Endo-Repro L30 Contraception Flashcards Preview

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Flashcards in Endo-Repro L30 Contraception Deck (39):
1

Hormonal contraception



1. Contraceptive pills → Combined pill, progestin0only pill, post-coital pill
2. Patch
3. Injectable
4. Implants
5. Intrauterine systems (mirena)
6. Vaginal ring (Nuvaring)
7. Male pill

2

Combined oral contraceptive pill (COCP): Definition

Mix of estrogen and progestogen

3

Combined oral contraceptive pill (COCP): Mechanism of action (2)

1st prevention ovulation
• Remove normal cycle, withdrawal bleed has minimal medical significance
2nd Cervical mucus
• Thick (progesterone)
→Fallopian tubes
→Endometrium

4

Combined oral contraceptive pill (COCP):Advantages

Effective and easy to use
Convenient
Not intercourse related
Reversible
Periods (lighter, timed or no periods)

5

Combined oral contraceptive pill (COCP):Reduction in

PMS
Ovarian cysts and cancer
Benign breast disease

6

Combined oral contraceptive pill (COCP): Disadvantages

Forget-ability
Needs planning

7

Combined oral contraceptive pill (COCP): Side effects

Nausea and vomiting
Irregular bleeding
Tiredness change
Change in sex drive
Weight gain?
Sore breasts

8

Combined oral contraceptive pill (COCP): Risk factor for

VTE
Arterial disease
History of focal migraines

9

Contraceptive patches and vaginal ring →

same as COCP except wear or insert for 3 weeks then have one week off.

10

Progesterone only pill → General principles

Low dose of progestogen through out cycle

11

Progesterone only pill → Mechanism of action

1. Cervical mucus
• Thick (progesterone
2. Fallopian tubes
3. Endometrium
4. Prevents ovulation:
• Cerazette

12

Progesterone only pill → Progestogen action on fallopian tubes

It is a smooth muscle relaxant and therefore cant contract to move egg.

13

Progesterone only pill → Advantages

1. Effective and easy to use
2. Convient
3. Not intercourse related
4. Reversible

14

Progesterone only pill →Can use if

>35 yrs
Smoker
Obese
During lactation/breast feeding
High BP or Migraine/DM

15

Progesterone only pill →Disadvantages

Forget ability →
• 3hrs with standard POP
• 12 hrs with Cerazette

16

Progesterone only pill → Side effects

• Irregular bleeding
• Functional ovarian cysts
• Headaches, weight, spots, breast tenderness

17

Post-coital (Emergency) contraceptive: Examples

Levonelle
EllaOne
Emergency IUD

18

Levonelle

Is a tablet containing a hormone called progestogen. 1 pill (within 72 hours)

19

Ellaone

A tablet containing ullipristal (progestogen receptor blocker)
1 pilll (120 hours)

20

Emergency IUD

Is a small plastic and copper device that is fitted in your uterus up to five days (120 hours) after unprotected sex or within five days of the earliest time you could have released an egg.

21

Mechanism of action Levonelle

Levonorgestrel (levonelle)
• Progestogen hormone
• Prevents/delays ovulation if given early in the cycle – seems to prevent follicular rupture or cause luteal dysfunction
• Disrupts egg transport

22

Advantages Levonelle

• Allows a mistake to be corrected.
• No prescription needed
• No affect if one does become/is pregnant

23

Side effects Levonelle

• Nausea, vomiting, headache
• Menstrual disturbance
• May not work

24

Mechanism of action Ella one

Ullipristal acetate is a progestrogen receptor modulator
Prevents/de;ays ovulation if given early in the cycle
No current evidence on disruption of embryp-endometrial interface.

25

Advantages ellaone

• Allows a mistake to be corrected.
• No affect if one does become/is pregnant

26

Side effects ellaone

• Nausea, vomiting, headache
• Menstrual disturbance
• May not work

27

Mechanism of action cooper IUD

Disrupts egg transport and implantation (conception is at time of implantation not fertilisation

28

Consider with copper IUD

Antibiotics

29

Advantages copper IUD

Allows a mistake to be corrected
Can be inserted up to 120 hours after the first episode of unprotected sex intercourse (UPSI) or within 5 days of the earliest expected date of ovulation.

30

Side effects of copper IUD

Menstrual disturbance
May not work

31

Intrauterine Devices (IUD) → copper/plastic Mechanism of action

1. Cause mild inflammatory response
2. Cause toxic environment reducing survival of gametes and embryo
3. Disrupt inflammation (may inhibit endometrial enzymes)

32

Intrauterine Devices (IUD) → copper/plastic Advantages

Work long-term, and are highly effective
Non-intercourse related
No user error

33

Intrauterine Devices (IUD) → copper/plastic Disadvantages

Have to be fitted by an expert
Heavier periods
May be expelled or displaced
Increased risk of ectopic pregnancy

34

IUS (Mirena): Mechanism of action

1. Increases the thickness of cervical mucus
2. Thinning of the endometrium (prevents implantation)
3. Preventing ovulation

35

IUS (Mirena): Advantages Mirena

Effective
Not user/intercourse dependent
Local hormone action

36

IUS (Mirena): Mirena reduces

Periods (Heavy menstrual bleeding)
Risk endometrial cancer

37

IUS (Mirena):Side effects Mirena

Irregular bleeding

38

Oestrogen contraindications/cautions:

1. Pregnancy
2. Focal migraines
3. VTE
4. Breast cancer

39

Non-hormonal methods:

1. Intrauterine devices (coil)
2. Barrier methods
a. Condoms
b. Diaphragms
c. Caps
3. Spermicides
4. Natural methods
5. Sterilisation

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