Birth Control (1)

Question 1

What is included in Natural Family Planning?

What are Condoms made of? Who should avoid the use of it
→ The use of what can make it more likely to tear?
→ How does it affect risk of STI?

What are the types of Caps/Diaphragms?
→ What’s important to use with these?
→ How does it affect risk of STI?

Answer 1

• • Temperature - raised after ovulation
  • Cervical position and mucous consistency - thinner mucous during ovulation
  • LH testing - detection of ovulation
  • Lactational Amenorrhea - prolactin during breastfeeding inhibits menstrual cycle
• Latex - avoid in those with latex allergy
  → Oil-based lubricants
  → Good protection against STIs
• Diaphragm (Vaginal) Caps made of Latex; Suction (Cervical) Caps made of Plastic
  → Spermicide and leave in at least 6 hours after sex
  → Little protection against STIs, so Condoms still needed

Question 2

Combined Oral Contraption (COCP):
What does Oestrogen act on?

What does Progestogerone act on?

What is the COCP Protocol?

What are the benefits?

What are the risks?

Answer 2

• Anterior Pituitary, Hypothalamus, as well as Ovary and Endometrium
• Anterior Pituitary, Hypothalamus, as well as Endometrium, Uterine tubes, and Cervical mucous
• • 1st pill taken on 1st day of Menstrual period
  • 21 pills, 7 day break (Pill Free Interval), Restart on new packet
  o If pill wasn’t taken within 1st 7 days, depend on other forms of contraception
  o If pill wasn’t taken within last 7 days, skip the Pill Free Interval
• • Extremely effective and Fertility returns as soon as it’s stopped
  • Helps Endometriosis, Premenstrual symptoms, Dysmenorrhea, and Menorrhagia
  • Reduces risk of Ovarian and Endometrial cancer
• • Random bleeding - Very common and should settle over time
  • Cardiovascular - HTN, VTE
  o Risk of VTE is still much higher with Pregnancy
  • Neoplastic - Breast, Cervical, Liver cancer
  • Psychological effects - Mood swings, Depression, Libido
  • GI, Hepatic, Dermatological disease

Question 3

Progestogen Only Methods:
What does include?

What are the characteristics?

Answer 3

• Pills (POP), Implants, IUDs, Injections
• • As effective and predictable as COCP
  • New generation POPs - Favourable side effect profile, Less CI’s due to no Oestrogens
  • 12-hr window vs 3-hr window for COCPs

Question 4

_Intrauterine Devices (IUD):_
What are the types and how does it work?

What are the advantages of it?

What are the disadvantages of it?

What are the risks with this?

What are its Absolute contraindications?

Answer 4

• • Copper bearing/Hormone bearing, inserted and left in Uterus long term - Long-acting reversible contraception
  • Destroy spermatozoa and Prevent implantation (mechanical interference, inflammatory reaction, and prostaglandin secretion)
• • Extremely effective and Fertility returns as soon as it’s stopped
  • Long-term option, Works as emergency contraception
• • Can cause Pain and Discomfort on insertion
  • Heavier, more painful periods
  • Offers little protection against STIs
• • Miscarriage if left in during pregnancy
  • Increased risk of Ectopic pregnancy
  • May be expelled or may perforate Uterus (rare)
• Current Pelvic inflammatory disease, Suspected/Known pregnancy, Unexplained Vaginal bleeding, Abnormal cervical/uterine anatomy

Question 5

Emergency Contraception:
What is UPSI?

What is the usual option used?

What is the other option?

Answer 5

• Unprotected Sexual Intercourse
• Copper-bearing IUD - up to 120 hours after UPSI or after presumed ovulation - Very low failure rate - Kills sperm and prevents implantation in Luteal phase
• Post-coital pill (Oestrogen or Progestogen-based) - Up to 72-120 hours after UPSI - 1-1.7% failure rate - Postpones ovulation by lengthening Follicular phase