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Human Development > Contraception > Flashcards

Contraception Flashcards

1
Q

what contraception acts at the ovary

A

Combined hormonal contraception
Progesterone-only pill
Injection
Implant

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2
Q

what contraception acts at the endometrium

A

IUS

IUD

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3
Q

what contraception acts at the cervix

A

IUS
Progesterone-only pill
CHC

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4
Q

what is the mode of action of the combined hormonal contraction

A

Inhibits LH and FSH this prevents ovulation
Thickens cervical mucus this acts as a natural sperm barrier
Thins endometrium this prevents implantation

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5
Q

what is the failure rate of the combined hormonal contraception

A
  • If used perfectly 0.3 per 100 woman years

- If used typically 9 per 100 woman years

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6
Q

what are the time of the combined hormonal contraception

A
  • birth control pill
  • vaginal ring
  • brith control patch
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7
Q

what are the advantages and disadvantage of the combined contraceptive pill

A

advantages

  • Reduce menorrhagia / dysmenorrhoea / PMS
  • Reduce risk of PID
  • Reduce risk of benign ovarian tumours / colorectal cancer / ovarian cancer
  • Improve acne
  • May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease

disadvantages

  • Higher risk of VTE / stroke / CV disease
  • Increased risk of breast cancer (returns to normal 10 years after stopping)
  • Small increased risk of cervical cancer
  • Depression / low mood
  • Temporary side effects include headache, nausea, breast tenderness, mood changes
  • Breakthrough bleeding
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8
Q

what publishes the UKMEC guidelines

A

FSRH

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9
Q

what does a UKMEC 1 condition mean

A
  • a UKMEC 1 condition means it is fine to take that form of contraception with the disease
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10
Q

what does an UKMEC 4 mean

A

this means that you should not take the contraception with that condition

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11
Q

what are the UKMEC 4 conditions for the combined contraception pill

A
  • VTE / CV disease (inc atrial fibrillation) / stroke – either personal or close family history
  • Hypertension
  • Any thrombophilic condition
  • Oestrogen-dependent cancers (usually breast or cervical)
  • Migraine with aura – slightly higher risk of stroke with hormonal contraception
  • Liver disease
  • Combination of risk factors for cardiovascular disease, e.g. hypertension/diabetes
  • Over 35 years and a smoker
  • BMI > 35
  • < 6 weeks postpartum if breastfeeding – it can mess with postpartum hormone regulation
  • <3 weeks postpartum if non-breastfeeding
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12
Q

what is the mode of action of progesterone

A
  • Thickens cervical mucus this act as a natural sperm barrier
  • Thins endometrium prevents implantation
  • Inhibits ovulation (97% desogestrel, 60% others
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13
Q

what is the failure rate of progesterone only contraception

A

If used perfectly 0.3 per 100 woman years

If used typically 9 per 100 woman years

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14
Q

what are the types of progesterone only contraception

A 
POP
Injection (Depo-Provera)
- lasts 3 months
Implant (Nexplanon/Implanon)
 - lasts 3 years
Intrauterine system (IUS)
- lasts 5 years
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15
Q

what is the advantages and disadvantages of the progesterone

A

Advantages

  • Reduces menorrhagia / dysmenorrhoea / PMS
  • Amenorrhoea
  • Reduce risk of endometrial cancer
  • Can be used when breastfeeding
  • Fewer adverse effects compared to CHC

disadvantages

  • Irregular spotting
  • Acne
  • Headaches, nausea, mood swings, bloating, breast tenderness, weight gain
  • Ovarian cysts
  • All above usually settle after 6 months
  • IUS only – uterine perforation, expulsion, ectopic pregnancy, PID
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16
Q

what are the UKMEC 4 diseases for progesterone pill only

A
  • Unexplained vaginal bleeding
  • If VTE / stroke / IHD occur during use
  • Breast cancer
  • Severe liver disease
  • IUS only – PID, >48h - <4w postpartum
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17
Q

what is the mode of action of intrauterine device

A

Copper is spermicidal
Thickens cervical mucus this acts as a natural sperm barrier
May act as physical barrier to implantation

18
Q

what is the failure rate for the IUD

A

0.6-0.8 per 100 woman years

19
Q

what are the advantages and disadvantages to the IUD

A

Advantages

  • Long-acting (5-10 years)
  • No hormones

Disadvantages

  • Uterine perforation
  • Expulsion
  • Ectopic pregnancy
  • PID
  • Menorrhagia (IUD only) – more painful periods
20
Q

what is the contraindications of the IUD

A
  • Unexplained vaginal bleeding
  • PID / untreated STI
  • Cancers (cervical, endometrial)
  • Puerperal sepsis – it would come out as soon as you put it in
  • > 48 hours - <4 weeks post-partum
  • Distorted uterine cavity (may be appropriate under imaging guidance after discussion)
21
Q

what are the two types of barrier methods

A

male codon

diaphragm cap

22
Q

what is the failure rate of the male codon

A

If used perfectly failure rate 2 per 100 woman years

if used typically failure rate 18 per 100 woman years

23
Q

what is the filature rate of the diaphragm and cap

A

If used perfectly, failure rate 6 per 100 woman years

If used typically, failure rate 12 per 100 woman years

24
Q

what contraceptions protect against STIs

A

barrier method - male codon, diaphragm/cap

25
Q

how do you do natural family planning

A

Involves education and charting of various indicators of female fertility including:

  • Temperature
  • Consistency of cervical
  • mucus
  • Position of cervix
  • Day of cycle
26
Q

what is the failure rate for natural family planning

A

If used perfectly failure rate is 0.5 per 100 woman years

If used typically failure rate is 24 per 100 woman years

27
Q

what are the advantages and disadvantages of natural family planning

A

Advantages

  • Does not involve using any chemicals or physical devices
  • No physical side effects
  • Can help person to recognise normal and abnormal vaginal secretions
  • Can help with communication around fertility and sexuality
  • Acceptable to all faiths and cultures

disadvantages

  • Takes 3-6 menstrual cycles to learn effectively
  • Have to keep daily records
  • Some events - e.g. illness, lifestyle, stress, travel – may make fertility indicators harder to interpret
  • Need to avoid sex or use barrier methods during fertile time
  • Does not protect against STIs
28
Q

what is coitus interruptus

A
  • the withdrawn method
29
Q

what is the mode of action of coitus interruptus

A

Male partner pulls penis out of vagina before he ejaculates so that sperm cannot reach uterus

30
Q

what is the failure rate of coitus interrupts

A

With typical use, rate is 22 per 100 woman years

31
Q

what is the mode of action of female sterilisation

A

Typically laparoscopic bilateral tubal occlusion with clips/ligation/rings/diathermy

Can be done under local or general anaesthetic

32
Q

what is the failure rate of female sterilisation

A

Lifetime failure rate 1 in 200

33
Q

what is the mode of action of male sterilisation

A

Ligation/diathermy/excision of vas deferens bilaterally

Done under local anaesthetic

34
Q

what is the filature rate of male sterilisation

A

Lifetime failure rate 1 in 2000

35
Q

what is the risk of sterilisation for females

A 
Female
Pain
Heavier periods if <30 years
Ectopic pregnancy
Injury to internal organs
Regret
36
Q

what is the risk of sterilisation for males

A 
Male
Pain
Swelling
Infection
Retrograde ejaculation
Regret
37
Q

what are the two types of emergency contraception

A

oral

IUD

38
Q

what is the mode of action of emergency contraception oral

A

Delay ovulation

39
Q

what are the two emergency contraception for oral

A

Levonelle. Levonorgestrel 1.5mg single dose. Licensed up to 72 hours post-UPSI. Pregnancy rate 0.6 – 2.6%

EllaOne. Ullipristal acetate 30mg single dose. Licensed up to 120 hours post-UPSI. Pregnancy rate 1 – 2%

40
Q

what is the emergency contraction IUD mode of action

A

Inhibits fertilisation by direct toxicity

Affects implantation by causing endometrial inflammation

Overall pregnancy rate <0.1%

Licensed up to 5 days after UPSI / earliest possible ovulation

Human Development (28 decks)

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