Fertility Control Flashcards
(47 cards)
What is the most used contraceptive in the UK?
Combined hormonal contraception 25%
What is the pearl index?
Number of pregnancies per 100 women - years
Total months or cycles of exposure from initiation of the product to the end of the study
What is LARC?
Long acting reversible contraception
When can sex cause pregnancy?
If 26-32 day of cycle and not on hormonal contraception
Ovulate 12-18 day and egg survives 24 hrs and sperm survive less than 4 days
So highest chance on day 8-19
Describe the combined hormonal contraception
Pill, patch and vaginal ring
Combination of 2 hormones - ethinyl estradiol and synthetic progesterone
Stops ovulation and affects cervical mucus and endometrium
What is the regime of the combined hormonal contraception?
Standard regime - 21 days with a hormone free week
Tailored - tricycling or continuous use
Pill taken daily, Patch (EVRA) is changed weekly and ring is changed every 3 weeks
What are the non-contraceptive benefits of combined hormonal methods?
Regulates and reduces bleeding
Stops ovulation
Reduces functional ovarian cysts
Reduction in ovarian and endometrial cancer
Improves acne/ hirsutism
Reduction in benign breast disease, RA, colon cancer and osteoporosis
What are some side effects of combined hormonal methods?
Breast tenderness, nausea, headache and irregular bleeding in first 3 months
Mood and weight gain
What are the serious risks of the combined hormonal methods?
Increased risk of DVT or PE, arterial thrombosis - MI/ ischaemic stroke, cervical cancer and breast cancer
When should combined hormonal methods be avoided in risk if venous thrombosis?
If BMI > 34, previous VTE, 1st degree relative VTE under 45, reduced mobility and thrombophilia
When should combined hormonal methods be avoided in risk of arterial thrombosis?
Smokers >35, personal history, focal migraine, age > 50 and hypertension of 140/90
When should combined hormonal methods be avoided?
If active gall bladder disease or previous liver tumour
Avoid if previous breast cancer - BRCA
What is the increase risk of VTE on combined hormonal methods?
Increases three-fold
Describe the progesterone only pill (POP or mini pill)
Take it same time every day without pill free interval
Not good if have GI upset
Desogestrel pill
LNG NET pills
Oestrogen free
Describe the desogestrel pill
12 hour window period
Nearly all cycles anovulant and also affects mucus
Most users are bleed free after4-6 months
Describe LNG NET pills
3 hour window period
1/3 anovulant 2/3 rely on cervical mucus effect
1/3 are bleed free, 1/3 irregular and 1/3 regular periods
What are the progestogenic side effects?
Appetite increase, hair loss/ gain, mood change, bloating or fluid retention, headache and acne
When should progesterone only pill be avoided?
If current breast cancer or liver tumour past/ present
Describe the injectable progesterone ‘the jag’
Solution of medroxyprogesterone acetate dose every 3 weeks
1ml deep IM injection into upper quadrant of buttock - Depoprovera
0.6 SC injection in abdomen or thigh - Sayana press
How does the injectable progesterone work?
Prevents ovulation
Alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation
What are the positives of injectable progestogen?
Only need to remember every 12-14 weeks
70% of women amenorrhoeic after 3 doses
Oestrogen free so few contraindications
What are the negatives of injectable progestogen?
Delay in return to fertility - average 9 months
Reversible reduction in bone density
Problematic bleeding esp first 2 doses
Weight gain 2/3 of women (2-3kg)
What is ‘the rod’?
Subdermal progestogen implant Nexplanon
Describe the progestogen implant
Inhibition of ovulation and effect on cervical mucus
Can last 3 years and no user input needed
No effect on weight
