Contraception Flashcards by rebecca duff

What are the most common forms of contraception?

Of women using contraception:

25% Combined OCP
28% sterilized

Implants only mkae 3% and Coil 6%

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How do we determine the effectiveness of a contraceptive method?

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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Whats in the Combined OCP?

Ethinyl Oestradial (EE)
Synthetic Progesterone (Progestogen)

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

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Dose for cOCP?

20-35microgram but 50 if on liver enzyme inducers

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How often is the cOCP taken?

Every day for 21 days then 7 days off

takes 7 days to become effective when you start it

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How does the cOCP work?

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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What are the non contraceptive benefits of the cOCP?

 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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What are the major risks of cOCP?

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

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

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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How does Depoprovera work?

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

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What do we properly call the coil?

Long Acting Reversible Contraception (LARC)

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What are the best forms of Emergency Contraception?

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

All less effective than ongoing contraception

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How long after sex can you use emergency contraception?

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

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What is the main form of female sterilization?

Laparascopic Tubal Ligation with Filshie clips

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How is Vasectomy done?

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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Can you get pain from vasectomy? Testicular cancer?

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

No risk of cancer

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Is vasectomy reversible?

.Low success rate for reversals

When is a termination best performed?

<9wks as it reduces complications if its early

AT what point do we stop doing terminations?

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

Why would you terminate a pregnancy?

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

What do we do during a clinic consultation on termination?

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

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

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

What are the risks of Medical TOP?

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

Whats the alternative to the Combined OCP?

Progestogen Only Pill (POP)

How often do you have to take the POP?

Take the desogestrel pill every day within the same 12 hr window (Traditional PoPs have only a 3hr window)

How does the POP work?

Renders Cervical mucus impenetrable to sperm | Also has some effect inhibititing ovulation

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

Day 8-19 20-30%

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

Egg: 24h Sperm: 4 DAYS

How does the patch work?

 changed weekly |  < 5% have skin reaction

How does the ring work?

 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

What are potential side effects of combined hormonal therapy?

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

How does POP work?

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

Types of PoP pills

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

Side effects for POP

```  Appetite increase  Hair loss/gain  Mood change  Bloating or fluid retention  Headache  Acne ```

When to avoid a POP

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

What is injectable progesterone?

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

Benefits of injectable progesterone?

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

Side effects of injectable progesterone?

 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

what is the ROD?

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).

Benefits of the ROD?

 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

Side effects of the ROD

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

How does the copper coil work?

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