Contraception (inc emergency) Stu

Broad Topic Condensed Contraceptive Pill Depot Injections & Patches Longer-lasting contraception EMERGENCY Other Methods NICE stuff

Contraceptive Pill The Combined Pill –Oestrogen + Progesterone –Taken for 21 days then 7 day gap –C.I.s (smoking, obesity, older age, history of clots, certain meds) –Pro: regular cycle & lighter periods, reduced dysmenorrhoea, cycle control……..Con: compliance, SEs, increase risk of breast Ca & thromboembolism.

Contraceptive Pill Progestogen-only –‘mini pill’, taken every day –Some taken within 3 hours of the same time every day –Pros: Few SEs and CIs…..Cons: Compliance, irregular bleeding, progestogenic SEs

Depot Injection Works by: –Stopping ova release from ovaries, producing sperm- shielding mucus in cervix, disables the ‘landing pad’ for a fertilised egg i.e affects lining of uterus. Can last 8 – 12 weeks (e.g. Noristerat & Depo- Provera respectively) Then need another injection Effectiveness affected by meds (e.g antiepileptics) Pros: No pill-taking, less bleeding, reduced risk ectopic pregnancy & endometrial Ca…..Cons: Menstrual irregularity, weight gain, unpredictable return of fertility, increased risk osteoporosis

Patches Delivers oestrogen and progesterone through skin Acts similarly to the depot (same effects triad) Lasts a week Same timetable as combined pill – 3 weeks on, 1 week off.

Longer-lasting Contraception IUD “The Coil” –Small plastic & copper ‘T’ shaped device sits inside uterus –Lasts 5-10 years or until removed –Pros: No systemic effects….Cons: menorrhagia, no protection vs PID & ectopic pregnancy IUS “Mirena” –Also plastic and ‘T-shaped’ but contains progestogen –Acts in the same 3 ways as any progestogen –Pros: 5 year duration, reduced risk of – bleeding, ectopic pregnancy, dysmenorrhoea, confers endometrial protection……Cons: Erratic bleeding & progestogenic SEs

Long-acting Contraception Implant –Called Nexplanon, pre-Oct 2010 twas Implanon. –Flexible tube containing progestogen inserted under LA into upper arm –Lasts 3 years –Pro: Immediately reversible….Cons: Training required for insertion and removal, irregular bleeding & progestogenic SEs.

EMERGENCY!!!!!! 2 types –‘Morning-after pill’, IUD MAP –Levonelle, take within 72 hours of unprotected sex –ellaOne, take within 5 days (120 hours). IUD –As before, but can be inserted up to 5 days afterwards –Can be kept as regular contraceptive method

Barriers Condoms –Protects vs STI –Physical barrier Diaphragm (Cap) –Made of soft latex or silicone –Creates barrier by covering cervix –Needs to be used with spermicide –Placed pre-sex, and should remain in situ up to 6 hours afterwards –Reusable but less effective than other methods –Barrier cons: user-dependent & allergy.

Sterilisation Vasectomy –For males, operation done under LA often. –Prevents pregnancy by cutting, tying or blocking tubes from testes, stopping passage of sperm –Permanent, though vasectomy reversal is possible (not on NHS usually) –Effective (1 in 2000 lifetime failure rate) –Be aware of post-op complications

Sterilisation Female –Same principle as vasectomy but targets fallopian tubes –Under GA + permanent –50-80% reversal success rate –About 10 times less effective than vasectomy –Other Cons: Post-op comps, increase risk ectopic pregnancy.

Natural Family Planning Relies on womens’ ability to tune in to… –Fertility signals like periods, body temperature, and changes in cervical mucus Can take 3-6 menstrual cycles to learn Requires daily monitoring of fertility signals Less effective if not done exactly Teaching required

NICE stuff Give information and offer choice of all available methods (pros & cons) Counsell: –Contraceptive efficacy –Duration of use –Risks and possible side effects –Non-contraceptive benefits –Procedure for initiation and removal/discontinuation –When to seek help