Contraception Flashcards by Heo Mun Ho

List the common methods of contraception and describe the mechanism of action of each
Describe the side-effects associated with the common methods of contraception
Describe the methods of male and female sterilisation along with their indications and failure rates
To be aware of the issues involved during counselling of a couple prior to sterilisation
Describe the Abortion Act + the common medical and surgical methods of termination of pregnancy

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List the 3 combined hormonal methods of contraception (all contain ethinyl estradiol (EE) and synthetic progesterone (progestogen)); just in different forms of use)

Combined pill
Patch
Vaginal ring

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List the 4 progestogen only methods of contraception

Progestogen-only pill (mini pill)
Implant
Injection
IUS (intra-uterine system)

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Name the long term non-hormonal contraceptive that females use

Copper IUD

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Mechanism of action of combined hormonal contraceptives (ethinyl estradiol (EE) and synthetic progesterone (progestogen))

Stop ovulation (due to the negative feedback effect of the oestrogen and progesterone) AND thicken cervical mucus on the cervix to slow the sperm

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Non-contraceptive benefits of combined hormonal contraceptives

Regulate/reduce bleeding

Reduces functional ovarian cysts and risk of ovarian or endometrial cancer

Improve acne/hirsutism (excessive hair growth)

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Side effects of combined hormonal contraceptives (pill/patch/ring)

Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months

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Serious risks with use of combined hormonal contraceptives (pill/patch/ring)

Increased risk of

DVT
arterial thrombosis –> MI/stroke
cervical/breast cancer

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Contra-indications of combined hormonal contraceptives

BMI >35

Breast feeding

Smoking >35

Hypertension

History of or family history of venous thromboembolisms

Prolonged immobility due to surgery or disability

History of migraines with aura

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Mechanism of action of progestogen-only contraceptives (pill/implant/injection/IUS)

Inhibit ovulation AND thicken cervical mucus to prevent passage of sperm

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Side effects of progestogen-only contraceptives (pill/implant/injection/IUS)

Irregular cycles
Appetite increase
Hair loss/gain
Mood change
Headache
Acne

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Contra-indications of progestogen-only contraceptives (pill/implant/injection/IUS)

Current or past history of breast cancer

Liver cirrhosis or tumours

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Disadvantages of injectable progestogen

Not rapidly reversible – can take up to a year to return to normal fertility

Loss of bone mineral density with long term use

Increase in body weight, up to 2-3kg over a year

Altered bleeding patterns

(the only contraceptive with a causal effect on weight gain, delayed return of fertility and bone density)

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Which progestogen only method has the best success rates

Implant

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What non-hormonal contraceptives are there (4)

Male condoms
Female condoms
Diaphragm
IUD

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Mechanism of action of IUDs

Releases copper which is toxic to sperm and may induce a sterile inflammatory response within the uterus that makes implantation impossible

Side effects of IUDs

Small risk of infection after fitted in

Small risk of expulsion of the IUD

Heavier bleeding during first few weeks

Mechanism of action of the IUS

Same as the progestogen only methods

-thins the endometrium (preventing implantation) and thickens cervical mucus

What are the 3 options of emergency contraceptives

IUD - most effective
Levonorgestrel (Levonelle)*
Ulipristal acetate (EllaOne)*

*morning after pill

When should you ideally start combined hormonal contraceptives if you want immediate cover from pregnancy without needing additional contraception

Within first 5 days, ideally first day

But if you have a short cycle like 23 days then you should also use condoms within the first week to be safe

Describe the procedure for female sterilisation

Permanently preventing pregnancy by blocking/sealing the fallopian tubes to by prevent eggs travelling down the fallopian tubes to meet sperm coming up from the cervix

Indications for female/male sterilisation

If you do not want any more children or do not want children at all

Females should only be considered if their male partner are unable or unwilling or does not have a permanent partner

Describe the procedure for male sterilisation

Vasectomy (cutting and sealing or tying the vas deferens which carries sperm from the testes to the penis)

Failure rates of

female sterilisation
male sterilisation

1 in 200

1 in 2000

What issues should you be aware of during counselling of a couple prior to sterilisation

If they definitely are done with children Other forms of long-acting contraception Permanent and reversal is not routinely funded

Describe the basis of the abortion act 1967

A person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith

Criteria for abortion under abortion act 1967

That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family OR That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman OR That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated (acceptable past 24 weeks) OR That there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped (acceptable past 24 weeks)

Medical abortion

Mifepristone (inhibits progesterone) first then misoprostol (induces uterine contraction to expel pregnancy) 24-48 hrs later Will happen within 4-6 hrs of taking misoprostol

Surgical abortion

Vacuum or suction aspiration (up to 15 wks gestation) Dilation & evacuation (beyond 15 wks) -forceps to remove it