18 - Contraception

Question 1

What are 4 classes of contraception?

Answer 1

Male
Female
Reversible
Irreversible

Question 2

What is the medical eligibility of contraception?

Answer 2

No restriction
Advantages outweigh risks
Unacceptable health risk if method used

Question 3

How do you measure effectiveness of contraception?

Answer 3

Pearl index
High number - high chance of getting unintentionally pregnant
PI - number of intended pregnancies/100 women years of use

Question 4

What is the pearl index for -
No contraception
Condom 
Combined oral contraceptive
Progesterone only pill
IUD
Injection/implant
IUS
Tubal ligation
Vasectomy

Answer 4

25% - No contraception
22% - Condom
17% - Combined oral contraceptive
4% - Progesterone only pill
4% - IUD
4% - Injection/implant
1% - IUS
11% - Tubal ligation
12% - Vasectomy

Question 5

What are advantages of using condoms

Answer 5

Protects against STI

Question 6

What is a vaginal diaphragm?

Answer 6

Inserted each time intercourse occurs
Must be combined with spermicide
No STI protection

Question 7

What is the combined oral contraceptive pill?

Answer 7

Contains oestrogen and progesterone

Question 8

How can you make COCP more potent?

Answer 8

use ethinyl oestradiol

Question 9

Why would you use different doses of the combined pill?

Answer 9

Higher dose - hyperactive hepatic enzyme activity e.g alcoholics, drug users
Lower dose - declining fertility, family history of breast cancer

Question 10

What is the difference between mono/bi/tri phasic preparations of the COCP?

Answer 10

Mono - same dose throughout
Bi - oestrogen at first then add progesterone
Tri - Mimics natural cycle

Question 11

What are the side effects of the COCP?

Answer 11

Migranes, nausea, vomiting, weight gain

Question 12

What are the risks of COCP?

Answer 12

VTE, MI ,Breast cancer

Question 13

What is the mechanism of action of the COCP?

Answer 13

Oestrogen inhibits FSH secretions - anovulation

Progesterone inhibits LH secretion - prevent ovulation, changes cervical mucous to interfere with sperm transport

Question 14

What are contraindications of COCP?

Answer 14

IHD
Thrombosis
Stroke
Hyperlipidaemia
Liver disease
Pregnancy
Gall stones
Obesity

Question 15

What is the mechanism of action of the progesterone only pill?

Answer 15

Suppresses ovulation and uterine atrophy
Can be used if have contraindication to COCP
Does not increase risk of CVD

Question 16

What are the different ways progesterone can be administered?

Answer 16

Injectables - every 3 months
Implants - works for 3 years
Intrauterine system

Question 17

How long do intrauterine devices last for?

Answer 17

5-10 years

Question 18

What are copper containing intrauterine devices?

Answer 18

Make womb lining unreceptive to implantation
Prevents sperm motility
Increases menstrual loss and risk of ectopic pregnancy

Question 19

What is the Mirena IUS?

Answer 19

20ug of levonorgesterol released per day

Inhibits cervical implantation and thickens cervical mucous

Question 20

What are the 2 hormonal emergency contraception?

Answer 20

1500mcg progesterone pill - 72 hours after intercourse
prevents ovulation and implantation
EllaOne - 30mg up to 120 hours after intercourse

Question 21

What is the emergency copper IUCD?

Answer 21

Used up to 5 days post intercourse
Prevents implantation
Then used long term

Question 22

What is the male permanent contraception?

Answer 22

Vasectomy
Highly effective
Poor uptake
Complication - sperm granulosas and chronic pain
No increase in testicular or prostate cancer

Question 23

What is the female permanent contraception?

Answer 23

Laproscopic tubal occlusion
Mini laparotomy
Hysteroscoptic tubal occlusion