W6 - Contraception Flashcards
What are potential methods of contraception?
- Methods which
require ongoing action
by the individual - Oral Contraception
- Barrier Methods
- Fertility awareness
- Coitus interruptus
- Oral Emergency
contraception - Methods which
prevent conception by
default - IUCD/IUI/IUS
- Progestogen Implants
- Progestogen Injections
- Sterilisation
What is a perfect contraception?
- 100% Reliable
- 100% Safe
- Non User Dependent
- Unrelated to Coitus
- Visible to the Woman
- No ongoing Medical Input
- Completely reversible within 24 hours
- No Discomfort
What are the risks?
Risks of Treatment
* Cardiovascular
* Neoplastic
* Emotional
* Infection related
* Allergic
* Iatrogenic
Risks of no treatment
* Childbirth related
* Abortion related
* Social costs
* Economic costs
What are benefits?
Benefits of Treatment
* Non Contraceptive
* Psychosexual
* Choice
* Sexual Health
* Cost savings
* Female equality
Benefits of no Treatment
* Non interference
* Population growth
* Control of women
What are the combined oral contraception?
- Oestrogen EthinylOestradiol - 20,30,35,50
micrograms - Progestogens
- Older (2nd generation) – Norethisterone
(Norethindrone) & Levonorgestrel - Newer(3rd generation) – Desogestrel, Gestodene
& Norgestimate (Noregestromin) - Latest (derived from Spironolactone) - Drospirenone
Oestrogens act
* On anterior pituitary & hypothalamus
* Directly on the ovary
* On the Endometrium
It switches off follicular development and ovulation. If we give just oestrogen, it would cause continuous endometrium disintegration, which is why we combine it with progesterone.
Progestogens act
* On anterior pituitary & hypothalamus
* Directly on the ovary
* On the Endometrium
* On the fallopian tubes
* On cervical mucus thickens - prevents sperm entering
Very high levels of progesterone would combine with oestrogen to cause negative feedback on the hypothalamus and the pituitary - stops ovulating. The combination of oestrogen and progesterone is atrophy. There is a real thinning of the endometrium - not receptive if a sperm and egg gets together. The smooth muscle of the fallopian tubes dilate and doesn’t function very well.
This is a very good contraceptive because it’s got a lot of backup.
What are the benefits of oral contraception?
- Contraceptive
- Reliable
- Safe
- Unrelated to coitus
- Woman in control of when she takes it
- Rapidly reversible - as soon as she stops taking it, it’s reversed to natural cycle in a few days.
- Non contraceptive
- Halve ca ovary
- Halve ca endometrium
- Helps endometriosis, menorrhagia, dysmenorrhoea,
Thin the endometrium when you take it. It halves the risk of ovarian, uterine and endometrium cancer when they take it for year. It treats endometriosis (causes a lot of period pain and pain during sex). It lightens heavy periods because of the thinning of the endometrium. Less pain generally.
What are risks of oral contraception?
- Cardiovascular - Arterial – Progestogen , High Blood Pressure, so if you are smoking - not the best idea.
- Venous – Oestrogen-VTE-clotting disorders (DVT, PE, Migraine) Increases clots in the liver.
- Neoplastic - Breast, Cervix, Liver
Oestrogen upsets carbohydrates and insulin metabolism. - Gastrointestinal– COH/insulin metabolism, Weight gain (in objective measurements, there is no evidence, but could happen).
Crohns disease - Hepatic – hormone metabolisms, congenital nonhaemolytic jaundices, gall stones
- Dermatological – Chloasma, acne, erythema multiforme. In some women acne improves.
- Psychological – Mood swings, depression, Libido
What are the combined oral contraception pill rules?
- Start 1st packet 1st day of a menstrual period
- Take 21 pills and stop for 7 day break (PFI)
- Restart each new packet on 8th day (same)
- Do not start new packets late
- If late or missed pills in 1st 7 days, condoms
- If missed pills in last 7 days no PFI
What are the Combined Oral Contraception-Interacting Medication?
When people take the pill, they need to be careful of some drugs.
* 1. Liver enzyme inducing drugs - see list/MIMS
* Affect metabolising of both oestrogen and
progestogen
* Beware rifampicin and anti-epileptics
* 2. Broad spectrum antibiotics
* Affect enterohepatic circulation of oestrogen
only (40%) This has to do with gut bugs - the serum levels drop.
What are the vaginal contraceptives?
This is a ring that goes inside the vagina.
* Same as COCP except vaginal delivery
(ring) for 21 days
* Remove for 7 days
It releases oestrogen and progesterone into the vagina, where it is absorbed, and we take it out for 7 days where we have a bleed, then we put a new one back in.
* Adv – don’t have to take every day
* Disadv - don’t have to take every day!!
What are the contraceptions using progestogen only?
- Default Methods
- Implants: Nexplanon, Norplant (LNG) - goes in for 3 years at a time. They get under a little local anaesthetic into the subcutaneous area - usually just above the elbow.
- Hormone releasing IUCD:
Mirena IUS (LNG) - best known one.
User Dependent Methods
* POPs
Desogestrel (Cerelle) - pills you take everyday - no breaks
- Norethisterone
- Ethynodiol diacetate
- Levonorgestrel
- Norgestrel
Injectables
- Depo Provera (MPA) (12weekly)
- Noristerat (NET)
Why Cerelle is better than older POPs….
* As effective as COCP
* No oestrogen – CIs e.g. breastfeeding
* Favourable side effect profile vs older
POPS
* Bleeding as predictable as COCP
* 12 hour window
POP would cause funny bleeding, spotting etc. If you missed it by 3 hours, it was like a missed pill.
What are CONTRACEPTION-IUCDs
Copper bearing intrauterine contraceptive
devices are inserted into the uterus by
suitably trained practitioners and may be
left in situ long term and act by
* 1. Destroying spermatozoa
* 2. Preventing implantation – Inflammatory
reaction and prostaglandin secretion as well
as a mechanical effect.
What are the CONTRACEPTION-IUCDs-Types?
- Copper bearing Ortho T 380 – 8 -12yr
* Multiload 375 – 5yr
* Multiload 250 – 5yr (Standard & Short)
*Nova T 380 – 5yr
* Nova T 200 – 5yr
* GyneFix (IUI) – 5yr
The number describes how much copper is in them. If you put any of these in after 40 yrs old, you can leave them in until after menopause.
- Hormone bearing – Mirena (IUS) – 5yr
- Kyleena (IUS) - 4 yrs - it has marker, smaller and easier to get in.
- Hormone bearing – Mirena (IUS) – 5yr
What are the contraception-IUCDs-benefits?
- Non user dependent
- Immediately and retrospectively effective
- Immediately reversible
- Can be used long term
- Extremely reliable
- Unrelated to coitus
- Free from serious medical dangers
What are the contraception-IUCDs-risks?
- Miscarriage if left in situ if a pregnancy
- ?ectopics - someone with a coil in gets pregnant = must rule out ectopic.
- May be expelled
- The uterus may be perforated
When you put them in, if you struggle to put them in, they might not get far enough, they can sit in the cervix, or partially there, it will irritate because the uterus wants to get rid of it. It will squeeze a lot and there will be a lot of pain and bleeding and the coil will come out.
On the other hand, if you don’t push it in far enough, the uterus may be perforated.
