Contraception Flashcards
Describe how barrier contraception works and the different options available?
Physically prevent sperm from reaching the ovum
92% effective with perfect use and 82% effective with typical use
Male Condom – can be used for vaginal, anal or oral sex, must use new condom every times, check use by date and be careful not to tear or split the condom.
Female Condom – used for vaginal or anal sex push as far in as possible and make sure the outer ring stays on the outside. To remove twist and pull
What are the advantages of barrier contraception
Prevent spread of STIs
No hormones involved
Easy to use – can’t forget
Easily available
What are the disadvantages of barrier contraception?
May interfere with the flow of sex
Can break
Female condoms are not as widely available
Must be careful with the type of lubricant used
What are the contraindications of barrier contraception?
Latex allergies
How does the COCP work?
Prevents ovulation, thicken cervical mucus and hold woman in pregnant state so endometrium will not accept a fertilised egg.
Perfect use = 99.7% effective
Typical use = 91% effective
How should the COCP be initiated?
Start pill on day 1 of menstrual cycle
If started on day 1 – immediate protection
Up to and including day 5 – also immediate protection but if irregular cycle use additional protection
Any other day of menstrual cycle – avoid sex or use condoms for first 7 days
Encourage to take pill at the same time each day
What are the different regimens available for the COCP?
Usually has a pill free break or placebo where withdrawal bleed occurs – 21 pills – no evidence for this anymore so now take 21 pack back to back or tricyclic
Can be monophasic 21 in each pack with same dosage
Phasic pills – different doses and must be taken in order
Note can also be given as a patch changed every 7 days or a plastic vaginal ring. 3 weeks on and 1 week off. Becoming popular due to 48hour window to change if you forget and not effected by N and V.
What are the advantages of the COCP?
Very effective
Can be stopped at any time
Can relieve menstrual symptoms and make period lighter and regular
Can be taken in a way that stops bleeding
Reduced risk of ovarian cysts and cancers as well as uterus and colon
Doesn’t interrupt sex
Help with acne
What are the disadvantages of the COCP?
Initial breakthrough bleeding is common Hormonal side effects (breast tenderness, mood swings, weight gain, acne) Easily forgotten If D and V may be ineffective Careful regarding liver inducing drugs Can raise Blood Pressure No protection against STIs Can increase risk of blood clots, MI, breast and cervical cancer Many contraindications
What are the absolute contraindications for taking the COCP?
Age > 35 and smoking > 15 per day
Migraine with aura
History of thromboembolic disease or thrombophilia (including SLE and antiphospholipid)
History of stroke or IHD
Breast feeding < 6 weeks post-partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
-In this situation you can stop the COCP 4 weeks before the surgery and restart 2 weeks after.
What are the general contraindications for taking the COCP?
Smoking > 10 per day BMI > 35 Family history if thromboembolic disease in first degrees relative < 45 years old Controlled hypertension Immobility Carrier of known breast cancer mutation Diabetes diagnosed > 20yrs (may be absolute depending on severity) At altitude of >4500 for > 1 week Liver inducing anti-epileptic drugs
How should a missed COCP pill/patch be managed?
Missed pill = 24 hours passed since the pill is normally taken e.g. if no pills taken for 76 hours then 2 missed pills and 1 pill 4 hours late. Only protected if they have been taken the COCP for 7 consecutive days so only need to use emergency contraception if having missed a whole weeks’ worth of pills.
If missed one pill just take missed pill ASAP and continue as normal (even if taking 2 pills in one day).
2 or more missed – take the last pill even if taking 2 in one day (never take more than 2 in one day) then continue taking pills daily.
If >/=2 missed in week 1 emergency contraception is only required if she had UPSI in the pill-free week.
If >/=2 missed in week 2 no need for emergency contraception if 7-day consecutive pills have been taken
If >/=2 missed in week 3 finish pills in current pack then start a new pack straight away omitting the pill free week.
How does the progesterone only pill work?
Thicken cervical mucus, prevent implantation and ovulation – dependant on dosage
Perfect use – 99.7%
Typical use – 91%
How should the progesterone only pill be initiated?
Start on day 1 of menstrual cycle – immediate protection
Up to day 5 – protected immediately unless cycles irregular then use additional contraception
Any other day – use additional contraception in first 2 days
Take pill every day at the same time – low dose POP has 3 hour window, higher dose has 12 hour window.
What are the advantages of the progesterone only pill?
Less hormonal side effects Less contraindications Can relieve menstrual symptoms Can be used when breast feeding Can be used at any age – especially useful >35 and smoker May reduce risk of endometrial cancer
What are the disadvantages of the progesterone only pill?
Hormonal side effects (breast tenderness, mood swings, weight gain, acne)
Irregularity of period
Small window for taking the pill every day
Easily forgotten
No protection against STIs
What are the contraindications for taking the progesterone only pill?
Pregnant
Liver inducers – rifampicin, carbamazepine, phenytoin etc.
Heart disease and stroke
Liver disease
Have breast cancer
Current DVT or PE, Liver disease or history of breast cancer
How should a missed progesterone only pill be managed?
If over 3 hours (or 12 hours for Cerazette - higher dosage)
No protection, take next pill anyway but use additional protection until normal pill consumption resumed for 48 hours
How does the progestogen depot work?
Injection of slow release Progestogen which last 8-13 weeks
Perfect use = 99.8%
Typical use = 94%
How should the progestogen injection be initiated?
Can be started at any time in the cycle
If first day then immediate protection
After day 5 need additional methods for 1 week
What are the advantages of the depot?
Nothing to remember
Can relieve menstrual symptoms
Safe if breast feeding
What are the disadvantages of the depot?
Hormonal side effects (breast tenderness, mood swings, weight gain, acne)
Slow return of fertility
Irregular bleeding
Not easily reversible
Small loss of bone density – should not be used continually in young individuals
No protection against STIs
What are the contraindications for the depot?
Pregnant Unexplained vaginal bleeding Heart disease, stroke and liver disease Have breast cancer Current DVT or PE, Liver disease or history of breast cancer
How does the implant work?
Small device in the arm which slowly release progestogen
This stops ovulation, thicken cervical mucus and makes endometrium thinner
99.95% effective
