Contraception - Fertility control Flashcards
(36 cards)
what is the most common form of contraception in the UK?
Combined hormonal contraception CHC - 25%
what would make the ideal contraceptive?
100% reversible, effective, free of side effects, sti protection, low maintainance
define what the pearl index is…
the number of contraceptive failures per 100 women-years of exposure. It looks at the total months or cycles of exposure from the initiation of the product to the end of the study
what is Life table analysis?
provides the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure
define LARC
long acting reversible contraception - this minimises user input and thus minimised user failure rates (the coil)
on what days is there the highest chance of pregnancy?
sex on days 8-19, however sperm survical and ovulation is variable.
What is in the COC (combined oral contraceptive)?
combination of 2 hormones: ethinyl estradiol (ee) and synthetic progesterone (progestogen), 20-30mgs, taken for 21 days with a hormone free week
what is the mode of action of COC?
stops ovulation, alters FSH and LH, prevents implantation by making the endometrium inadequate and alters the character and quantity of the mucus thus inhibiting sperm penetration
what are the different mediums of the COC?
Pill - takenn daily, Patch - changed weekly, Ring - changed every 3 weeks)
What are the non-contraceptive benfits of COC?
regulates bleeding to reduce painful heavy menstruation and anaemia, reduction in ovarian cysts, 50% reduction in ovarian and endometrial cancer, improves acne reduction in benign breast disease
What are the side effects of COC?
3 times increased risk of dvt (venous thromboembolism) or arterial thrombosis leading to MI or ischaemic stroke, headache, nausea, breast tenderness, weight gain and mood swings, Increased risk of breast cancer and cervical cancer. Avoid giving to patients with reactive gall bladder disease or a previous liver tumour. irregular bleeding for the first 3 months.
How does one take the Progesterone only pill (POP)
take at the same time everyday without a pill-free interval - desogestrel pill; can have a 12 hour window period
What is the mode of action of a POP?
cervical mucus made impenetrable by sperm, maintains regularity of ovulaiton
contraindications of POP
Breast ca, Liver tumours
What are the side effects of the POP?
increase in appetite, hair loss, mood swings, bloating or fluid retention , acne, headache.
What is the mode of action of the Injectible progesterone ‘depoprovera’
Prevents Ovulaiton, alters cervical mucus so its more hostile to sperm and makes the endometrium unsuitable for implantation.
What are the side effects of depoprovera?
delay in return to fertility once off it, reduction in bone density, problematic bleeding, weight gain.
What is the mode of action of the subdermal progesterone implant - The Rod?
inhibition of ovulation and effect on cervical mucus to prevent sperm reaching the upper reproductive tract. This implant can last 3 years or be removed at any time.
IUD (coil) - how long can It last for?
5-10 years
IUD method of action?
Toxic to sperm -stop sperm reaching egg- may sometimes prevent implantation of fertilised egg
How does the Levonorgestrel IUS work?
Affect cervical mucus and endometrium most women still ovulate. Stop fertilisation of the egg- may prevent implantation the fertilised egg, Slow release progestogen on stem, Low circulating progestogen levels compared with pill/implant/injection, Reduce menstrual bleeding after up to 4 months initial irregular bleeding Mirena TM- 5 years contraception, 85% women almost bleed free by 1 year, also licensed to treat heavy menstrual bleeding and as the progestogenic part of HRT.
Emergency contraception - what aer the options available?
a) Levonelle (LNG), 0-72 hours (85% risk reduction) or 73-96 hours – off licence (64% risk reduction) – ineffective thereafter b) Ullipristal/Ella One (UPA), 0-120 hours (60-80% risk reduction – different studies) c) Cu IUD, 0-120 hours after first episode of UPSI or up to 5 days after expected ovulation (>99% risk reduction)
name some barrier methods of conntraception
- Male condoms 2. Female condoms (FEMIDOM) 3. Diaphragm/cap
outline female sterilisation…
Laparoscopic Sterilisation- Usually Filshie clips applied across tube to block tube lumen. Risks of GA and laparoscopy: Irreversible- risk regret, Failure rate 1 in 200 lifetime risk – could be ectopic, No effect on periods / hormones, Reduces ovarian cancer risk ( ? Even more reduction if salpingectomy but more complex surgery). May do salpingectomy at planned caesarean section if baby seems well and discussed in advance ESSURE- hysteroscopic sterilisation, local anaesthetic- No longer available for commercial reasons
