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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the most common forms of contraception?

A

Of women using contraception:

  • 25% Combined OCP
  • 28% sterilized

Implants only mkae 3% and Coil 6%

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2
Q

How do we determine the effectiveness of a contraceptive method?

A

Life Table Analysis or Pearl Index
Pearl index: % of women using a the method who get pregnant anyway.

Life table analysis: contraceptive failure rate over a specific period of time.

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3
Q

Whats in the Combined OCP?

A 
Ethinyl Oestradial (EE)
Synthetic Progesterone (Progestogen)

3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)

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4
Q

Dose for cOCP?

A

20-35microgram but 50 if on liver enzyme inducers

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5
Q

How often is the cOCP taken?

A

Every day for 21 days then 7 days off

takes 7 days to become effective when you start it

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6
Q

How does the cOCP work?

A

Prevents the FSH/LH surge by -ve feedback on the GnRH producing hypothalamus

Also prevents implantation by providing an inadeqaute endometrium.
Alters cervical mucous to Inhibit sperm penetration

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7
Q

What are the non contraceptive benefits of the cOCP?

A

 Regulate/reduce bleeding- help heavy or painful natural periods
 Stop ovulation- may help premenstrual syndrome
 Reduction in functional ovarian cysts
 50% reduction in ovarian and endometrial cancer
 Improve acne / hirsutism

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8
Q

What are the major risks of cOCP?

A
  • .Very small increased risk of VTE
  • Very small increased risk of Ischaemic stroke
  • Small risk of breast cancer
  • Doubles Cervical cancer risk if used for 10yrs
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9
Q

the cOCP is often blamed for VTEs, how risky is it really?

A

.The pill triples risk from 5 to 15 per 100,000.

However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant

It just sounds scary if you don’t actually know the numbers

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10
Q

What groups might we actually worry about VTEs in if we give them the cOCP?

A
  • BMI >34
  • previous VTE
  • 1st degree relative VTE under 45
  • Avoid in smokers >35
  • personal history arterial thrombosis
  • focal migraine
  • Age>50
  • Hypertension>140/90
  • Avoid if active gall bladder disease
  • Avoid if previous liver tumour
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11
Q

How does Depoprovera work?

A
  • Prevents Ovulation by -ve feedback
  • Alters cervical mucous preventing sperm penetration
  • Renders endometrium unsuitable, preventing implantation
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12
Q

What do we properly call the coil?

A

Long Acting Reversible Contraception (LARC)

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13
Q

What are the best forms of Emergency Contraception?

A

CU-IUD (copper coil)
Levonorgestrel pill/ Levonelle
Ella One pill

All less effective than ongoing contraception

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14
Q

How long after sex can you use emergency contraception?

A

Copper coil up to 5 days post sex of post cycle
Levonorgestrel - 72 hours
Ella One - 120 hours

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15
Q

What is the main form of female sterilization?

A

Laparascopic Tubal Ligation with Filshie clips

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16
Q

How is Vasectomy done?

A

Permanent division of vas deferens under local anaesthetic

Then they have to come back for semen analysis before they start having unprotected sex

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17
Q

Can you get pain from vasectomy? Testicular cancer?

A

Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)

No risk of cancer

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18
Q

Is vasectomy reversible?

A

.Low success rate for reversals

19
Q

When is a termination best performed?

A

<9wks as it reduces complications if its early

20
Q

AT what point do we stop doing terminations?

A

20wks. then we refer to england who do it till 24wks

21
Q

Why would you terminate a pregnancy?

A

IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating

  • Maternal health
  • Social reasons
  • Fetal Anomaly
22
Q

What do we do during a clinic consultation on termination?

A
  • Talk about methods
  • Advise they may have prolonged bleeding post-TOP
  • Offer counselling post-TOP
  • Contraception advice
  • FBC, Rubella & STI checks
  • Certificate A signed
23
Q

Most terminations in Grampian are medical, how are they done?

A

Mifepristone:
Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix & expels pregnancy

24
Q

What are the risks of Medical TOP?

A 
,Haemorrhage
Uterine Perforation
Cervical Trauma
Failure
Infection
RPOC
Damage to future fertility
Psychological problems
25
Q

Whats the alternative to the Combined OCP?

A

Progestogen Only Pill (POP)

26
Q

How often do you have to take the POP?

A

Take the desogestrel pill every day within the same 12 hr window

(Traditional PoPs have only a 3hr window)

27
Q

How does the POP work?

A

Renders Cervical mucus impenetrable to sperm

Also has some effect inhibititing ovulation

28
Q

When is one most likely to get pregnant? and likelihood of getting pregnant during one of these days?

A

Day 8-19

20-30%

29
Q

How long are sperm and the egg most likely to survive?

A

Egg: 24h
Sperm: 4 DAYS

30
Q

How does the patch work?

A

 changed weekly

 < 5% have skin reaction

31
Q

How does the ring work?

A

 Ring Nuvaring TM
 changed every 3 weeks
 can take out for 3 hrs in 24 so may prefer to take out for sex
 Latex free

32
Q

What are potential side effects of combined hormonal therapy?

A 
	Breast tenderness
	Nausea
	Headache
	Irregular bleeding first 3 months
Mood- THOUGH COULD BE RELATED TO OTHER LIFE EVENTS
Weight gain- not causal
33
Q

How does POP work?

A

 Take at the same time every day without a pill-free interval

34
Q

Types of PoP pills

A
  1. Desogestrel pill – 12 hour window period
    o Nearly all cycles anovulant- also effect mucus.
    o Most bleed free.
  2. Traditional LNG NET pills
    o 3 hour window period
    o 1/3 anovulant
    o 2/3 rely on cervical mucus effect: 1/3 bleed free, 1/3 irregular, 1/3 regular periods
35
Q

Side effects for POP

A 
	Appetite increase
	Hair loss/gain
	Mood change
	Bloating or fluid retention
	Headache
	Acne
36
Q

When to avoid a POP

A

 No increased risk venous or arterial thrombosis with contraceptive dose progestogens
 Still avoid if current breast cancer or liver tumour past/present

37
Q

What is injectable progesterone?

A

 Aqueous solution of the progestogen depomedroxyprogesterone acetate DepoproveraTM
 Every 13 weeks

38
Q

Benefits of injectable progesterone?

A

 Only need to remember every 12 weeks
 70% women amenorrhoeic after 3 doses
 Estrogen-free so few contraindications

39
Q

Side effects of injectable progesterone?

A

 Delay in return to fertility – average 9 months
 Reversible reduction in bone density- discuss her other risks for osteoporosis
 Problematic bleeding especially first 2 doses
 Weight gain 2/3 women gain 2-3 kg

40
Q

what is the ROD?

A

Subdermal progesterone
 Implanon is a small plastic rod measuring 4cm in length and 2mm in cross sectional diameter.
 The rod contains 68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA).

41
Q

Benefits of the ROD?

A

 Inhibition of ovulation + effect on cervical mucus
 Can last 3 years- or be removed at any time
 No user input needed
 No causal effect on weight

42
Q

Side effects of the ROD

A

60% are almost bleed free but 30% have prolonged / frequent bleeding
May cause mood change more often than other progestogen only methods

43
Q

How does the copper coil work?

A

 Affect cervical mucus and endometrium most women still ovulate Stop fertilisation of egg- may prevent implantation fertilised egg
 Slow release progestogen on stem

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