Contraception Flashcards
(28 cards)
Contraceptive implant
Etongesrel (progesterone) 25-70mg daily
Duration = 3 years
Removal is easy - rapid resumption of fertility
Side effects of contraceptive implant?
Irregular bleeding (12%) - improves with time
Injection depo-provera
Deep Im injection - 150mg
duration = 12 weeks
Side effects of contraceptive injection?
Irregular bleeding in first few weeks - usually followed by amenorrhoea
Amenorrhoea is prolonged after discontinuation (may take 6 months to resume fertility)
Reduced bone density after 2-3 years, recovers after discontinuation (Nb. avoid in those at risk of OA)
Weight gain (2-3kg in a year)
Advantages of injection?
Improves PMS
Effective in treatment for heavy, painful periods
Copper IUD
Copper = spermatoxic and prevented implantation
10 years
V. effective
Disadvantages of IUD
Pain/cervical shock can occur
Presence of asymptomatic STI can cause PID
Heavier and more painful periods can occur
Perforation –> migration into abdominal cavity
Advantages of IUD?
Can be inserted >4 weeks after birth
48 hours after TOP
Can be used as emergency contraception if inserted 5 days after ovulation
Mirena IUS
Levonorgestrel (20mcg daily over 5 years)
Pearl index = <0.2
thickens cervical mucus, thins endometrial lining, inhibits sperm survival
DOESN’T STOP OVULATION
Disadvantages of Mirena IUS?
Pain/cervical shock
Irregular periods
PID risk with presence of STI
Perforation risk
Advantages of mirena?
Can be used to treat menorrhagia
Local release of hormone prevents systemic effects
E and 6 P’s for concealing for IUD/IUS?
Expulsion
Pregnancy (rate failure and ectopic) Periods Perforation PID Procedure (pain) Progesterone side effects - acne, weight gain, loss of libido, vaginal dryness, breast tenderness
Mode of action of COCP?
Synthetic oestrogen and progestogen prevent release of FSH and LH (prevent ovulation)
Thicken cervical mucus
Thins endometrium
Monthly schedule for COCP?
21 days on
7 days off - allows withdrawal bleed
Pearl index of COCP?
~1%
V. dependent on user effectiveness
Advantages of COCP?
Leads to regular, lighter and less painful periods (used to treat menorrhagia and dysmenorrhoea)
Can reduce acne, ovarian cysts and benign breast disease
Can be protective against PID (but still use condoms for casual sex!)
Protective against endometrial, ovarian and colorectal cancer
Contraceptive effects reversible upon stopping
Disadvantages of COCP?
Heavily reliant on correct use
Increased risk of VTE, stroke and IHD
Offers no protection against STIs
Side effects of COCP?
Temporary (<3months)
Headache, nausea and breast tenderness
Drug interactions of COCP?
CYP450 inducers reduce efficacy of COCP
Carbemazepine, phenytoin, rifampicin, barbiturates, st johgns wort
Absolute CI for COCP?
CVD: Hx of VTE Hx of cerebrovascular accident Severe hypertension Inherited thrombophilia Pregnancy Dm with vascular problems Active chronic liver disease
Head: Migraine with aura
Cancer: Breast/endometrial
BMI> 40
Smokers >35 who have been smoking for >15 cigs a day
Relative CI of COCP?
BMI 35-40 Age>40 Smokers <35yrs Chronic inflammatory disease Renal impairment, DM Breast feeding (<6 months)
When is there no need for barrier contraception when starting the COCP?
If they start taking the pill in the first 5 days of menstruation
If started at another time must use condoms for 7 days
Method of action of POP?
Thickens cervical mucus and thins endometrial lining
Usually causes amenorrhoea
Use of POP
Started within first 5 days - immediate proptection
Started >5 days - use barrier contraception for 2 days
