14 - Repro - Contraception

Question 1

Name the 2 methods of natural contraception:

Answer 1

1) Fertility awareness

2) Lactational amenorrhoea

Question 2

What can be used to monitor fertility, as a method of natural contraception?

Answer 2

• Cervical secretion
• Body temperature
• Length of cycle

Question 3

What are the advantages of natural contraception?

Answer 3

• No hormones

- No contraindications

Question 4

What are the disadvantages of natural contraception?

Answer 4

• Not as effective

- Unreliable

Question 5

Name the 6 main types of contraception:

Answer 5

1) Natural
2) Barrier
3) Prevention of ovulation
4) Inhibition of sperm transport
5) Inhibition of implantation
6) Sterilisation

Question 6

List 2 types of barrier contraceptions:

Answer 6

1) Condoms

2) Female diaphragm/cap

Question 7

What are the advantages of barrier contraceptions?

Answer 7

• Can prevent STIs

- No hormones

Question 8

What are the disadvantages of barrier contraceptions?

Answer 8

• Latex allergies (male condoms)
• Female condoms are not widely available
• Female diaphragms/cap require spermicide

Question 9

What hormone is used in contraceptions which prevent ovulation? How does it work?

Answer 9

Progestogen (synthetic progesterone) at moderate/high dose
- Inhibits positive feedback of oestrogen on the hypothalamus
= no LH surge = no ovulation

Question 10

What are the 3 methods of contraception used to prevent ovulation?

Answer 10

1) Combined Oral Contraceptive Pill (COCP)
2) Progesterone Implant
3) Progesterone Depot (injection)

Question 11

What are the disadvantages/side-effects of the Combined Oral Contraceptive Pill?

Answer 11

• User dependent (inconvenient)
• Bleeding
• Breast tenderness
• Mood disturbances
• Headaches
• Hypertension
• Gallstones + cholestatic jaundice
• Increased risk of venous thromboembolism
• Increased risk of myocardial infarction
• Many contraindications

Question 12

What are the disadvantages of the prosterone depot (injection)?

Answer 12

• Bleeding
• Not quickly reversible (return of fertility <1yr)
• Small loss of bone mineral density

Question 13

How long does the progesterone depot (injection) last?

Answer 13

~ 8-13 wks

Question 14

How long does the progesterone implant last?

Answer 14

~ 3yrs

Question 15

What are the disadvantages of the progesterone implant?

Answer 15

• Small procedure required
• May have local adverse effects
• Can affect bleeding

Question 16

Name the main method of contraception which inhibits sperm transport:

Answer 16

Progesterone-only pill (POP)

Question 17

How does the progesterone-only pill work as a method of contraception?

Answer 17

Low-dose progesterone thickens cervical mucous, which becomes impenetrable to sperm

Question 18

What are the disadvantages/side-effects of the progesterone-only pill?

Answer 18

• Breast tenderness
• Mood swings
• Heavy bleeding or spotting
• Abdominal cramps
• User dependent, must be taken at same time everyday (error margin = 3hrs)

Question 19

What are the 2 main methods of contraception which inhibit implantation?

Answer 19

1) IUD (copper coil)

2) IUS (progesterone coil)

Question 20

How does an Intrauterine System work as contraception?

Answer 20

Progestogen:

• Decreases endometrial proliferation
• Thickens cervical mucous

Question 21

How does an Intrauterine Device work as contraception?

Answer 21

Copper:

• Toxic to sperm and ovum
• Inflammatory endometrial reaction = prevents implantation
• Changes cervical mucous

Question 22

What are the disadvantages of using a coil for contraception? (copper + progestogen)

Answer 22

• Unpleasant insertion
• Displacement/expulsion may occur
• Menstrual irregularity + may be longer/heavier/painful
• Uterine perforation

Question 23

What are the methods of sterilisation used as contraception?

Answer 23

• Vasectomy

- Tubal ligation

Question 24

Define primary infertility:

Answer 24

Failure of conception in a couple having regular unprotected sex for 1+ yr, with no previous pregnancy.

Question 25

Define secondary infertility:

Answer 25

Failure of conception in a couple having regular unprotected sex for 1+ yr, with 1+ previous pregnancy.

Question 26

What percentage of couples concieve within 1 yr of havinf regular unprotected sex?

Answer 26

~ 75 - 80%

Question 27

Is infertility more likely due to the female or male?

Answer 27

Female ~ 70%

Question 28

What causes Polycystic Ovary Syndrome (PCOS)?

Answer 28

Lack of pulsatile GnRH secretion

= abnormal oestrogen secretion

Question 29

What is the typical presentation of Polycystic Ovary Syndrome?

Answer 29

• Secondary amenorrhoea
• Hirsutism
• Infertility
• Obesity

Question 30

Why are women with Polycystic Ovary Syndrome at higher risk of endometrial carcinoma?

Answer 30

Abnormal oestrogen secretion

= Abnormal endometrial proliferation

Question 31

Why are women with Polycystic Ovary Syndrome at higher risk of diabetes + CVD?

Answer 31

Commonly have high insulin resistance = obese

Question 32

What investigations may you do on a couple presenting with infertility?

Answer 32

Female:

• LH/FSH/Progesterone check
• Cervical smear
• Pelvic USS

Male:

• Sperm analysis
• LH/FSH/Testosterone check
• USS

Question 33

What are some methods of inducing ovulation?

Answer 33

• Weight loss/gain
• Clomiphene citrate
• Gonadotrophins
• GnRH agonists
• Ovum donation

Question 34

How does clomiphene citrate induce ovulation?

Answer 34

Anti-oestrogen = reduces negative feedback of oestrogen at the hypothalamus
= ^ GnRH = ^ FSH + LH