Non-hormonal contraception - Barrier methods:
Condoms:
- How often does it need to be changed?
- What should it not be used with an oil-based lubricant?
- Why are female condoms not popular?
Diaphragm and cervical caps:
- What is the difference between the 2?
- Up to how many hours before sex does it need to be inserted?
- What must it be used with?
- How long after sex does it need to stay in for?
–
What does barrier methods protect against?
Each episode of sexual intercourse
It destroys the latex
The penis can go alongside it instead of in
They can be pushed up and fall out
Noisy
–
D - stretches from pubic bone to posterior fornix
C - fit over the cervix
3 hrs
Spermicide (E.g. Nonoxynol-9)
STIs
Non-hormonal contraception - Natural Methods:
What is coitus interruptus?
Fertility awareness:
- What is it?
- How many days before ovulation is a woman fertile?
- How many days after ovulation is a woman fertile?
- What would happen to the mucus prior to ovulation?
What might the mother do for her baby after birth to delay the return of her menses?
Withdrawal of penis before ejaculation
Monitoring mucus and temperature for signs of ovulation
6 days before (life of a sperm)
2 days after (life of ovum)
Breastfeeding - lactational amenorrhoea - look up!
Non-hormonal contraception - Natural Methods:
High-technology natural methods:
- What do they do?
Use urine test sticks to measure hormones around ovulation
It learns the variability over time
It gives women the green/red light for unprotected intercourse
Intra-uterine contraceptive devices (IUCD):
2 types:
- Non-hormonal - what is it more commonly known as?
- Hormonal - what is it more commonly known as?
Copper coil
Mirena - Intra-uterine system (IUS)
Intra-uterine contraceptive devices (IUCD) - Copper Coil:
- What is it?
- How does it work?
- What are women advised to do to make sure it is still there?
- How long does it take to begin working?
- How long does it last?
- What else can it work as aswell?
3cm plastic device with copper wire and trailing thread
Inhibits implantation and sperm migration
Immediately
5-10 yrs
Emergency contraception***
Intra-uterine contraceptive devices (IUCD) - Copper Coil:
Insertion:
- What must be screened for before?
- What must you make sure is negative?
- What meds are women advised to take before insertion?
What if the woman falls pregnant?
Side effects:
- How may it make periods worse?
- Post-insertion risks?
- Why are STI’s screened for?
STD
A preg test - they should not be preg
Analgesia - may cause cramps -- Remove immediately to reduce the risk of miscarriage -- Increased pain and bleeding
Cramps and perforation
PID post-STI and insertion if they have a current STI
Intra-uterine contraceptive devices (IUCD) - Mirena:
What is it?
How does it prevent pregnancy?
Advantages:
- How long does it last?
- Why does it help periods?
- What can it also be used as a treatment for? - 2
Side effects:
- What to warn about in the first few wks?
A device that releases levonorgestrel
5 yrs
Reduced pain and bleeding, therefore, can be used for dysmenorrhoea and menorrhagia.
Spotting
Heavy bleeding
Combined Oral Contraception (COCP):
Mechanism:
- What is it made of? - 2
- How does it work?
Use:
- What 2 ways can it be taken?
- It should be started on the 1st day of cycle. What do they need to use as a backup if they want to start it at any time?
Oestrogen - ethinylestradiol
Progesterone - norethisterone
- ve feedback on HPO system, therefore, prevents ovulation
- -
(1) 3 wks on, 1 wk off for withdrawal bleed
(2) Taken back to back - skipping wk off to avoid period (e.g. for holiday)
Condoms for 7 days + checking not pregnant
Combined Oral Contraception (COCP):
Missing pills/severe diarrhoea:
- What should be done if they miss 1 pill (>24 hrs)?
- What should be done if they miss 2 pills (>48 hrs)? - 2
- What should be done if they miss 2 pills (>48 hrs) in wk 1?
- What should be done if they miss 2 pills (>48 hrs) in wk 3 (<7 days left of a pack)?
- What should be done if they vomit within 2 hrs of taking a pill?
- Where should they look for most accurate advice non the less?
Take it ASAP the next day
Forget there 1st but take the 2nd ASAP
Use condoms for 7 days (+ days of diarrhoea)
Offer emergency contraception if she has unprotected sex
Continue to next pack without a wk off
Take another
The advice in the packs themselves
Combined Oral Contraception (COCP):
Advantages:
- Why does it make the period better?
- What does it reduce the risk of?
- What else dermatologically can it improve?
Side effects which settle after 2-3 months:
- Most common side effect?
Oestrogenic effects:
- Breast
- GI - 2
- Weight
- Vagina
Reduced pain, bleeding, PMS
Reduced risk of benign breast disease
Reduced risk of ovarian and endometrial cancer
Breakthrough bleeding, mainly spotting
Oestrogen:
- breast tenderness**
- nausea**
- bloating
- cyclical weigh gain
- vaginal discharge (usually dry without)
Combined Oral Contraception (COCP):
Progetogenic effects:
- Mood
- Vagina
- Weight
Another main side effect?
Mood swings
Vaginal dryness
Sustained weight gain
HEADACHE** especially if migraines with aura
That is why you shouldn’t have COCP if you have a history of migraines
Combined Oral Contraception (COCP):
What does it increase the risk of?
Contraindications:
NO PILLS CHUM mneumonic
VTE
HTN and CVD - check BP every 6 months
Neoplasia PMH - breast/gynae
Obesity
Pressure - HTN or history of CVD Insulin deficient - DM Late in life Lactating - currently breastfeeding Smoking
Clotting - VTE PMH
Hydatidiform mole pMH
Undiagonosed PV bleeding
Migraine with aura
Combined Oral Contraception (COCP):
Drug interactions reducing COC effectiveness:
- Why are epileptics denied this?
- A herbal Rx for low mood
- Antibiotics - R
Interaction wtih anticonvulants
St. Johns Wart
Rifampicin
Progesterone only pill (POP):
3 examples of what they could contain? - N, L, D
Mechanism - 2
Norethisterone
Levonorgestrel
Desogestrel - +/- 12hrs
Thickens cervical mucus
Inhibition of ovulation
THINK OF SAME EFFECTS PROGESTERONE HAS IN PREGNANCY
Progesterone only pill (POP):
Use:
- How should it be taken?
- It should be started on the 1st day of their cycle. What should be done if it is started at any time?
- What should they do if they miss a pill? - 2
- Do you have any breaks?
Side effects:
- Changes to period
- Breast
- GI
- Head
- Mood
- Sex
- Weight
- Derm
Why is this a good alternative to the COC pill?
Taken daily at the same time +/- 3 hrs
2 days of condom use
Take it ASAP Condom use for 2 days ---- Irregular periods and spotting Breast pain Headache Nausea Low mood Reduced libido Weight gain Acne
It has very few contraindications but does have a slightly higher failure rate
Non-oral hormonal contraceptives:
Name the different types? - 3
Depot injection
Implant
Patches and rings
Non-oral hormonal contraceptives - Depot injection:
Route?
How often?
How does it work?
Advantages:
- How does it affect periods?
Side effects:
- Weight
- Derm
- What can it increase the risk of, which needs monitoring every 2 yrs?
- How long does it take to regain fertility after stopping?
IM - gluteal or deltoids
Every 12 wks
The contraceptive injection works by preventing the ovaries from releasing an egg each month. It also thickens the fluid around the cervix (opening to the uterus/womb). This helps to prevent the sperm from entering - Basically from PROGESTERONE.
Initially irregular bleeding but later mostly amenorrhoeic -- Weight gain Acne Osteoporosis - recovers when stopped 18 months
Non-oral hormonal contraceptives - Implant:
What is it?
Where is it placed?
Advantages:
- How long does it last?
- What does it decrease in most cases?
- Why is it preferred by young women?
Sub-dermal implant that releases etonogestrel, a progestogen
3 yrs
Decreased bleeding - can become amenorrhoeic
Long-acting and doesn’t carry the potential osteoporosis risk of Devo-Provera
Non-oral hormonal contraceptives - Patches and ring:
What is it?
How is it taken?
Side effects?
Combined hormonal contraception - same as COCP BUT NOT ORAL
Combined so both OESTROGEN & PROGESTERONE
3 wks in
1 wk out
Then replace
Breast pain
Breakthrough bleeding
Expensive
Sterilisation:
Option for men
Option for women
Vasectomy
Tubal ligation
Sterilisation - Vasectomy:
Risks?
How long does it take to be effective?
What is done to confirm it has been successful?
Sterilisation - Tubal Ligation:
Risks?
Can both V and TL be reversible?
Bleeding
Infection
Sperm granuloma
Chronic testicular pain
4-5 months
2 confirmatory semen analysis --- Bowel/bladder perforation Bleeding Infection Ectopic pregnancy
50% are reversible
Emergency Contraception:
Indications:
How many POP pills are missed before this is needed?
How many COC pills are missed in the first before this is needed?
1 missed POP
2 missed COC
Emergency Contraception:
Options:
What is given within 3 days?
Dose?
What is given within 5 days which is more effective?
Levonorgestrel 1.5 mg - SINGLE DOSE
Copper IUCD
Postpartum Contraception Advice:
How long postpartum should this be discussed?
How long does natural contraception last if
breastfeeding?
If not breastfeeding, how long after birth is contraception needed?
6 wks in the postpartum app with GP
6 months
3 wks
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History8
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Examination10
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Anatomy1
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Sexual dysfunction5
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Genital Abnormalities9
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Case 14 Basics12
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Amenorrhoea9
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Dysmenorrhoea6
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Bleeding3
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PCOS17
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Menorrhagia7
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PMS9
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Menopause18
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Termination of Pregnancy8
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Miscarriage21
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Ectopic Pregnancy ****11
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Gestational Trophoblastic Disease (GTD)8
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The Vulva6
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Vulval Lumps and ulcers7
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Bartholin's Cyst and Abscess6
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Benign Cervical Disease3
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Cervical Cancer9
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Cervical Cancer Screening9
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Fibroids12
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Endometrial Cancer11
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Ovarian Cysts14
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Ovarian Cancer15
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Vaginitis12
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STI's causing urethritis10
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Pelvic Inflammatory Disease15
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Endometriosis12
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Genital Prolapse10
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Sub/Infertility27
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Contraception25
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GO TO SURGERY FOR BREAST PATHOLOGY1
