5.1 + 5.2 Contraception basics + Barrier methods

Question 1

What are the key contraceptive methods available?

Answer 1

• Natural family planning (“rhythm method”)
• Barrier methods (i.e. condoms)
• Combined contraceptive pills
• Progesterone only pills
• Coils (i.e. copper coil or Mirena)
• Progesterone injection
• Progesterone implant
• Surgery (i.e. sterilisation or vasectomy)

Emergency contraception is also available after unprotected sex but should not be relied on regularly.

Question 2

What is the criteria called that categorises an individuals risk to each contraceptive method?

Answer 2

Faculty of Sexual & Reproductive Healthcare (FSRH) has:

UK Medical Eligibility Criteria (UKMEC)

Question 3

What are the four levels in UKMEC?

Answer 3

UKMEC 1: No restriction in use (minimal risk)

UKMEC 2: Benefits generally outweigh the risks

UKMEC 3: Risks generally outweigh the benefits

UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)

Question 4

What is the FSRH UKMEC guideline on the effectiveness natural family planning and condoms?

Answer 4

Natural family planning:
Perfect: 95-99.6%
Typical: 76%

Condoms:
Perfect: 98%
Typical: 82%

Question 5

What is the FSRH UKMEC guideline on the effectiveness COCP and progestogen-only pill?

Answer 5

COCP:
Perfect: >99%
Typical: 91%

Progestogen-only:
Perfect: >99%
Typical: 91%

Question 6

What is the FSRH UKMEC guideline on the effectiveness the progesteron-only injection and progestogen-only implant?

Answer 6

Progesteron-only injection:
Perfect: >99%
Typical: 94%

Progestogen-only implant:
Perfect: >99%
Typical: >99%

Question 7

What is the FSRH UKMEC guideline on the effectiveness coils (Mirena or copper) and surgery (sterilisation / vasectomy)?

Answer 7

Coils:
Perfect: >99%
Typical: >99%

Surgery:
Perfect: >99%
Typical: >99%

Question 8

What factors mena you should avoid the COCP (UKMEC 4)?

Answer 8

• Uncontrolled hypertension (particularly ≥160 / ≥100)
• Migraine with aura
• History of VTE
• Aged over 35 smoking more than 15 cigarettes per day
• Major surgery with prolonged immobility
• Vascular disease or stroke
• Ischaemic heart disease, cardiomyopathy or atrial fibrillation
• Liver cirrhosis and liver tumours
• Systemic lupus erythematosus and antiphospholipid syndrome

Question 9

In older women, how long after the last period is contraception required?

Answer 9

After the last period, contraception is required for 2 years in women under 50 and 1 year in women over 50

Question 10

In older women, can HRT be contraceptive?

Answer 10

HRT does not prevent pregnancy, and added contraception is required

Question 11

In older women, until what age can COCP be used?

Answer 11

COCP up to age 50 years, and can treat perimenopausal symptoms

Question 12

In older women, when should progesterone injection stop and why?

Answer 12

The progesterone injection (i.e. Depo-Provera) should be stopped before 50 years due to the risk of osteoporosis

Question 13

In older women that are amenorrhoeic, how long should they take continue their progesterone-only contraception?

Answer 13

Continue until:

• FSH >30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year) or
• 55 years of age

Question 14

Things to consider when choosing each contraception method for under 20s?

Answer 14

• progestogen-only injection is UKMEC 2 due to bone mineral density concerns whilst growing
• coils are UKMEC 2 as they have higher rate of expulsion
• progestogen-only implant is good choice of LARC
• COCP and progestegen-only pills unaffected by age

Question 15

After childbirth when does fertility return?

Answer 15

Fertility returns at 21 days, need to then use condoms 7days (COCP) or 2days (progesterone only pill)

Question 16

How long can lactational amenorrhea be a contraceptive for?

Answer 16

Up to 6 months:

• 98% effective
• must fully breastfeed incl nighttime
• must be amenorrhoeic

Question 17

Things to consider when choosing each contraception method for women after childbirth?

Answer 17

• COCP should avoid in breastfeeding / VTE risk (UKMEC 4 before 6 weeks; UKMEC 2 between 6 weeks and 6 months which is ok to start)
• LARC (Mirena or copper) can be inserted within 48hrs or after 4 weeks (UKMEC 1 but UKMEC 4 if between those times)
• progestogen-only pill and implant are considered safe and can be started at any time

Question 18

What are the different barrier methods?

Answer 18

Condoms
Diaphragms and cervical caps
Dental dams

(contraception and some STI protection)

Question 19

Effectiveness and use of condoms?

Answer 19

98% but 82% with typical use.
Oil-based lube damaged latex, use water-based.

Polyurethane condoms for latex allergy.

Question 20

Effectiveness and use of diaphragms and cervical caps?

Answer 20

Perfect use is 95% effective:

• leave in for 6 hours after sex
• use with spermicide
• little STI protection

Question 21

What infections can dental dams protect you from?

Answer 21

Mouth to: vulva, vagina, anus

Chlamydia
Gonorrhoea
Herpes simplex 1 and 2
HPV (human papillomavirus)
E. coli
Pubic lice
Syphilis
HIV