5.2 Introduction to Contraception Flashcards by Imogen Marriott

What is contraception?

Any method to prevent pregnancy

Blocking transport of sperm
Disruption of HPG axis
Inhibit implantation

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What categories can methods of contraception be broadly split into?

Natural 
Barrier 
Hormonal 
Prevention of implantation 
Sterilisation 
Emergency

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Name three methods of natural contraception

Abstinence
Withdrawal method
Lactational amenorrhoea method

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What are three fertility indicators?

Cervical secretions
Basal body temperature
Length of menstrual cycle

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What is the principle behind the lactational amenorrhoea method?

Breastfeeding delays return of ovulation after childbirth

Suckling stimulus disrupts release of GnRH
Affects HPG axis

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How long is the lactational amenorrhoea method reliable for and what does this rely on?

6 months after giving birth

Exclusive breast feeding

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What types of barrier contraception?

Condoms

Diaphragm/Cap

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What do low doses of progesterone do in contraception?

Thicken cervical mucus

Does not inhibit LH surge so ovulation still likely

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How do contraceptives with high dose of progesterone work?

Inhibit positive feedback of oestrogen
No LH surge
No ovulation

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What is the principle action of the COCP?

Prevents ovulation

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What are secondary actions of the COCP?

Inhibit implantation

Thicken cervical mucus

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Advantages of COCP

Relieve menstrual disorders

Reduced risk of ovarian and endometrial cancer

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Disadvantages of COCP

User dependent 
Interactions with medications 
Increased risk of breast and cervical cancer
Increased risk of MI/stroke 
No STI protection

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What is the principle action of high dose progesterone contraceptives? (Injection and implant)

Prevents ovulation

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What are the secondary actions of high dose progesterone contraceptives? (Injection and implant)

Thicken cervical mucus

Prevent endometrial proliferation.

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Advantages of progesterone injection

Reliable

Useful for women who can’t have contraception with oestrogen

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Disadvantages of progesterone injection

Appointment every 12 weeks
Osteoporosis in low weight patients
Delay in fertility returning
No STI protection

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How long does the progesterone implant last for?

3 years

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Advantages of progesterone implant

Reliable
LARC
Women who can’t have oestrogen in contraception
Fertility returns quickly

Disadvantage of progesterone implant

Minor procedure
May have unpredictable periods
No STI protection

How should the progesterone only pill be taken?

Every day, without a break

What is the principal action of the progesterone only pill?

Thicken cervical mucus

Which contraceptive pill does not stop ovulation and why?

Progesterone only pill

Because it is low dose progesterone so the LH surge is not inhibited

What are the two types of coil?

Intrauterine system IUS - Progesterone releasing

Intrauterine device IUD - Copper

How long does the IUS work for?

3-5 years

What is the principal action of the IUS?

Prevents implantation | - Reduces endometrial proliferation

What is the secondary action of the IUS?

Thickens cervical mucus

What is the IUD?

Plastic device with added copper

How long is the IUD effective for?

5-10 years

What is the principal action of the IUD?

Copper is toxic to sperm and ovum

What is the secondary action of the IUD?

Endometrial inflammatory reaction - Prevents implantation - Changes consistency of cervical mucus

Advantages of the coil

Convenient | Long duration of action

Disadvantages of the coil

``` Unpleasant insertion Risk of uterine perforation Irregularity in menstruation No protection from STI Displacement ```

Name for male and female sterilisation

Vasectomy Tubal ligation/Clipping

How does a vasectomy work?

Vas deferens cut or tied to prevent sperm from entering ejaculate

How does tubal ligation work?

Fallopian tubes cut or blocked to stop ovum travelling from ovary to uterus

Define subfertility

Failure of conception in a couple having regular, unprotected coitus for one year

Difference between primary and secondary infertility

Primary - Never conceived Secondary - Previously conceived including abortion and ectopic pregnancy

Name the three groups of ovulatory disorders leading to subfertility

Hypothalamic-pituitary failure Hypothalamic-pituitary-ovarian Dysfunction Ovarian failure

Broad groups of uterine/peritoneal disorders

Uterine fibroids Endometriosis Pelvic inflammatory disease

Causes of tubal damage

``` Endometriosis Ectopic pregnancy Pelvic surgery Past pelvic infection Mullerian developmental anomaly ```

How can fertility be increased?

Stop smoking Reduce alcohol levels Reduce stress Healthy diet Women only- loose weight

Who may be referred to a fertility clinic?

A woman of reproductive age who has not conceived after one year of unprotected vaginal intercourse, in absence of any known cause of infertility

Who may be suitable for an early referral to a fertility clinic?

Women >36yrs Known clinical cause for infertility History of predisposing factors for infertility

What are the three main types of treatment for infertility?

Medical treatment to restore fertility Surgical treatment to restore fertility ART