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Yr3 Reproductive > Contraception > Flashcards

Flashcards in Contraception Deck (32)
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1
Q

What are the most common forms of contraception?

A

Of women using contraception:

  • 25% Combined OCP
  • 28% sterilized

Implants only mkae 3% and Coil 6%

2
Q

How do we determine the effectiveness of a contraceptive method?

A

Life Table Analysis or Pearl Index
% of women using a the method who get pregnant anyway.
One % for perfect use and one % for “Typical” use

3
Q

Whats in the Combined OCP?

A
Ethinyl Oestradial (EE)
Synthetic Progesterone (Progestogen)

3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)

4
Q

Dose for cOCP?

A

20-35microgram but 50 if on liver enzyme inducers

5
Q

How often is the cOCP taken?

A

Every day for 21 days then 7 days off

takes 7 days to become effective when you start it

6
Q

How does the cOCP work?

A

Prevents the FSH/LH surge by -ve feedback on the GnRH producing hypothalamus

Also prevents implantation by providing an inadeqaute endometrium
Alters cervical mucous to Inhibit sperm penetration

7
Q

What are the non contraceptive benefits of the cOCP?

A
  • Regular periods & ~reduce painful, heavy periods and anaemia
  • Reduces Functional Ovarian Cysts
  • 1/2s OVarian & endometrial cancer
  • Reduces Acne, benign breast disease, RA, Colon cancer and Osteoporosis
8
Q

What are the major risks of cOCP?

A

.Very small increased risk of VTE
Very small increased risk of Ischaemic stroke
Small risk of breast cancer
Doubles Cervical cancer risk if used for 10yrs

9
Q

the cOCP is often blamed for VTEs, how risky is it really?

A

.The pill triples risk from 5 to 15 per 100,000.

However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant

It just sounds scary if you don’t actually know the numbers

10
Q

What groups might we actually worry about VTEs in if we give them the cOCP?

A

Major surgery or immobility

Thrombophilias

FH/o VTE <45yrs

BMI > 30

Vascular Disease

first 21 days post-natally

11
Q

How does Depoprovera work?

A
  • Prevents Ovulation by -ve feedback
  • Alters cervical mucous preventing sperm penetration
  • Renders endometrium unsuitable, preventing implantation
12
Q

What do we properly call the coil?

A

Long Acting Reversible Contraception (LARC)

13
Q

What are the best forms of Emergency Contraception?

A

CU-IUD (copper coil)
Levonorgestrel pill
Ella One pill

All less effective than ongoing contraception

14
Q

How long after sex can you use emergency contraception?

A

Copper coil up to 5 days post sex or 19 day of a cycle

Levonorgestrel - 72 hours
Ella One - 120 hours

15
Q

What is the main form of female sterilization?

A

Laparascopic Tubal Ligation with Filshie clips

16
Q

What are the pros of Depoprovera injections?

A

.- Good if you forget to take pills

  • Stops periods in 70%
  • Oestrogen-free
17
Q

What are the cons of DepoProvera?

A
  • Delayed return to fertility
  • Reduces BMD (Reversible)
  • Bleeding
  • Weight Gain
18
Q

What is used in the Subdermal Implant?

A

Etonogestrel (ENG) - a progestin

Coated in a rate controlling membrane of EVA

19
Q

How does the subdermal implant work?

A

,Inhibits ovulation for 3yrs

Also has some effect on cervical mucus inhibiting sperm entry into upper repro tract

20
Q

What is the main form of female sterilization?

A

Laparascopic Tubal Ligation with Filshie clips

21
Q

How is Vasectomy done?

A

Permanent division of vas deferens under local anaesthetic

Then they have to come back for semen analysis before they start having unprotected sex

22
Q

Can you get pain from vasectomy? Testicular cancer?

A

Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)

No risk of cancer

23
Q

Is vasectomy reversible?

A

.Low success rate for reversals

24
Q

When is a termination best performed?

A

<9wks as it reduces complications if its early

25
Q

AT what point do we stop doing terminations?

A

20wks. then we refer to england who do it till 24wks

26
Q

Why would you terminate a pregnancy?

A

IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating

  • Maternal health
  • Social reasons
  • Fetal Anomaly
27
Q

What do we do during a clinic consultation on termination?

A
  • Talk about methods
  • Advise they may have prolonged bleeding post-TOP
  • Offer counselling post-TOP
  • Contraception advice
  • FBC, Rubella & STI checks
  • Certificate A signed
28
Q

Most terminations in Grampian are medical, how are they done?

A

Mifepristone:
Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix & expels pregnancy

29
Q

What are the risks of Medical TOP?

A
,Haemorrhage
Uterine Perforation
Cervical Trauma
Failure
Infection
RPOC
Damage to future fertility
Psychological problems
30
Q

Whats the alternative to the Combined OCP?

A

Progestogen Only Pill (POP)

31
Q

How often do you have to take the POP?

A

Take the desogestrel pill every day within the same 12 hr window

(Traditional PoPs have only a 3hr window)

32
Q

How does the POP work?

A

Renders Cervical mucus impenetrable to sperm

Also has some effect inhibititing ovulation