contraception Flashcards
(50 cards)
what are the reasons for using contraception?
- Preventing pregnancy-related health risks in women
- Reducing infant mortality
- Helps to prevent HIV/AIDS
- Empowering people and enhancing education
- Reducing adolescent pregnancies
- Slowing population growth
what are the sites of action of contraception?
ovary
endometrium
Cervix
what drugs target the ovary?
Combined hormonal contraception, Progesterone-only pill, Injection, Implant
what drugs target the endometrium?
IUS
IUD
what drugs target the cervix?
IUS, Progesterone-only pill, CHC
what hormones are involved in the female menstruation cycle?
FSH
oestrogen
LH
Progesterone
what does FSH do in the female menstrual cycle?
Ovarian follicular development, Oestrogen levels rise
what does oestrogen do in the menstrual cycle?
Endometrial proliferation, LH surge
what does LH do in the menstrual cycle?
Ovulation, Corpus luteum formation, Oestrogen and progesterone rise
what does progesterone do?
endometrial thickening
what is the combined hormonal contraception?
Combination of oestrogen and progesterone
what is the mode of action of CHC?
o Inhibits LH and FSH –> prevents ovulation
o Thickens cervical mucus –> natural sperm barrier
o Thins endometrium –> prevents implantation
what is the failure rate of CHC?
o If used perfectly 0.3 per 100 woman years
o If used typically 9 per 100 woman years
what are the types of CHC?
Birth control pills, Vaginal ring, Birth control patch
what are the advantages of CHC?
o Reduce menorrhagia / dysmenorrhoea / PMS
o Reduce risk of PID
o Reduce risk of benign ovarian tumours / colorectal cancer / ovarian cancer
o Improve acne
o May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease
what are the disadvantages of CHC?
o Higher risk of VTE / stroke / CV disease
o Increased risk of breast cancer (returns to normal 10 years after stopping)
o Small increased risk of cervical cancer
o Depression / low mood
o Temporary side effects include headache, nausea, breast tenderness, mood changes
o Breakthrough bleeding
what are the contraindications of CHC?
o VTE / CV disease (inc atrial fibrillation) / stroke – either personal or close family history
o Hypertension
o Any thrombophilic condition
o Oestrogen-dependent cancers (usually breast or cervical)
o Migraine with aura
o Liver disease
o Combination of risk factors for cardiovascular disease, e.g. hypertension/diabetes
o Over 35 years and a smoker
o BMI > 35
o < 6 weeks postpartum if breastfeeding
o <3 weeks postpartum if non-breastfeeding
what is progesterone only contraception?
various different forms of synthetic progesterone
what is the mode of action of progesterone only contraception?
o Thickens cervical mucus natural sperm barrier
o Thins endometrium prevents implantation
o Inhibits ovulation (97% desogestrel, 60% others)
what is the failure rate of progesterone only contraception?
oIf used perfectly 0.3 per 100 woman years
o If used typically 9 per 100 woman years
what are the types of progesterone only contraception? how long do they last?
o POP
o Injection (Depo-Provera) - lasts 3 months
o Implant (Nexplanon/Implanon) - lasts 3 years
o Intrauterine system (IUS) - lasts 5 years
what are the advantages of progesterone only contraception?
o Reduces menorrhagia / dysmenorrhoea / PMS; Amenorrhoea; Reduce risk of endometrial cancer; Can be used when breastfeeding; Fewer adverse effects compared to CHC
what are the disadvantages of the progesterone only contraception?
o Irregular spotting
o Acne
o Headaches, nausea, mood swings, bloating, breast tenderness, weight gain
o Ovarian cysts
o All above usually settle after 6 months
o IUS only – uterine perforation, expulsion, ectopic pregnancy, PID
what are the contraindications of progesterone only pill?
o Unexplained vaginal bleeding o If VTE / stroke / IHD occur during use o Breast cancer o Severe liver disease o IUS only – PID, >48h - <4w postpartum
