Flashcards in CONTRACEPTION AND STERILIZATION Deck (81)
What are the different types of contraception used today?
Intrauterine devices and Mirena intrauterine system
What are the different natural methods used as contraception?
What are the fertility indicators used to make the rhythm method of contraception more effective?
A menstrual calendar
Chart basal body temp - rises by 0.2 - 0.4 ˚C when progesterone is released
Recognise changes in cervical mucus
Ovulation predictor kits eg Persona
What are the different barrier methods of contraception?
How can barrier methods of contraception be increased in effectiveness?
The addition of nonoxynol-9 which is a spermicidal
What are the advantages of method barriers compared to oral contraceptives?
Protection against STIs
What are the components of the combined oral contraceptive pill? What are the modes of action of the combined oral contraceptive pill?
Ethinyl oestradiol with levonorgestrel or norethisterone
Prevents LH surge
Thickens cervical mucus to prevent sperm reaching uterus
What are the absolute contraindications to prescribing the COCP?
Arterial or venous thrombosis (MI or stroke)
Undiagnosed vaginal bleeding
History of oestrogen-dependent tumour
Recent hydatidiform mole
Breast feeding less than 6 weeks post partum
Migraine with aura
Age over 35 and smoking more than 15 a day
BP of more than 160 systolic or 95 diastolic
Major surgery with prolonged immobilisation
Diabetes diagnosed over 20 years old
What are the relative contraindications to prescribing the COCP?
Family history of thrombosis - consider investigations for thrombophilia
Breast feeding 6 weeks - 6 months post partum
Migraine without aura and over 35 years old
BMI over 35
Immobilty - eg wheelchair use
What are the advantages of the COCP?
Reliable if taken correctly
Reduces menorrhagia, dysmenorrhoea and premenstrual syndrome
Controls functional ovarian cysts
Reduces risk of ovarian and endometrial carcinoma
What are the main risks of the COCP?
Increased risk of cervical cancer
What are the side effects of the COCP?
What should patients be warned about when prescribing the COCP?
Reduced efficacy with some antibiotics ( amoxicillin, ampicillin, erythromycin and tetracycline) and other liver-enzyme inducing drugs
Will not take effect for 7 days so use barrier contraception until then
Who would you choose to prescribe the progesterone-only pill for rather the COCP?
In those in whom oestrogen is contraindicated
This includes women over 35 who smoke
Those who are breast feeding
Women who have had an abortion
Women with diabetes
Women with migraine with aura
What are the advantages of the progesterone only pill versus the COCP?
Very few side effects
What is the cut off time for missing a progesterone only pill beyond which action must be taken? What action must be taken?
Traditional POPs: 3 hours (i.e. more than 27 hours since the last pill was taken)
Cerazette (desogestrel): 12 hours
Take missing pill. Then take next pill at what would have been usual time. Use condoms for 48 hours. Continue rest of pack.
What are the main risks of the progesterone only pill?
Very small risk of ectopic pregnancy
What are the injectable methods of contraception and how often do they need to be given?
Intramuscular injections of medroxyprogesterone acetate given every 3 months (Depo-provera)
What are the disadvantages of the injectable progesterones (Depo-provera) as contraception?
Cannot be removed and any side effects must be tolerated for 3 months
Can have heavy unpredictable bleeding patterns
Delay to return to full fertility of up to 12-18 months
What are the main side effects of the injectable progesterones (Depo-provera)?
Slight weight gain
Osteoporosis with long term use
Amenorrhoea in 50% by 1 year and 70% by 2 year
What is the main risk of the injectable progesterones (Depo-provera)?
Prolonged used has been associated with osteoporosis
Other than oral methods of hormonal contraception, what systemic methods of hormonal contraception are widely used?
Injectable progesterones (Depo-provera)
Transdermal combined contraceptive patch
Combined contraceptive vaginal ring
What is the drug contained in the implantable contraceptive and how often does the implant have to be changed?
Every 3 years
What are the advantages of the progestin implant over the depo preparation (injectable)?
Quicker return to fertility
Regular menses once discontinued
What are the main side effects and contraindications of the progestin implant?
Headache, nausea, breast pain
Small risk of increase in acne
Breast cancer in the last 5 years
Unexplained vaginal bleeding
What are the different intrauterine methods of contraception?
IUCD - intrauterine contraceptive device - copper coil
IUS - MIRENA intrauterine system - contains progesterone
What are the contraindications to the intrauterine device?
Undiagnosed uterine bleeding
Active or past history of PID
Previous ectopic pregnancy
Previous tubal surgery
How long can an IUCD or IUS remain in place for before it needs to be changed?
IUCD: 5 to 10 years
IUS: 3 to 5 years
What are the risks and side effects of intrauterine contraceptive devices?
Infection - PID
Expulsion of IUCD/IUS
Oligomenorrhoea / amenorrhoea