CARDIOVASCULAR - Superficial venous thrombosis - Thrombophlebitis - Severe varicosis METABOLIC - Hypercholesterinemia ( increases risk of CDI events) - Morbid obesity - Diabetes mellitus ``` OTHER Leiyomyomas! Smoking Ulcers & ulcerative colitis Age over 40 ```

Contraception Flashcards by Timi Lamikanra

What is contraception

Methods that prevent conception

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What are the methods of contraception

•Hormonal methods: introduce synthetic hormones into the woman to prevent ovulation, thicken cervical mucus, or prevent a fertilized egg implantation

/non hormonal methods:
block the meeting of egg and sperm physically

Behavioural methods:

Barrier
surgical

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What are the 5 types of hormonal contraceptives

1) Oral contraceptives (pills)
2) Vaginal ring (Nova Ring)
3) Transdermal patch (Evra)
4) Injected hormones (Depo-Provera)
5. Implants (Norplant, Implanon) ??
5) Hormonal IUDs (Mirena)

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General overview of oral contraceptive pills

1)combined oral contraceptive (COC)
Oral, Short-acting, reversible
containing estrogen and progestin
Indications :
-Hyperandrogenism (e.g., acne, hirsutism)
-Menstrual cycle disorders (menorrhagia, dysmenorrhea)
-Symptom control in endometriosis, leiomyomas

2)Progestin-only contraceptive pills (minipill)
Short-acting, reversible oral
containing low doses of norethindrone
Indications:
-Contraception when estrogen-containing contraceptives are contraindicated

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Types of oral contraceptives

Monophasic/ constant dose :
25 micro grams / day
Same dose of estrogen and progestin in each pill.

Multiphasic

biphasic: one hormone fixed and other fluctuates
triphasic: both hormones fluctuate w/in 21 day cycle

Protesting only :For women CI for estrogen —breastfeeding
high b.p
risk for blood clots
smokers

Antiprogestin: inhibits or delays ovulation by inhibiting the progesterone receptor

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How do oral contraceptives work/ MOA

Estrogen

↓ LH → inhibits ovulation secondary to reduces FSH and inhibited folliculorgenesis
↓ FSH→ prevents folliculogenesis( no Graafian follicle)

Progestin
-↓ release of GnRH
-Suppresses LH surge in secretory phase
→ suppresses ovulation
-Inhibits endometrial proliferation when withdrawn but maintains it when present
-↓ volume and ↑ viscosity of cervical mucus
-impairs fallopian tube peristalsis → inhibition of sperm ascension and egg implantation
Inhibits follicular maturation

Antiprogestin: inhibits or delays ovulation by inhibiting the progesterone receptor

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Side effects of contraceptives

Estrogen: 3xHHH, MnV
-Venous thrombo embolism
d/2 estrogen-mediated coagulopathy

-Cardiovascular events

-Hypertension :
d/2 sim of RAS esp w/
history of HTN during pregnancy or fam history of HTN

Headaches: early, common cause of discontinuation!!
Hepatic adenoma development
Mastopathy and mastodynia( breast pain)
Nausea

Progestin:

Breakthrough bleeding ( most common cause of discontinuation )
Follicular cysts( prevent ovulation so corpus luteum degeneration is affected)
Weight gain is not a side effect of hormonal contraceptive

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benefits of oral contraceptive

Regulation of menses
relieves menstrual cramps
postpartum contraception to allow body to recover from pregnancy
prevents pregnancy

Non contraceptive benefits/ indication

reduces risk of gynaecological diseases
1) endometriosis
2) myomas
3) endometrial and ovarian carcinoma
4) acne

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By what mech does OCP reduce risk of gynaecological diseases

Inhibits ovulation- reduces trauma, inflammation and repeated division associated w/ cancer formation

Reduced inflammation and ovulation therefore reduce
pathological process
1) aromatase reduced: reduced risk of oestrogen mediated disease ( endometriosis, menstrual sx, acne)
2) reduced COX2; reduced inflammation mediated diseases:

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What are the types of contraindications of oral contraceptives

Relative CI

ABSOLUTE CI

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Relative CI OF OC

CARDIOVASCULAR

Superficial venous thrombosis
Thrombophlebitis
Severe varicosis

METABOLIC

Hypercholesterinemia ( increases risk of CDI events)
Morbid obesity
Diabetes mellitus

OTHER 
Leiyomyomas!
Smoking  
Ulcers &amp; ulcerative colitis 
Age over 40

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Absolute CI of OCP

CDV
Thromboembolism !!
Coagulopathy, antiphospholipid ab’s
Coronary heart disease
Stroke
Arterial hypertension (> 160/95 mm Hg)

MET
Metabolic liver disorders

ONCOLOGICAL
Hepatic tumors
Estrogen-dependent tumors

OTHER
Over 35 y/o smokers
Pregnancy

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Principles of taking oral contraceptive

•Once a day at the same time everyday
-if you miss one take it ASAP & continue next day at normal time
•Use condoms for first month
•Use condoms when on antibiotics
•Use condoms for 1 week if you miss a pill or take one late
•The pill offers no protection from STD’s
Take it on the first day of the period

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Signs that oral contraceptive pills should be discontinued

ACHES

Abdominal pain

Chest pain: sharp pain, SON

Headache:aura, one side, dizziness

Eye problems: blurred vision

Severe leg pain: Pte in calf/ thigh

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What is Evra contraception

transdermal patch providing sustained low doses of estrogen and progestin

Short-acting, reversible contraceptive as effective as COC pills

Only require application to the skin on arm/ abdomen once a week
Similar indications as for COC

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What is the NUVARING

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Flexible vaginal ring that contains estrogen and progesterone

Short-acting, reversible flexible

Similar indications as for COC

What is depo poreva / DMPA

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Injectable progestin
Depot medroxyprogesterone acetate

IM •150 mg administered deep intramuscular
Sub cut •104 mg subcutaneous
once ever 3 weeks- 3months
Long term reversible use

Pros: effective in obese pt , little compliance

Side effects: 
Bleeding irregularities
•Delayed return of fertility
•Weight gain
•Decrease in bone mineral density

What is implanon etonestgtrel

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Sub dermal implant
subcutaneously in the forearm
Lasted 3 years

Side effects: weight gain, acne, altered bleeding

CI:
Anitphospohlipod ab’s In SLE

Intrauterine devices

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Hormonal
Progestin
Levonestrel

Less than 1% failure
Long term and reversible
Changed every 3-5 years

Non hormonal
Copper
T-shaped device wrapped in copper wire that is inserted into the uterus to prevent pregnancy
Approved for 10 years of continuous use; may be effective for longer

increases tubal motility causing the fertilized egg to be transported to the uterus before the endometrium is receptive for implantation.

Ci
Uterine abnormalities (i.e. bleeding, malignancy, anomalies, infection)
Suspected pregnancy
Menorrhagia
Dysmenorrhea
Copper hypersensitivity

Comp
Menorrhagia
Dysmenorrhea
Uterine perforation
Ectopic pregnancy
Pelvic inflammatory disease

What are the barrier methods of contraception

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Male & female condom

spermicide:Foams, suppositories, jellies,creams

Diaphragm w/ spermicidal jelly or cream

Cervical cap with spermicidal jelly or cream

Lea’s Shield and FemCap

The sponge

Condoms

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Male 98% effective
Female 95% effective

Protection against some STD’s

Contraindication: latex allergy for latex condoms

Diaphragm

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95% effective
Placed into the anterior and posterior fornix of the vagina prior to sexual intercourse Prevents passage of semen into the cervix
Leave in place 6 hours after intercourse
Use with contraceptive jelly/ cream

Contraindications: cervical anomalies or abnormalities (e.g., infection, malignancy), spermicide or latex allergy

Complication: toxic shock syndrome

Cervical cap

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Cup shaped latex, metal, or plastic device that holds spermicide

Prevents passage of semen into the cervical canal

Placed over the base of the cervix;
inserted up to ∼ 8 hours before sexual intercourse
must be removed after 48 hours

Contraindications: cervical anomalies or abnormalities, spermicide or latex allergy

Complication: toxic shock syndrome, cervical erosion (resulting in spotting)

Foam

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80-85% effective
Works immediately
Effective for an hour
No douching for 6 hours after intercourse
20% have burning (reaction

Sponge

Foam disk containing spermicidal fluid; moistening the disc with tap water and gently squeezing before inserting into the vagina activates the disk Inserted up to 24 hours before intercourse; no less never than 30 hours after Prevents entry of semen into the cervix and has spermicidal effects Contraindications: similar to diaphragm Complication: vaginal irrigation, toxic shock syndrome (rare)

Behavioural methods of contraception

Withdrawal: (pull out 100% effective so far) removing the penis from the vagina just before ejaculation * Abstinence (never worked ever) * Fertility awareness - Cervical mucus method - Body temperature method - Calendar method

Emergency contraception

•Emergency contraception pills (ECPs) -taken within 3 days post I ntercourse to prevent fertilization or implantation. 1)morning after after unprotected intercourse but before a woman misses her period Contains anti progesterone 2Postinor Duo progestin-only pill taken as soon as possible after unprotected intercourse. A second pill follows 12 hours later

Surgical methods of contraception

Sterilisation -Female •Tubal ligation: seals the Fallopian tubes to block sperm. •Hysterectomy: removal of the uterus. -Male Vasectomy: cutting and tying off of both vasa deferentia. More effective and safer than female procedures Surgical abortion •Vacuum aspiration •Dilation and evacuation (D&E) •Dilation and curettage (D&C)

List the behaviour contraceptives (4)

Abstinence Coitus interruptus Fertility-awareness based methods - Calendar method - Cervical mucus method: - Basal body temperature method - Symptothermal method Vaginal douche Lactational amenorrhea

Coitus interruptus

known as the withdrawal method Method: The penis is withdrawn from the vagina before ejaculation Failure rate : 22% ``` Pros: Reversible Inexpensive Readily available No side effects ``` Com High risk for human error No protection from sexually transmitted infections Semen may enter vagina before ejaculation

How is the effectiveness of contraceptives measured

Failure rate with typical use -number out of every 100 women who become pregnant within the first year of typical use of the method of contraception. Pearl index -unintended pregnancies in 100 women per year with perfect use of the method of contraception.

What are fertility awareness methods 24% typical failure use

avoiding sexual intercourse during the ovulation period Calendar Cervical mucus Basal body temp Symptothermal method ``` Pros Reversible Inexpensive Readily available No side effects ``` Cons High risk for human error Requires regular periods No protection from sexually transmitted infections

Explain the Calendar method

Principles i) an egg can be fertilized for ∼ 24 hours after ovulation; (ii) the lifespan of sperm is 48 hours following ejaculation; and (iii) ovulation occurs 12–16 days before onset of the next menses. Fertilization can occur anytime from 3 days before to 1-3 day after ovulation. Determining time of ovulation based on first day of men’s then avoiding coitus around those days

Cervical mucus method

fertility period is estimated by evaluating the abundance and consistency of cervical mucus throughout the cycle Conception is more probable up to 4 days after cervical mucus reaches its maximum abundance and elasticity; CI: Post partum breast feeding women before 6 wks Post partum non breast feeding before 4 weeks Irregular menses

Basal body temperature method

body temperature is measured throughout the cycle. Ovulation triggers an increase in basal body temperature, thus indicating the fertility period. Temperature is taken in the morning after waking up (oral, vaginal and rectal; inner ear and axillary are inaccurate). Basal temperature decreases before ovulation and then increases by 0.2–0.5°C (32.4–32.9°C) due to the release of hormones. The temperature decreases at the beginning of the menstrual cycle. Fertilization is unlikely from the third day following the increase in basal body temperature(ovum lasts 2 days max)/

Vaginal douche

The vagina is flushed with water or other products immediately after male ejaculation during intercourse in an attempt to theoretically flush semen out Not recommended and unsafe

Lactational amenorrhea

Amenorrhea is induced by exclusively breastfeeding within the first 6 months postpartum Lactation → ↑ prolactin and ↓ gonadotropin-releasing hormone → suppression of ovulation Also inhibits follicular maturation (↓ luteinizing hormone)

Why does estrogen increase coagulation

Estrogen increases levels of factors II, VII, VIII, and X and fibrinogen, and decreases levels of antithrombin and protein S, and increases resistance to protein C

Contraception Flashcards

(38 cards)