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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

Define contraception

A

Any method used to prevent pregnancy

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2
Q

3 different methods that contraception work

A

Blocking sperm transport to avoid fertilisation

Disruptio to HPG axis - prevent ovulation

Inhibit implantation of conceptus into endometrium

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3
Q

Categories of contraception

A

Natural
Barrier
Hormonal control - short activing/long acting reversible
Intrauterine - IUD/IUS
Sterilisation
Emergency

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4
Q

Two things to consider when recommending/choosing contracteption for pt

A

Patient preference and patient safety

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5
Q

4 natural methods of contraception

A

Abstinence - only 100% effective method but not an option for most

Withdrawal - Coitus interruptus

Fertility awareness - monitoring and recording fertility indicators such as cervical secretions, cervix changes, basal body temp and length of menstrual cycle

Lactational amennorhoea

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6
Q

Advantages and disadvantages of coitus interruptus

A

+ve - no hormones/devices

-Ve - unreliable, some sperm in pre-ejaculate, no STI protection

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7
Q

+ve and -ve of fertility awareness method

A

+ve - no hormones/contraindications

-ve - time consuming, unreliable, no STI protection, not suitable for all - have to be disciplined

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8
Q

What does barrier contraception provide?

A

A physical +/- a chemical barrier to sperm entering the cervix

eg condoms (male/female), diaphragms/cervical caps, +/- spermicides

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9
Q

+ve and -ve of barrier contraception

A

+ve - reliable STI PROTECTION

-ve - disrupts intercourse, dislodging risk, allergy/sensitive to latex? can split

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10
Q

Two types of hormonal control contraception

A

Short acting or long acting reversible (LARC)

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11
Q

What is the lactational amennorhoea method?

A

Breatfeeding after childbirth to avoid pregnancy - high levels prolactin disrupt HPG axis

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12
Q

When can lactational amennhorhoea be used?

A

For up to 6 months postnatally as long as pt is EXCLUSIVELY breatsfeeding (no bottles) and has COMPLETE amennorhoea

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13
Q

3 specific types of hormonal contraception

A

Combined oestrogen and progesterone - COCP, patch, ring

Progesterone only pill

Progesterone Depot injection and implant - LARC (long acting)

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14
Q

Main action of COCP

A

Prevent ovulation

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15
Q

Secondary actions of COCP

A

Reduces endometrial receptivity to implantation
Thickens cervical mucus

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16
Q

What does COCP contain?

A

Synthetic oestrogen and progesterone

Many brands available with different strengths/types of hormones

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17
Q

Regime of COCP

A

21 days then 7 day break with withdrawal bleed
Or 21 days then 7 placebo pills
Or continiously for 1 year then 7 day break then start again

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18
Q

Advantages of COCP

A

Reliable if used torrectly - 99%

Relieve menstrual disorders - menorrhagia

Decreases risk of ovarian and endometrial cancer (less ovulations)

Decrease acne severity with specific pills

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19
Q

Disadvantages of COCP

A

User dependent - must remember to take

No STI protection

Medication interactions

Contraindications - raised BMI, migrane+aura, breast cancer

Side effects - menstrual irregularities, breast tenderness, mood disturbance

Increased risk of CV disease, stroke, VTE, breast cancer and cervical cancer

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20
Q

What else do pts on the COCP need to be aware of?

A

Missed pill rules - if miss 1 is it ok but multiple could result in no protection against pregnancy

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21
Q

Low levels vs high levels of progesterone effects

A

High level - enhances negative feedback of oestrogen = reduced FSH and LH, no +ve feedback from oestrogen to LH, no LH surge so NO OVULATION

Low level - does not inhibit LH surge, can still ovulate but WILL thicken cervical mucus

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22
Q

What type of progesterone is the POP?

A

Low dose - you still ovulate on it but thickens cervical mucus (main action)

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23
Q

Other actions of POP

A

Reduces cilia activity in fallopian tubes

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24
Q

Regime for POP

A

Daily witn NO breaks

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25
Q

Advantages of POP

A

Reliable if used correctly - 99%
Can be used if COCP is contraindicated

26
Q

Disadvantages of POP

A

No STI protection
Strict timing - either 3 or 12 hr window, user dependent
Menstrual irregularities
Increased risk of ectopic pregnancy

27
Q

Why does POP increase risk of ectopic pregnancy?

A

Reduced cilia activity means if egg is fertilised is unlikely to make it to the uterus to be implanted here

28
Q

What is type of progesterone is the progesterone injection and what is it called?

A

Depo-Provera - HIGH DOSE progesterone

29
Q

Main actions of progesterone injection

A

Inhibit ovulation
Thicken cervical mucus
Thin endometrial lining

30
Q

Regime of progesterone injection

A

Given intramuscularly every 12 weeks

31
Q

Advantages of progesterone injection

A

Reliable
No known medication interactions
Can be used if oestrogen is contraindicated and rasied BMI
Don’t have to remember to take daily

32
Q

Disadvantages of progesterone injection

A

No STI protection
Not rapidly reversible (can take 18 months for fertility to return)
Menstrual irregularities

33
Q

Progesterone injection in young people:

A

Not first line as can thin bones

34
Q

What is the progesterone implant?

A

Small subcutaneous tube inserted into the arm
HIGH DOSE progesterone

35
Q

Main actions of progesterone implant

A

Inhibit ovulation
Thicken cervical mucus
Thins endometrial lining

36
Q

Advantages of progesterone implant

A

Reliable
Lasts up to 3 years
Can be used if oestrogen contraindicated and raised BMI
Fertility returns faster than injection!!!

37
Q

Disadvantages of progesterone implant

A

NO STI protection
Menstrual irregularities
Complications with insertion and removal

38
Q

Two types of intrauterine contraceptives

A

Intrauterine device - Copper containing coil

Intrauterine system - local progesterone releasing coil - Mirena coil

39
Q

Main action of intrauterine system

A

Ovulation continues (low dose and local)
But prevents implantation
Reduces endometrial proliferation
Thickens cervical mucus

40
Q

What else can a intrauterine system be recommended for?

A

First line for heavy periods

41
Q

Main action of intrauterine device

A

Copper is toxic to ovum and sperm preventing fertilisation

42
Q

Secondary action of intrauterine device

A

Cervical mucus changes
Endometrial inflammatory reactions prevent implantation

43
Q

Another use of copper intrauterine device

A

Can be used as emergency contraception even after ovulation has occurred (unlike emergency contraception pills)

44
Q

Common side effect of copper coil

A

HEAVY periods - inflammatory response from endometrium

45
Q

Advantages of intrauterine contraceptives

A

Convenient
Effective - 99%
LARC - 3-10 years
IUS is treatment for menorrhagia

46
Q

Disadvantages for intrauterine contraceptives

A

No STI protection
Complications with insertion - perforation or infection
Menstrual irregularities
Displacement/expulsion can occur (typically after 1st period on it)

47
Q

How to know if displacement/expulsion has occured off intrauterine contraception

A

Strings are left in vagina so pt and GP can check that they are there

48
Q

Male sterilisation name

A

Vasectomy

49
Q

What occurs during a vasectomy?

A

VAS deferens if snipped or tied to prevent sperm entering ejaculate
Under local anaesthetic

50
Q

What do you have to do post vasectomy?

A

Do post vasectomy semen analysis - 12 weeks

51
Q

Failure rate for vasectomy

A

1 in 2000 men

52
Q

Female sterilisation name

A

Tubal ligation/clipping

53
Q

What occurs during tubal ligation/clipping

A

Fallopian tube occluded to prevent ovum transport
Usually under general anaesthetic (asleep)

54
Q

Failure rate for tubal ligation/clipping

A

1 in 200-500 women depending on method

55
Q

Advantages of sterilisation

A

Permanent

56
Q

Disadvantages of sterilisation

A

No STI protection
NOT easily reversed - not on NHS and about 50% success rate

57
Q

When is emergency contraception used?

A

following unprotected sexual intercourse or contraception failure

58
Q

3 types of emergency contraception

A

Levonorgestrel
Ulipristal acetate (EllaOne)
Copper IUD

59
Q

Levonorgestrel - when can it be used and what does it do

A

AKA morning after pill
Can be used up to 72 hrs following UPSI
High dose of progesterone to inhibit ovulation

(pointless if already ovulated)

60
Q

Ulipristal acetate EllaOne - what is it and when can you use it

A

Up to 120 hours (5 days) post UPSI
Selective progesterone receptor modulator = inhibits/delays ovulation

61
Q

Copper IUD - when can it be used

A

Up to 5 days post ovulation as it prevents implantation

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