Contraception

• Natural cycle: Day 1 of cycle is natural or day 1 of period, HC is day 1 of pill, regardless when period is.
• Devices: Barriers protect against STI, diaphgram is a barrier but an internal one so will not protect against STI.
• LAM: Breastfeeding (lactation) can be used as a contraceptive method, up to 98% efficacy if all conditions apply: Fully breastfeeding, baby under 6 months and amenorrhoeic, no other liquids or solid food, and risk of pregnancy increases if breastfeeding reduces, long intervals between feeds, or night feeds cease and use supplement feeding occurs.
• Types of hormonal contraception: COC (Combined Oral Contraception) is a combination of EE (Ethinyl Estradiol - oestrogen) and Progesterone, variations over menstrual cycle include Monophasic, Biphasic, Triphasic, and Tailored regimens.
• When combined contraception is used, there will be a hormone free period, during the hormone free period there will be a menstrual period.
• Non-oral contraception includes contraceptive patches, vaginal ring, and contraceptive implant.
• The primary action of CHC (Combined Hormonal Contraception) is to inhibit ovulation, it thickens cervical mucus and alters the endometrium, making it hard for sperm to enter the uterus.
• Oestrogen causes endometrial proliferation, progestogen opposes proliferation, endometrial proliferation is the thickening of the lining to prepare for pregnancy.
• Miscarriage risk increases if the contraception is missed for more than 24 hours.
• POC (Progestin only Oral Contraceptive) suppresses ovulation, it thickens cervical mucus, delays ovum transport, makes endometrium hostile to implantation, and reduces cilia activity in fallopian tube.
• Hormonal contraception is only immediately effective if taken at the start of the cycle.
• Changing COC(ED) to POP requires using additional precaution for 2/7 if ED/placebo pills are taken.
• POP to COC requires using additional precautions for 9 days if switching to Qlaira (COC).
• POP to COC (add precautions for 7/7) requires using additional precautions for 7/7.
• Contraception methods with higher user failure rates include COC over 99% effective, POP up to 99% effective, male condom up to 98% effective, female condom up to 95% effective, diaphragm or cap + spermicide up to 96% effective, and natural family planning = combining two or more fertility indicators and new technology up to 98% effective.
• Contraception methods with higher independent effectiveness rates include injectable contraceptive over 99% effective, implants over 99% effective in first year and over 98% per year over five years, IUS over 99% effective, IUD 98 to over 99% effective, and sterilisation: female over 99% effective, male over 99% effective.
• Hormonal contraception is not affected by enzyme inducing drugs.
• The Pregnancy Prevention Programme advises enrolling all female patients of child-bearing age, regardless of sexual activity, and providing a patient card, patient guide, and complete Annual Risk Acknowledgement form.
• POP to Zoely requires using additional precautions for 7 days.
• Changing oral hormonal contraceptive COC to POP requires ensuring previous contraception was taken effectively or excluding pregnancy, and using additional precautions for 2/7 if pill-free period is skipped.
• Hormonal contraception is affected by enzyme inducing drugs and griseofulvin.
• Changing COC(non-ED) to POP requires omitting pill-free period and starting POP immediately.
• Changing COC to Cerazette (POP) requires omitting pill-free period and starting POP immediately.
• Hysterectomy is an option for women who do not plan further/any pregnancy.
• Surgical treatment for menorrhagia can include UAE (uterine artery embolisation), myomectomy (fibroidectomy), hysterectomy, and non-pharmacological management can provide symptomatic relief and improve fertility if desired.
• Symptoms of endometriosis can include common and rare symptoms that indicate involvement of the bowel, bladder or lungs.
• Pharmacological management for menorrhagia can include contraception, IUS/parenteral progesterone, tranexamic acid, mefenamic acid, oral cyclical progestogen, GnRH analogues/antagonists, antiprogestogens, and last resort options.
• Management of endometriosis is influenced by the need to preserve/restore fertility, with surgical options and pharmacological options which can reduce pain and inhibit growth of endometrial tissue.
• Endometriosis consolidation summary: the condition often has an unclear cause and can vary in presentation depending on the severity and staging at diagnosis.
• Causes of menorrhagia can include aetiology, gynaecological causes, endocrine & haematological causes, and non-pharmacological management can provide symptomatic relief and improve fertility if desired.
• Management options for endometriosis provide symptomatic relief and improve fertility if desired, with surgical treatment aiming to restore normal pelvic anatomy, divide adhesions, and ablate endometrial tissue.
• Common symptoms of endometriosis include pain, fatigue, subfertility, dyspareunia, dyschezia, dysuria, chronic pelvic pain, and menstrual irregularities.
• Pharmacological treatment for endometriosis includes analgesia, utilising the oestrogen dependency of endometrial tissue, and laproscopy involving ablation/shave or resection.
• Diagnosis of endometriosis involves a pelvic exam, ultrasound or diagnostic laparoscopy, and is not done through bloods or MRI.
• Rarer symptoms of endometriosis include cyclical haematuria, cyclical haemoptysis, cyclical tenesmus, ureteric obstruction, rectal bleeding or rectal obstruction.
• Endometriosis is staged from Grades 1 to 4, with stages 1 and 2 being minimal to mild, tissue localised to uterus and ovaries, and stages 3 and 4 being moderate to severe, commonly associated with adhesions, tissue invades GI tract.
• Endometrial tissue is found outside the reproductive tract in the GI tract, urinary tract, and lung.
• Endometriosis aetiology is unclear, with reflux of menstrual loss and distal autoimplantation of endometrial tissue/implants being potential causes.
• Increased myometrial contractility is a potential mediator of dysmenorrhoea.
• Dysmenorrhoea is a condition characterized by pain associated with menstruation, affecting 50 - 80% of women, of whom 10% are severely debilitated.