8- Contraception

Question 1

how are oestrogen and progesterone present in the COCP?

Answer 1

oestrogen as synthetic ethinyl oestrogen

progesterone as levonorgestrel (older). desogestrel or drospirenone (newer)

both given at supraphysiological levels - greater than normally present in the body

Question 2

mechanism of action of COCP pill

Answer 2

through oestrogen and progesterone actions:
- stops ovulation
- stops uterine tubes working efficiently
- thins endometrium
- doesn’t allow sperm in = thickening of cervical mucus

Question 3

benefits to COCP

Answer 3

-reliable, safe, unrelated to sex
-woman is in control, reversible

can help endometriosis, menorrhagia and dysmenorrhoea – thins uterus lining

Question 4

risks of COCP

Answer 4

cardiovascular – progesterone contributes to high BP, induces production of clotting factors increasing risk of thrombosis

neoplastic – higher risk of liver and breast cancers

GI – affects insulin metabolism, causes weight gain, affects hormone metabolism

skin – chloasma (pigmentation), acne

mood swings, depression, affects libido

can’t be taken with liver-enzyme inducing drugs, TB drugs, older anti-epileptics or broad-spectrum antibiotics – affects metabolization of hormones

Question 5

examples of POPs as progesterone only pills

Answer 5

devonogestrel and Cerelle are newer forms
levonorgestrel is an older form

Question 6

different forms of progesterone only treatment?

Answer 6

depo provera - injectable version

hormone releasing IUCD

implant inserted into the subcutaneous area above the embow

pill - e.g. Cerelle, devonogestrel

Question 7

examples of the two forms of IUCD

Answer 7

copper bearing - e.g. Ortho T280

hormone bearing - e.g. Minera, Kyleena

Question 8

contraceptive mechanism of action of a copper-bearing IUCD

Answer 8

destroys spermatozoa

prevents implantation by causing a local inflammatory reaction of the endometriosis

Question 9

how do diaphragm cups work as contraceptives?

Answer 9

latex-made cups that are used with spermicide and fit across the vagina

exist in different sizes

Question 10

how do cervical/ suction cups work as contraceptives?

Answer 10

plastic-made cups that suction to the cervix, used with spermicide

exist in different sizes

Question 11

how does fertility awareness work as a contraceptive?

Answer 11

predicts ovulation though a regular cycle is needed

periodic abstinence or contraception to avoid pregnancy, or find the right time to conceive using the menstrual cycle

using indications of ovulation given by the body: temperature rising, cervical mucus, detecting LH surge in urine to mark ovulation

Question 12

what are the three forms of emergency contraceptiom?

Answer 12

post-coital pills - e.g. Levonelle, ellaOne, Schearing PC4

copper bearing IUCDs

hormonal medication

Question 13

describe postcoital pills as emergency contraception

Answer 13

taken within 72 hours of unprotected sex - postpone ovulation or prevent implantation depending on what part of the cycle they’re taken

Question 14

give three examples of postcoital pills and their compositions/ roles as contraceptives

Answer 14

Levonelle, ellaOne, Schearing PC4

Levonelle = 2 pills with 750ug levonorgestrel

Schearing PC4 = 250ug levonorgestrel, 50ug ethinylestradiol

ellaOne = selective progesterone receptor inhibitor

Question 15

compare Schearing PC4 and Levonelle

Answer 15

both have a lower failure rate within the first 24 hours

Schearing causes nausea and vomiting, Levonelle doesn’t

Schearing is contraindicated during focal migraine attacks, Levonelle is contradicted with liver-enzyme or anti-TB meds

Question 16

what is an IUS?

Answer 16

an intrauterine system

a small plastic device inserted into the uterus that releases progesterone - thickens cervical mucus.

e.g. Mirena