CONTRACEPTION
THE COMMUNITY PHARMACIST IS OFTEN THE FIRST PORT OF CALL FOR EMERGENCY CONTRACEPTION, BUT CAN ALSO PLAY A VITAL ROLE IN PROVIDING PATIENTS WITH INFORMATION AND SUPPORT ON ALL ASPECTS OF CONTRACEPTION. PHARMACIST CHANEL JONES PROVIDES SP WITH THIS COMPREHENSIVE GUIDE….
CONTRACEPTION METHODS
THE MAIN METHODS OF CONTRACEPTION1
ARE: • Barrier method
• Short acting contraception – eg, the pill and the patch
• Long-acting reversible contraception (LARC) – eg, parenteral progesterone (Depo Provera®), progesterone implant (Nexplanon®) and the intrauterine device (MIrena®)
• Emergency contraception • Natural family planning
• Sterilisation (female ‘tube tying’ and male vasectomy) BARRIER METHODS
Barrier methods include: condoms (male and female), the diaphragm, cervical cap and spermicide sponges, foams and films1
is made from polyurethane as is just 24 - SCOTTISH PHARMACIST
as effective as the male condom (95 per cent for perfect use)2
; however,
the success rate of preventing pregnancy, STIs and HIV heavily depends on the user. It can be used with any lubricant and can be inserted up to eight hours before sex. The disadvantage is that they are not as common and male condoms and can be more expensive to purchase.2
. The female condom
The cervical cap and diaphragm are made from rubber or silicone and can be use with a spermicide. If applied correctly, both methods are effective, but are not as effective as the pill. The cervix must be measured by a nurse or doctor to be fitted with the appropriate size. They will also train the woman on how to insert the device if it is suitable for them. It is most important for women to know that both the cap and the diaphragm need to stay in place at least six hours after intercourse
(maximum 48 hours for rubber or silicone and 30 hours for latex) 3,4
.
FEMALE REPRODUCTIVE ENDOCRINOLOGY AND THE MENSTRUAL CYCLE There are four hormones involved in the control of the human menstrual cycle. Two are produced by the ovaries: oestrogen (produced by follicle cells) and progesterone (produced by the corpus luteum or ‘yellow body’). The other two hormones (gonadotropins) are secreted from the anterior pituitary gland: follicle stimulating hormone (FSH) and luteinising hormone (LH). The hypothalamus releases gonadotropin-releasing hormone which stimulates the production FSH and LH in the gonadotrophic cells in the anterior pituitary gland 5
only one in one ovary continues develop into a secondary oocyte. The granulosa cells of the developing follicle secrete oestrogen which has a negative feedback effect on FSH, thus inhibiting its the secretion. Oestrogen causes the uterus lining (endometrium) to thicken. Near to the middle of the cycle, there is a surge in LH causing the granulosa cells to reduce secretion of oestrogen and start secreting progesterone. LH also causes ovulation which theoretically happens on day fourteen as this is halfway through a normal 28-day cycle. However, in some women it can occur anywhere from day eleven to day 21 as cycle lengths vary and ovulation can be very unpredictable6
. . Secretion
of FSH increases slightly during the first few days. This causes a number of primary follicles to develop; although,
When the follicle has ruptured and the egg has been released, the remaining granulosa cells enlarge and fill with a yellow substance. It is now called the corpus luteum or yellow body which
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
