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Contraception and HRT Flashcards

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1
Q

What is contraception

whats the point and how

A
  • aims to prevent pregnancy
  • can prevent pregnancy
    • prevent ovulation
    • prevent fertilisationon
    • prevent implantation
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2
Q

Why is contraception important

what can life without contracpetion

A
  • a third of pregnancies are unplanned or unwanted
    • can lead to a health impact
  • spacing pregnancy gives better health outcomes
  • pregnancy is a high risk
    • high risk for people for morbidities
  • it’s about choice/employment/ human rights
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3
Q

Failure rates

What is meant by typical use

A

Typical use - failure rate when used as in real life – not always correctly
- may have other medications that interact, or forget etc

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4
Q

What is meant by the term perfect use

A

Perfect use - failure rate when the method used consistently and correctly at all times

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5
Q

Types of contraception

What methods have no user failure

A
  • Copper Coil (CuIUD) – copper
  • Hormonal Coil (LNGIUD)– levonorgestrel
  • Implant
  • Sterilisation
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6
Q

Types of contraception

What methods can have user failure

A
  • Barrier – External and Internal Condoms, diaphragm
  • Hormonal – Combined pill / patch / ring, POP, injectables
  • Natural family planning and lactational amenorrhoea
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7
Q

What is the role of UK MEC

A

Defines the safety of a contraceptive for individuals with certain characteristics, physical states or medical conditions

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8
Q

What are the UKMEC catagories

A

UKMEC 1: a condition for which there is no restriction for the use of contraceptive method

UKMEC 2: A condition for which the advnatages of using the method generally outweigh the theorirtcial or proven risk

UKMEC 3: A condition where the theortical or proven risks usually outweigh the advntages of using the method

UKMEC 4: A condition which represents an unacceptbale health irsk if the contracpetive is used

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9
Q

What are the things that a long acting reverisble contraception needs to be

A
  • Methods that require administration less than once per cycle or month
  • these are more effective
  • you fit them and forgot
  • More effective
  • Longer lasting
  • Convenient
  • Cost effective
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10
Q

give examples of long acting reversible contraceptions

A
  • can also be fully reversible
  • like the coil, implant, injecting
  • no impact on future fetrlty
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11
Q

what is the….

Implants

duration, method, mechanism, failure rate. fitted

A
  • most effective
  • fitted subdermally over trcipes
  • single rod
  • failure rate 0.03%
  • contains progesterone
    • inhibits ovulation
    • causes thickend cervical muscus
  • Duration - 3 years
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12
Q

Implants

Advantages and disadvantages

A

Advantages

  • highly effective and reversible
  • Reduce HMB and dysmenorrhoea - may cause amenorrhoea
  • Quick return of fertility when removed

Disadvantages / side-effects

  • Fitting and removal procedure required
  • Irregular menstrual bleeding
  • Hormonal side effects – headache, breast-tenderness, changes to skin, mood changes
  • Affected by enzyme inducers
  • No STI protection
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13
Q

Hormonal coils

mechanim, duration, failure rate, fitting, method, examples

A
  • t shaped device
  • sits in womb
  • slowly releases progesterone
  • thin lining of the womb
  • thickens cervical mucus
  • inhibits ovulation in some people
  • Mirena example

Duration of use
- between 3-8 years depending on type
- its 99%

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14
Q

Hormonal coil

advantages and disadvantages

A

Non-contraceptive benefits

  • Reduces menstrual bleeding / may induce amenorrhoea
  • Reduced dysmenorrhoea
  • May reduce pain from endometriosis or adenomyosis

Disadvantages / Side effects

  • Requires pelvic examination and speculum to fit
  • Hormonal - headache, breast tenderness, acne
  • Irregular bleeding - can last up to 9 months
  • Benign ovarian cysts
  • Ectopic risk if pregnancy does occur
  • Expulsion – <1:20
  • No STI protection
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15
Q

Copper coil

mechanim, duration, failure rate, fitting, method

A
  • t shaped
  • has a copper stem

insertition
-inserted into uterus
-has short threads for removal

It works

  • prevents implansation because copper is toxic to sperm and ovum
  • you can use this for 5-10 years
  • and its over 99%
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16
Q

Copper coil

advantages and disadvantages

A

Advantages
- Effective immediately
- Can be used as emergency contraception
- Non-hormonal (?perceived advantage)

Disadvantages / Side effects

  • Requires pelvic examination and speculum to fit
  • May increase menstrual blood loss
    • may make it longer, heaver in some women
  • May worsen dysmenorrhoea
  • Expulsion – <1:20
  • Ectopic risk if pregnancy does occur
  • No STI protection
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17
Q

What are the contrindications of the copper coil

A
  • cant use of >48hr or <4wk post partum
  • cant use if post-partum sepsis
  • cant use for
    • PID (don’t want to make it worse
    • Unexplained vaginal bleeding
    • gestational trophoblastic disease
  • cervical cancer
    • don’t want to spread cancer
  • cardiac arrhythmias
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18
Q

Injections

mechanim, duration, failure rate, fitting, method

A
  • Depo-Provera
    • injected in the gluteal muscle every 12-14 weeks by a doctor or nurse
  • Sayana

How it works

  • Inhibit ovulation
  • Thicken cervical mucus
  • Thin endometrium

Effectiveness

  • Perfect use = >99%
  • Typical use = 96% - due to late injections
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19
Q

Injections

advantages and disadvantages

A

Advantages

  • highly effective, convenient, reversible
  • not affected by other medications/enzyme inducers
  • reduces bleeding and pain, improved PMS
  • reduces the severity of sickle cell crises

Disadvantages/side effects

  • once given cannot be removed
  • menstrual irregularities
  • weight gain
  • no STI protection
  • may delay the return of fertility – up to 1 year
  • hormonal side-effects - same as implant/POP
  • decrease bone mineral density – returns after stopping
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20
Q

Combined hormonal contraception

mechanim, duration, failure rate, fitting, method

Study These Flashcards
A
  • these contain oestrogen and progesterone
    • pill, patch, vaginal ring

Works by

  • prevents ovulation
  • also thickens, cervical mucus, and thins endomterial

Efficacy

  • perfect use there’s 0.3% of failure
  • typical use is 8%
21
Q

combined pills

Study These Flashcards
A
  • contains oestorgen progestrone
  • one pill 8 every day same time
  • rules for missing pill
22
Q

combined vaginal ring

Study These Flashcards
A
  • Ethinyl Oestradiol and Etonogestrel
  • Flexible transparent ring 54mm wide
  • Mode of action – inhibition of ovulation
  • One ring per 21 days
  • Removed for 7 days – withdrawal bleed
  • Not a LARC
  • Perfect use 1% failure
  • Typical use 9% failure
  • Combined Vaginal Ring (Nuvaring)
23
Q

Combined hormonal contraceptives

advantages and disadvantages

Study These Flashcards
A

Benefits
* regular, lighter, less painful periods
* Reduced risk of ovarian / endometrial and colon cancer
* May reduce premenstrual symptoms
* May improve acne

**Disadvantages / risks
** Increase Venous or arterial thrombosis risk
* Increase Heart attack and stroke risk
* Increase Breast cancer risk - reduces with time after stopping the pill
* Increase Cervical cancer risk with longer use - reduces with time after stopping the pill
* Hypertension

Takes 7 days to become effective (if started outside of day1-5 of cycle)

If started within day-1-5 of period then effective immediately.

24
Q

What are the side effects of combined contraceptive methods

Study These Flashcards
A
  • Temporary - headaches, nausea, breast tenderness, mood changes
  • Breakthrough bleeding
  • Effectiveness affected by enzyme inducers
  • No STI protection
  • Pill effectiveness affected by diarrhoea / vomiting (may need to use alternative contraceptives during this time)
25
Patch | mechanim, duration, failure rate, fitting, method
- transdermal - e.g Evra - can see patch's quite place - you can have 1 patch for 1 week for 3 weeks - perfect use there's a 1% failure - typical use is 9% Efficacy is reduced is over 90kg -Efficacy may be reduced if > 90 kg (14 stone) -Not affected by GI upsets (diarrhea/vomiting)
26
Combined hormonal contraceptives contraindications
High BMI *Migraines *Smoking *Age *VTE <45 (patient or 1st degree relative) *Hypertension *Thrombophilias | complete list on UKMEC
27
How do we take hormonal contraceptives
How to take: * Standard: take for 21 days, 7 day break (hormone-free interval | there can also be tailored reigimes
28
Progestorone only pill | mechanim, duration, failure rate, fitting, method
Synthetic progesterone * tablets: desogestrel / levonorgestrel / norethisterone / drospirenone * Should be taken daily at the same time each day, every day * NO pill-free interval Mode of action * Prevent ovulation * Thicken cervical mucus * Thin endometrium Failure rates: perfect use 1% failure typical use 9% failure Be aware – traditional vs desogestrel POPs
29
Progestorone only pill | advantages and disadvantages
Benefits * Effective, reversible * Now available OTC Disadvantages / side effects * Menstrual irregularities * Same time each day - 12 hour window for desogestrel (3 hour for * traditional POPs) * Functional ovarian cysts * Hormonal (headaches, changes to mood, depression, bloating, * breast tenderness) * No STI protection
30
Why are progestrone only pills better
* Much fewer contraindications than combined methods * No increased stroke risk * Current breast cancer * Severe liver disease / liver tumours * Stroke/IHD | See UKMEC for full list
31
# barrier methods External condoms | mechanim, duration, failure rate, fitting, method
* Latex/latex free, placed over an erect penis before any contact * Acts as a barrier to stop sperm entering the vagina * * Perfect use = 2% failure * Typical use = 17% failure * * Single use only! * Check - date, kite mark, not damaged * Avoid – oil based lubricants * STI and HIV protection
32
Internal condom | mechanim, duration, failure rate, fitting, method
- inserted before sex - loosely lines the vagina, and rectum and partially covers the vulva - barrier to sperm Perfect use 5% failure typical use is 21% - these are single-use only - can have protection against STIs and HIV
33
Internal condom: diaphragm
- Reusable flexible latex or silicone device - Put into the vagina to cover the cervix - Acts as a barrier to sperm - Used with spermicide - Can be inserted up to 3 hours before sex - Needs to be left in for 6 hours after sex - for spermcide to work - if your going to have more sex needs to have more spermcide - Perfect use = 4 - 8% failure - Typical use = 12 – 29% failure - Do NOT offer STI or HIV protection
34
Natural family planning | how does it work
main fertility indicators - basal body temperature - cervical secretions - length of menstrual cycle - can use this info to work out fertile window
35
Natural family planning | advantages and disadvantages
Advantages - can be used to avoid or plan pregnancy - there are no side effects physical ones anyway - the couples are in control, and may improve communication - avoids hormones - acceptable to all faiths and cultures Disadvantages - much more reliable cycles - need to have regular cycles - us ireegualr girlies can't really do this - takes some time to learn this - can be time consuming and require motivation - things like illness, and lifestyle stress make fertility harder to interpret - need to avoid sex or condoms during fertile time - and there's no STI protection
36
Lactational amenorrhea | what is it, when, failure rates etc
- Baby <6m old - A woman must be amenorrhoeic - Exclusively breastfeeding – 4hrly in day, 6hrly at night - If all 3 criteria are met then it should workkk - Typical failure rate = 2% - Perfect use failure rate = 0.5%
37
Male sterilisation | what is it, failure rate
- vascoectmy → cut vas defferns - the failure rate is 1 in 2000 - its permanent and irrevirvle on NHS - doesn't affect sex drive, erections - ejaculation occurs but no sperm - need do to contrapcetion for 8-12 weeks in case there was sperm downstream
38
Female sterilsation | what is it, failure rate
- works by tubual occulsaion - prevent egg and sperm meeting - fails for 1 in 200 - permanent and irreversible on NHS
39
Types of emergency contraception | name of types
copper coil pill
40
# emergency contracpetion Copper IUD | when, efficacy,
Copper IUD -Can be inserted up to 120 hours after first UPSI -Or within 5 days of the earliest expected ovulation -Overall efficacy = 99.9% -same benefits and risks as for non-emergency copper IUD -Can be used for ongoing contraception or removed once pregnancy excluded
41
# Emergency contraception oral pills Oral pills: Ulipristal Acetate | name of brand, time taken, mechanism, efficacy,
Ulipristal Acetate - Current brand = ellaOne - single 30 mg tablet - Licensed for up to 120 hours after sex - Synthetic progesterone receptor modulator - Primary mode of action - delays ovulation - Prevents about 60-80% of expected pregnancies - copper coil is most effective - Effectiveness decreased by progestogen contraception used 7 days before or 5 days after - decreased by progesterone - Can be used multiple times per cycle - if it happens once, can use it again
42
# emergency contraception pills Oral pills: Levonorgestrel
- single tablet usually 1.5mg if BMI is over 26 is 3mg - efficacy is 96 hours - delays ovulation
43
What is menopause defined as
- Menopause is defined as the cessation of menses for: - 12 months > if your over 50 years - 24 months <45 years - Average age of menopause in UK = 51 years - there's a 7 year lead up to menopause - Early menopause = <45years - Premature ovarian insufficiency = <40 years
44
Symtoms of menopause | due to reduced oestrogen → since there's oestrogen receptors EVERYWHERE
- Hot flushes and night sweats - loss of libido - vaginal dryness - skin dryness / dry hair / thinner hair - Frequency of micturition, urgency, nocturia - lethargy and fatigue - low mood/anxiety - Arthralgia/myalgia - Poor sleep/insomnia - Palpitations
45
What are the long-term effects of oestrogen defiency
- increased CVS risk - can cause MI - stroke - reduced bone mineral density - bone mass decreases with age - we have a lower peak bone mass - the decline is much more accelerating in females - increase total cholesteral and LDL - decreased glucose tolerance or insulin sensitivity
46
How can we help treat menopause symptoms | what do you need to add
HRT - give hormones - if they have uterus add progesterone alongside oestrogen - oestrogen grows lining of the womb, so you have progesterone to keep the womb lining in check - cyclic - half oestrogen - half progesterone - after years we move them onto a continuous one
47
How do we give HRT | routes of
- can give transdermally - or as gel, spray, gel - no blood clot risk associated with - can take orally - can give a hormonal coil as well - implants - can have oestrogen implants and decide on progesterone - can give vaginal oestrogen for vaginal symptoms
48
What are the benefits and risks of HRT
Benefits - eases symptoms - reduces CVS risk - protects bone mineral density Risks - through the skin is safer than oral - oral - risk of DT, PE - risk of MI, and stroke - not contraceptive - increases the risk of breast cancer and endometrial

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