Contraception Flashcards
What would be the perfect contraceptive?
- 100% reliable and safe
- Non-user dependent
- Unrelated to sex
- Visible to the woman
- No ongoing medical input
- Completely reversible within 24 hours
- No discomfort
What are the risks of contraception?
Treatment
- CVS
- Neoplastic
- Emotional
- Infection related
- Allergic
- Iatrogenic
No treatment
- Kids
- Abortion related
- Social and economic costs
What is the combined oral contraceptive pill?
- Oestrogen and Progesterone
- Oestrogens act on anterior pituitary and hypothalamus; directly on the ovary; on the endometrium
- Progestogens act on same + fallopian tubes and cervical mucus
What are the benefits of COCP?
Contraceptive: reliable, safe, unrelated to sex, woman in control, rapidly reversible
Non-contraceptive: Halve risk of ovarian and endometrial cancer, reduce risk of colon cancer. Helps endometriosis, fibroids, RA, premenstrual syndrome, dysmenorrhoea, menorrhagia
What are the risks of COCP?
- CVS - clotting disorders
- Neoplastic - breast, cervical, liver
- GI - weight gain, Crohns, carb/insulin metabolism
- Hepatic - hormone metabolisms, jaundices, gall stones
- Dermatological - acne
- Psychological - mood swings, depression, libido
What are the COCP rules?
- Start 1st packet 1st day of menstrual period
- Take 21 pills and stop for 7 day break
- Restart each new pack on 8th day
- Dont start late
- If late or missed pills in 1st 7 days - condoms
- If missed pills in last 7 days, no pill-free interval
What medications interact with COCP?
- Liver enzyme inducing drugs - affect metabolism of oestrogen and progestogen
- Broad spectrum antibiotics - affect enterohepatic circulation of oestrogen
What is the combined vaginal contraceptive?
- Same as COCP but vaginal delivery
- Dont have to tae every day (leave in for 21 days and take out for 7)
What progestogen only methods are there?
- Implants, P releasing coil
- Pills (cerazette/Desogestrel), injectables
Why is Cerazette (POP) so good?
- As effective as COCP
- No oestrogen - no adverse effects from that
- “Better” side effects
- bleeding as predictable as COCP
- 12 hour window
What are IUCDs?
- Copper IUDs
- Destroy sperm
Prevent implantation - inflammatory reaction, PG secretion and mechanical effect - Copper bearing and hormone bearing
What are the benefits of IUCDs?
- non-user dependent
- immediately and retrospectively effective
- immediately reversible
- can be used long term
- extremely reliable
- unrelated to coitus
- free from serious medical dangers
What are the disadvantages of IUCDs?
- has to be fitted by trained medical personnel
- fitting may be painful
- periods become heavier and painful
- Doesnt offer protection against infection
- Threads may be felt by the male
What are the risks of IUCDs?
- miscarriage if left in if a pregnancy
- possibly ectopics
- may be expelled
- may perforate uterus
What are the absolute contraindications of IUCDs?
- current pelvic inflammatory disease
- Suspected or known pregnancy
- Unexplained vaginal bleeding
- Abnormalities of the uterine cavity
What are the advantages of condoms?
Male
- male in control
- protects against STIs
- No serious health risks
- Easily available
Female
- Woman in control
- Protects against STIs
- Can be put in in advance and left inside after loss of erection
- not dependent on male erection to work
What are the disadvantages of condoms?
Male
- last minute use
- needs to be taught
- may cause allergies
- may cause psychosexual difficulties
- higher failure rate among some couples
- oily preparations rot rubber
Female
- obtrusive
- expensive
- messy
- rustles during sex
- uncertain failure rate
Diaphragm caps vs Suction caps
D
- made of latex
- fit across vagina
- Varied sizes 55-95mm
- Must be used with spermicide ad left in at least 6 hrs after sex
S
- Made of plastic
- Suction to cervix or vaginal vault
- Different sizes
- Must be used with spermicide and left in 6 hrs or more
What are the advantages of caps?
D
- Woman in control
- Put in in advance
- Offers protection against cervical dysplasias
- Perceived as natural
S
- Suitable for women with poor pelvic floor muscles
- No problems with rubber allergies
- very unobtrusive
- Woman in control
What are the disadvantages of caps?
D
- needs to be taught
- messy
- higher failure rate
- higher UTI
- Higher candiasis
S
- needs an accessible and suitable cervix
- higher failure rate than diaphragm
- not easy to find experienced teacher
What other methods of contraception are there?
- Natural family planning
- Withdrawal
- Fertility awareness
- Emergency pill
