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BIMA Obstetrics and Gynaecology: Contraception By Dr Abigail Badrick 7pm, Thursday 7 th March @BRITISHINDIANMEDICASSOCIATION BRITISH INDIAN MEDICAL @BINDIANMEDICS ASSOCIATION @BIMA BIMA Clinical SeriesObjectives EarlyPregnancy • Understandbenefitsofpregnancyplanningand principlesof contraception Contraception • Demonstratebasic knowledgeofcurrentlyavailablecommon contraceptivemethodsandbe able to communicatetoclientsthe mechanismofactionand failurerate • Describeto aclientmethodsof emergencycontraceptionand indicationsfor use19yearold Chloe… • Presentsto see you inclinicrequesting contraception • Shehasheardof the“contraceptivepill”but isn’tawareofmuchelse • Whatdifferentmethodsof contraceptionare availablefor Chloe?• External/internal condoms • Diaphragm • Cap • Spermicide • Progesterone-only pill • Combined pill • Combined patch • Vaginal ring • Implant • IUS • IUD • Depo-Provera injectable • Sayana Press injectableBarrierMethods • Preventspermfromtravelling throughcervicalcanalto reachtheuterusandFallopian tube • Alsohelp preventspreadof some STIs by containing genitalsecretions • Some canbe usedin conjunctionwithspermicide gelsHormonalContraception Chloe has heard that hormonalcontraceptivespreventpregnancyby causingabortion.Is this… TRUE FALSE 1. Inhibits ovulation 2. Effects onendometrium to prevent implantation 3. Effects oncervical mucous toprevent sperm penetrationHormonalSideEffects Oestrogen Progesterone Menorrhagia Irregularbleeding cervicalectopy leukorrhoea,dryvagina breastfullness breasttenderness migrainetypeheadaches dulltypeofheadache-oftenofpillwithdrawal fluidretention(weightgain) appetiteincrease(weightgain) tiredness premenstrualdepression irritability legcramps, softeningofligaments nausea acne,greasyhair bloating lowmood lowlibidoCombinedHormonalContraception • Containoestrogenand progesterone Theoestrogen and • Patches progesterone • Ring delnegativeve a feedbackeffect • Pill(COC) thus preventthe LH surge and • Monophasic inhibit ovulation • Biphasic • TriphasicMonophasicRegimens 11CombinedHormonalContraception+Cancer Risk • Decreasedriskof endometrialcancer • Increasedriskof • Decreasedriskof breastcancer ovariancancer • Increasedriskof • Decreasedriskof cervicalcancer colorectalcancerCHCandCardiovascularRisk • Increasedriskof VTE/PE • Risk ofMI and stroke • Otherpatientfactorsto consider-age, smoking,BMI/obesity, increasedriskofischaemicstroke inpatientsknownto have migrainewithauraAcomprehensivehistoryis crucialtoanycontraception consultation!Progesterone-onlyPill Brand name Type of Dose Progestogen (μg) Cerazette® Desogestrel 75 Micronor® Norethisterone 350 Norgeston® Levonorgestrel 30 Noriday® Norethisterone 350 Slynd® DrosperinoneChloehastriedoralcontraceptivesbefore, butisstrugglingtoremembertotakethem… • Whatmethods dowehaveavailablethat donotrequirethis?Howlongdotheselongactingmethodslast for? • Injection 3 Months • Implant 3 Years • IUD 5 or10 Years • IUS 3, 5, 6or 8 YearsProgesteroneInjectables • Depo-Provera IM • Sayana Press SC • Givenonceevery 12-14 weeks • Weight gain • Delayed returnoffertility • Reducedbone mineral densitySubdermalContraceptiveImplant • Progesteronereleasedover3 years • HighlyeffectiveLARC • NoadverseeffectonBP , risk ofVTE or CV disease • BMD– No effect • Rapid returnofovulation→ fertility followingremovalProgesteroneIntrauterineSystem • Levonorgestrel (LNG) 52 19.5 13.5 • Jaydess(3years) • Kyleena(5years) mg mg mg • Mirena(8years) • Levosert(6years) • Benilexa(6years) Mirena Kyleena Jaydess • Inhibits ovulation • Thinningendometrium Contraceptio Contraceptio Contraception: n:3 yrs • Prevents implantation n:8 yrs 5 yrs HRT: 5 yrs • Thickens cervicalmucusCopperIntrauterineDevice • Cu-IUD • 5 year • 10 year • Toxicto spermand ova • Preventionofimplantation • BleedingeffectIUCandEctopicPregnancy • BothIUS andIUD very effectiveat preventing pregnancy • Ifpregnancydoes occur morelikelytobe ectopic • IUCis NOT contraindicated inpatientswithhxof ectopic Laparoscopicview ofleftsided ectopicpregnancytaken from pregnancy Jimi's blog| UK ConsultantGynaecologist& Obstetrician (ukgynaecologist.com)NaturalFamilyPlanning • Sperm5-7 days • Egg 24hours • Rhythm/Calendarmethod • Monitoringbasalbody temperature • Cervicalsecretions • Pull-outmethodPermanentContraception • Vasectomy • Tuballigation Vasectomy Surgery - FACEmed Cosmetic Medical &Dental CentreHoweffectivearedifferentmethods? 1. Highlyeffective 2. Effective 3. Relativelyeffective © ShutterstockWhatdowemeanbyeffectiveness? < 1 pregnancy in100 womenper year 1. Highlyeffective If 100 women have sex for a 2. Effective year how many will get pregnant? 3. Relativelyeffective >10pregnancies in 100womenper year © ShutterstockEffectivenessofcontraceptivemethods Implant, IUS, IUD (Sterilisation) 1. Highlyeffective Injection, CHC (COC, Ring, Patch), 2. Effective POP 3. Relativelyeffective Condoms, Diaphragms (Fertilityawareness methods) © Shutterstock Failure rateswithtypicaluseper100 woman-years 18 12 9 9 6 0.06 0.15 0.2 0.6 0.8 Trussell J. In: Hatcher et al. (eds) Contraceptive Technology (20 Edition). New York, ALeaflets oftenquote‘perfect’useEmergencyContraception 1. Oral: Levonorgestrel(LNG) 2. Oral: Ulipristal(UPA) 3. CopperIUD Images © ShutterstockWhenisemergencycontraceptionneeded? • Condomnotused/ condomaccident • Missed COCP (≥2 pills) • Late POP (>36 hoursfor Desogestrel) • Late Depo>14w since last injection • Impalpable implant or > 3yrs • IUD expulsion, lost threads • Whilst taking liver enzymeinducers and for 28 days afterHowdoesemergency contraceptionwork? • Oral EC– delayovulation >5days • Levonelle • EllaOne • Cu-IUD– prevents implantationKey messages • Manydifferent methods of contraception available in the UK • CondomsprotectfromSTIs buthigher contraceptive failure rate • LARCssuch as SDIand IUCDs are most effective reversible methods • IUD is the mosteffective formof ECFurtherreading • Websites: • The Facultyof Sexual and Reproductive Healthcare (FSRH) • SexWise • e-Learning forHealthcare • SexwisefpaleafletsTHANK YOU FOR LISTENING ANY QUESTIONS BIMA Clinical and OSCE seriesReferences • Intrauterine Contraception -Facultyof SexualandReproductiveHealthcare (fsrh.org) • FSRH Clinical Guideline: Combined Hormonal Contraception(January 2019,Amended October 2023)-FacultyofSexualand Reproductive Healthcare • Facultyof Sexual and Reproductive Healthcareion(March2017,amended July2023)- • FSRH Clinical Guideline: Fertility Awareness Methods (June 2015)- FacultyofSexualand ReproductiveHealthcare • HEE elfhHub(e-lfh.org.uk)-ContraceptiveChoices programme • combined contraceptivepill (oestrogenand progesterone effects) - GeneralPractice notebook(gpnotebook.com) • https://www.fsrh.org/documents/ukmec-2016/ • Sterilisation(vasectomyand tubal occlusion)-Contraception– Sexwise