Contraception Flashcards
(40 cards)
what contraception acts at the ovary
Combined hormonal contraception
Progesterone-only pill
Injection
Implant
what contraception acts at the endometrium
IUS
IUD
what contraception acts at the cervix
IUS
Progesterone-only pill
CHC
what is the mode of action of the combined hormonal contraction
Inhibits LH and FSH this prevents ovulation
Thickens cervical mucus this acts as a natural sperm barrier
Thins endometrium this prevents implantation
what is the failure rate of the combined hormonal contraception
- If used perfectly 0.3 per 100 woman years
- If used typically 9 per 100 woman years
what are the time of the combined hormonal contraception
- birth control pill
- vaginal ring
- brith control patch
what are the advantages and disadvantage of the combined contraceptive pill
advantages
- Reduce menorrhagia / dysmenorrhoea / PMS
- Reduce risk of PID
- Reduce risk of benign ovarian tumours / colorectal cancer / ovarian cancer
- Improve acne
- May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease
disadvantages
- Higher risk of VTE / stroke / CV disease
- Increased risk of breast cancer (returns to normal 10 years after stopping)
- Small increased risk of cervical cancer
- Depression / low mood
- Temporary side effects include headache, nausea, breast tenderness, mood changes
- Breakthrough bleeding
what publishes the UKMEC guidelines
FSRH
what does a UKMEC 1 condition mean
- a UKMEC 1 condition means it is fine to take that form of contraception with the disease
what does an UKMEC 4 mean
this means that you should not take the contraception with that condition
what are the UKMEC 4 conditions for the combined contraception pill
- VTE / CV disease (inc atrial fibrillation) / stroke – either personal or close family history
- Hypertension
- Any thrombophilic condition
- Oestrogen-dependent cancers (usually breast or cervical)
- Migraine with aura – slightly higher risk of stroke with hormonal contraception
- Liver disease
- Combination of risk factors for cardiovascular disease, e.g. hypertension/diabetes
- Over 35 years and a smoker
- BMI > 35
- < 6 weeks postpartum if breastfeeding – it can mess with postpartum hormone regulation
- <3 weeks postpartum if non-breastfeeding
what is the mode of action of progesterone
- Thickens cervical mucus this act as a natural sperm barrier
- Thins endometrium prevents implantation
- Inhibits ovulation (97% desogestrel, 60% others
what is the failure rate of progesterone only contraception
If used perfectly 0.3 per 100 woman years
If used typically 9 per 100 woman years
what are the types of progesterone only contraception
POP Injection (Depo-Provera) - lasts 3 months Implant (Nexplanon/Implanon) - lasts 3 years Intrauterine system (IUS) - lasts 5 years
what is the advantages and disadvantages of the progesterone
Advantages
- Reduces menorrhagia / dysmenorrhoea / PMS
- Amenorrhoea
- Reduce risk of endometrial cancer
- Can be used when breastfeeding
- Fewer adverse effects compared to CHC
disadvantages
- Irregular spotting
- Acne
- Headaches, nausea, mood swings, bloating, breast tenderness, weight gain
- Ovarian cysts
- All above usually settle after 6 months
- IUS only – uterine perforation, expulsion, ectopic pregnancy, PID
what are the UKMEC 4 diseases for progesterone pill only
- Unexplained vaginal bleeding
- If VTE / stroke / IHD occur during use
- Breast cancer
- Severe liver disease
- IUS only – PID, >48h - <4w postpartum
what is the mode of action of intrauterine device
Copper is spermicidal
Thickens cervical mucus this acts as a natural sperm barrier
May act as physical barrier to implantation
what is the failure rate for the IUD
0.6-0.8 per 100 woman years
what are the advantages and disadvantages to the IUD
Advantages
- Long-acting (5-10 years)
- No hormones
Disadvantages
- Uterine perforation
- Expulsion
- Ectopic pregnancy
- PID
- Menorrhagia (IUD only) – more painful periods
what is the contraindications of the IUD
- Unexplained vaginal bleeding
- PID / untreated STI
- Cancers (cervical, endometrial)
- Puerperal sepsis – it would come out as soon as you put it in
- > 48 hours - <4 weeks post-partum
- Distorted uterine cavity (may be appropriate under imaging guidance after discussion)
what are the two types of barrier methods
male codon
diaphragm cap
what is the failure rate of the male codon
If used perfectly failure rate 2 per 100 woman years
if used typically failure rate 18 per 100 woman years
what is the filature rate of the diaphragm and cap
If used perfectly, failure rate 6 per 100 woman years
If used typically, failure rate 12 per 100 woman years
what contraceptions protect against STIs
barrier method - male codon, diaphragm/cap
