Contraception Flashcards
(33 cards)
Contraception – Why Bother?
- Up to 50% of unintended pregnancies occur in women not using any contraception in the month they conceive
- Despite many advances in contraception available abortion rates in MK have not improved. We are one of the higher areas in the UK with 20.2/1000 women of child bearing age seeking termination in 2016 (1085 women in total)
- 4 in 10 women are using their method inconsistently/incorrectly and only 1 in 20 unintended pregnancies are attributable to method failure
Semen can live in a women’s vagina for
up to 7 days
When is conception window?
Therefore conception can occur from 7 days before up until 3 days after an egg is released, days 7-17 on a 28 day cycle
- Semen can live in a women’s vagina for up to 7 days
- The egg will last for up to 3 days
What do the UKMEC Eligibility Criteria grading mean?
1 = A condition for which there is no restriction for the use of the contraceptive method
2 = A condition where the advantages of using the method generally outweigh the theoretical or proven risks
3= A condition where the theoretical or proven risks usually outweigh the advantages of the method
4= A condition which represents an unacceptable health risk if the contraceptive method is used
Contraception Choices
PILLS
PATCHES, RINGS
IMPLANTS, INJECTIONS COILS
BARRIERS
Benefits of Combined Contraceptive Pill
- Very reliable if taken correctly but reduced if missed pills, on other medications, absorption reduced due to vomiting or diarrhoea
- Failure rate of all oral contraception in perfect use 0.1% but in typical use averages at 8%
- Take for 3 week and then have no more than 7 day break during which time a withdrawal bleed is likely to occur. More recent guidance suggests move towards extended pill regimens
Limitations or downsides of Combined Contraceptive Pill
- Side effects can include small amount of weight gain (average 2-3kg), headaches, mood swings, reduced libido, breast tenderness, nausea, irregular bleeding.
- Usually minimal and get better after first 3 packets Possibly not suitable if overweight, high BP, migraine, family history blood clots, liver problems
- Should not be given to smokers over 35 unless stop for over 1 year
Mechanism of Combined Contraceptive Pill
- Works primarily by inhibiting ovulation via it’s action on the hypothalamo-pituitary axis, reducing LH and FSH
- Additional effects on the endometrium and cervical mucus
- First 7 pills of a packet inhibit ovulation, the rest maintain anovulation
Indications for Patches and Vaginal Rings as contraception
For those who are suitable for the combined pill but have problems remembering to take it, or who get gastric side effects such as nausea
Examples of Patches and Vaginal Rings as contraception
Evra = Patches put on skin and changed once a week for 3 weeks and then 1 week off
Nuvaring = vaginal ring, inserted and left for 3 weeks and then removed for 1 week
Indication for Progesterone Only Pills for contraception
For those who are not suitable for combined pills due to side effects or other medical problems the progesterone only pill may be a good alternative
Describe the Depo Provera Injection
Progesterone only
Given every 12 weeks
Very reliable contraception - Failure rates if given regularly are <4 in 1000 over 2 years
Main preparation of Progesterone Only Pills for contraception
Desogestrel. Take every day with no pill free week
Counsel patient on bleeding with the Progesterone Only Pills for contraception
many will get amenorrhea after 6 months
A percentage of people have no periods but there is a risk of irregular bleeding or spotting in the beginning
Must counsel that they should try it for at least 6 months
Counsel on the Pros and cons of depo provera injections
- Often stop periods completely in first year of use (not ideal for someone who wants to get pregnant in the next year)
- This delay in periods can persist for up to 1 year after
stopping the injections - most risk of weight gain and most hormonal and can’t cease treatment once IM injection given
- Not the most suitable method for <18 years or over 40 years due to concerns about loss of bone mineral density
Mechanism of depo provera injections
- Works primarily by inhibiting ovulation
- Thickening of cervical mucus inhibiting sperm
penetration into the upper reproductive tract - Also changes the endometrium making it unfavourable for implantation
Most of action of Contraceptive Implant
Primary mode of action is inhibition of ovulation
Also alters cervical mucus to prevent sperm penetration and inhibits normal endometrial development
What is the Contraceptive Implant?
Nexplanon - 3 year progesterone only releasing rod inserted just under the skin of the upper arm
VERY reliable method of contraception - Contains 68mg etonogestrel
Side effects of Contraceptive Implant?
- Minimal weight gain, breast tenderness and mood changes
- Periods can be stopped all together, very infrequent, regular or irregular and frequent
- Irregular bleeding most likely to occur in first 3-6 months and then often settles
- Consider exchange after 2 years in patients with a high BMI
Options for Intra Uterine Contraception
Two kinds of coil, hormonal and non-hormonal
- Non Hormonal T-safe 380 Copper IUD lasts for 10
years - Hormonal IUS Mirena and Kyleena licensed for 5 years and Jaydess for 3 years
Kyleena and Jaydess for nulliparous women
What is Nexplanon?
Contraceptive implant
3 year progesterone only releasing rod inserted just under the skin of the upper arm
How does Copper IUD work?
Copper is toxic to ovum and sperm and inhibits
sperm penetration. Works primarily by inhibiting fertilisation/ Endometrial inflammatory reaction which has an anti-implantation effect
Counsel on pros and cons of copper IUD
No hormones so no side effects, keep normal cycles but can be heavier and more painful
1-2% failure rate
- risk of expulsion
What is the mirena IUS?
Mirena coil contains small amount of daily progesterone which is released directly into the uterus
5 year contraception, as reliable as being sterilised
Initial irregular bleeding but then lighter periods with less period pain and less PMT
