer protection strain away
after day : use other contraction (condoms) for first 7 days
COCP Missed pill: what do you do if 1 missed pill ?
Take missed pill asap (even if it means taking 2 pills in same day)
- 1 day: no extra protection required
COCP missed pill: more than 1 pill advice ?
take missed pill asap (even if it means taking 2 pills in same day)
- more than 1 pill missed: additional contraception until taken pill regularly for 7 days
apart form missing an actual pill, what else could count as a missed pill ?
episodes of committing or diarrhoea
