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
how does the routine of COCP compare to POP ?
COCP: 21 days on + 7 days off, 63 days on (3packs) + 7 days off
POP:taken continuously
how does the progestogen only pill work ? (mechanism) (3)
- thickening cervical much
- Alternating endometrium (=> less accepting of implantation)
- reduce ciliary action in Fallopian tubes
Describe the staring the POP rules for the different days of th emenstrual cycle ?
days 1-5: woman is protected immediately
other days: additional contraception required for 48hrs
how long does it take for POP and COCP to become effective contraception if started on day 7 ? why ?
COCP: takes 7 days before protect (as works by preventing ovulation)
POP: 48hrs (takes this long for vertical mucus to thicken)
POP SE ? (4)
- unscheduled bleeding (20% amenorrhoea, 40% normal bleeding, 40% unscheduled/prolonged/heavier bleeding)
- breast tenderness
- headaches
- acne
what is the progesterone only injection ? drug name
IM or SC depot medroxyprogesterone acetate (DMPA) given at 12-13 weeks intervals
how long after depot does fertility return ?
can take 12 months after stopping for fertility to return
progesterone depot injection mechanism ?
- Inhibit ovulation by inhibiting FSH secretion by the pituitary gland
- Also thicken cervical much + alters endometrium
depot injection SE ? which ones unique to this contraception ?
same as all progesterone only contraception (change to bleeding schedule 20/40/40, acne, libido, headaches
- Unique to progestogen injection: Reduce BMD (increase osteoporosis risk), weight gain
What is the progestogen-only implant ? where is it ? how long does it last for?
small (4cm) flexible plastic rod placed in upper arm (under skin + above SC fat)
- last for 3 yrs
progestogen-only implant mechanism ?
- Inhibits ovulation
- Thickens mucus
- Endometrial changes
implant benefits ?
- Effective and reliable contracption
- Improve dysmenorrhoea
- Can make periods lighter or stop
what are contraceptive coils ?
devices inserted into the uterus that provide contraception (long acting, reversible)
what 2 types of coil are there? what are they called ? briefly explain them
- copper coil (intra-uterine device): creates hostile environment for pregnancy
- Levonorgesterl (intrauterine system - mirena): contains progesterone that is slowly released
contradictions for coils ? copper coil ?
PID, pregnancy, uterine cavity distortion (fibroids)
- Cu-IUD: Wilsons disease
how does copper coil work ? benefits? drawbacks ?
copper is too to occur + sperm, alters endometrium
- pros: immediately effective after insertion, no hormones, emergency contraception
- cons: required procedure to insert + remove, increase risk of ectopic pregnancy, can fall out
How does mirena coil work? benefits? drawbacks?
progestogen thickens cervical mucu + alters endometrium
- Pros: maes periods lighter, improve dysmenorrhoea, no effect on BMD (like other progestogen contraception)
- cons: requires procedure, increase risk of ectopic, can fall out
What are the options for emergency contraception ? which is most effective ? time frame ?
- Copper coil (most effective) (within 5 days of unprotected sexual intercourse)
- Levanogestrel
- Unipristal
what is sterilisation ?
permanent surgical interventions to prevent conception
- NHS does not provide reversal procedures
what are the 2 sterilisation procedures ? describe them ? what conditions ?
- Tubal occlusion: laparoscopic under GA
- Vasectomy: cut gas deferens => preven sperm travelling form testes to ejaculate fluid
(under local anaesthetic)
what are the 5 guidelines in the fryer guidelines ?
1) They are mature and intelligent enough to understand the treatment
2) They can’t be persuaded to discuss it with their parents or let the health professional discuss it
3) They are likely to have intercourse regardless of treatment
4) Their physical or mental health is likely to suffer without treatment
5) Treatment is in their best interest
