Contraception Flashcards
Why use contraception?
- Able to control number of children
- Reduce need for TOP
- Women + girls more freedom of activity
- Reduce rate of STIs
- Manage menstrual Sx
What is Gillick competency?
Child <16YO is able to consent to their own treatment if the clinician deems them competent (decision and time specific)
COCP contains? MoA?
Oestrogen and progesterone
Suppress hypothalamo-pituitary-gonadal axis, prevent ovulation
Pros COCP?
Reversible
Control menstrual Sx
Reduce endometrial and ovarian cancer incidence
COCP cons?
Increased risk of VTE, MI.
Beware of interaction with other medication and liver disease
Why may POP be prescribed as oppose to COCP?
Recently pregnant or breastfeeding
Age >35, obese, smoker, migraine with aura
POP MoA?
Primary to thicken cervical mucous. Ovulation variable inhibited and endometrium thinned
POP CI?
Active breast cancer, liver failure
POP cons?
Dysfunctional bleeding
Unforgiving - small window must be taken in (3 hours)
Increase risk of breast cancer, ectopic pregnancy
Functional ovarian cysts
Depot progesterone injection MoA?
Inhibits ovulation, thins endometrium, thickens cervical mucous
Progesterone injection cons?
Small risk of bone mineral density decrease - need a DEXA scan if use >1 year.
Weight gain
Menstrual irregularities
Not quickly reversible
Implant - contains and MoA?
Progesterone
Inhibits ovulation, thins endometrium, thickens cervical mucous
Implant cons?
Irregular bleeding that can last a year (really common and really quite problematic)
Changes to weight, mood, libido
Implants pros?
<0.1% failure
Long acting and easily reversible
Reduce menstrual problems
IUCD (copper coil) MoA?
Fertilization inhibited by action of copper on egg and sperm
Endometrial inflammation inhibits implantation
IUCD pros?
10 years and reversible
Avoids hormones risk
IUCD cons?
Unpleasant insertion
Pain/bleeding - 6 months possibly - note very problematic
What must you have before IUCD fitted?
STI - do not want chlamydia or gonorrhoea in the cervix being pushed into the uterus
Mirena coil MoA?
Thin endometrium and prevents implantation. Thickens cervical mucous.
IUCD pros and cons?
Similar to copper coil: lasts 5 years, reduce menstrual bleed
Risk of expulsion, pain and dysfunctional bleed up to 6 months, ectopic pregnancy, PID
Why condom failure?
Split, fall off, fat soluble lubricant
Problems with female sterilisation?
Irreversible on NHS, abdominal surgery risks, ectopic pregnancy
Vas-ectomy problems?
Irreversible on NHS, not immediately effective, complications (failure, sperm granuloma, sperm antibodies, pain late recanalization)
Cycle counting - what is the fertile window of a woman?
5 days prior to ovulation and one day following
