Menopause and Contraception Flashcards
Name some symptoms of menopause.
Hirsuitism Hot flushes Memory loss Irritability Depression Urogenital atrophy Dry vagina Mood swings Menstrual irregularity Sleep disturbances Dry skin Lack of concentration
What causes menopause?
95% of oestrogen’s produced in the body are oestradiol produced by granulosa cells in the follicle. This means when you run out of follicles there is a significant decrease in oestrogen.
What things are more or less likely with older oocytes?
Less likely to fertilise
Less likely to implant
More likely to miscarry
More likely to have chromosomal abnormality (due to nondisjunction)
What are long term problems caused by the menopause?
Osteoporosis
Dry vagina
Alzheimer’s (risk potentially increased by HRT)
Ischaemic heart disease (risk potentially increased by HRT)
Why is unopposed oestrogen not usually given as HRT?
It would potentially cause endometrial carcinoma, so unopposed oestrogen can only be given to women who have had a hysterectomy. Otherwise a combination of oestrogen and progesterone is given.
What are the benefits of HRT?
Relief of symptoms Prevents osteoporosis Reduces risk of colon cancer Increased general wellbeing Reduced cardiovascular disease risk, but only in YOUNGER women
What are some risks of HRT?
Increased risk of thrombosis and stroke
Increased risk of Alzheimer’s disease
Increased risk of cardiovascular disease in older women
Increased risk of breast cancer
Increased risk of endometrial carcinoma if given as unopposed oestrogen
What is premature ovarian failure?
Premature menopause (occurs before age 40). This can have a familial link or can occur as a result of iatrogenic factors e.g radiotherapy. There is a large impact on the patient’s mental health.
What are the three different types of causes for contraception to fail?
User failure Method failure (e.g hole in the condom) Provider failure (e.g clinician putting it in place causes it to fail)
What is shown by the Pearl Index?
The effectiveness of contraception
What is shown by UKMEC?
The medical eligibility criteria for contraceptive use, which shows the risk versus the benefit.
What are the three classifications of contraception?
Barrier contraception (e.g condoms) Hormonal contraception (e.g COCP) Other (e.g copper coil, emergency, surgical)
What are the advantages of condoms?
Protect against most STIs
Easy and cheap
Effective and straightforward to use
Rarely any side effects (unless latex allergy)
What are the disadvantages of condoms?
User failure can occur because they require planning and can be seen as interrupting sex They can break or slip off (Method failure) Not as effective as hormonal or intrauterine methods Desensitises penis (which can be a positive thing in premature ejaculation)
What are the advantages of a femidom?
No side effects
Protects against some STIs
Can be used with oil based lubricants (unlike male condoms)
Thicker and less likely to tear than male condom
Can be left in place for up to 8 hours
What are the disadvantages of a femidom?
Not as socially acceptable Insertion is fiddly and takes time Can be noisy Penis may go outside it (Method failure) Inner ring can be uncomfortable Not as effective as hormonal or intrauterine methods
What are the advantages of the diaphragm?
Can be inserted up to 3 hours before (but needs to be left for 3 to 6 hours after) Rare side effects Puts female in control Not compromised by medication Cheap as it can be washed and reused
What are the disadvantages of the diaphragm?
Low effectiveness (usually due to user failure on insertion)
Doesn’t give full protection against STIs
Can’t be used until 6 weeks post partum
Need to check it doesn’t have a hole in it
Increased risk of UTI
Can be affected by weight gain or loss
Relies on being kept in a safe place by the vaginal walls, so not as good for older patients with weaker muscles
