Contraception 1&2

Question 1

What are the 2 types of pill?

Answer 1

Progesterone only pill (POP)
Combined oral contraceptive (COC)

Question 2

What is the mechanism of action of the pill?

Answer 2

Prevent fertilisation via inhibition of ovulation
Thickening of mucus (POP)
Decrease motility of uterus + fallopian tubes

Question 3

What are the advantages of COCs?

Answer 3

Reliable + reversible
Reduced dysmenorrhoea (painful periods) + menorrhagia (abnormal heavy bleeding)
Reduced incidence of premenstrual syndrome
Less symptomatic fibroids
Less benign breast disease
Decreased risk of ovarian + endometrial cancer
Decreased risk of PID

Question 4

What do most COCs contain?

Answer 4

Oestrogen ethinylestradiol

Question 5

What cautions with use is there for COCs?

Answer 5

Family history of VTE
Obesity
Long term immobilisation
>35 years + smoker
Smoking
Diabetes mellitis
HTN
Migraines

Question 6

What are the adverse effects of COCs?

Answer 6

Nausea
Abdominal pain
Breast pain
Menstrual irregularities
HTN
Weight gain
Mood changes

Question 7

What are the risks associated with COCs?

Answer 7

CVD + stroke
VTE
Breast cancer
Cervical cancer

Question 8

What are the drug interactions with COCs?

Answer 8

Antibiotics - Rifampicin
Antiepileptics - carbamazepine
Antiretroviral
St John’s Wort

Question 9

What are the reasons for stopping COCs?

Answer 9

Sudden severe chest pain
Sudden breathlessness
Unexplained swelling/severe pain in leg
Severe stomach pain
Serious neurological effects
Jaundice
Raised BP
Prolonged immobility after surgery

Question 10

What happens if you’ve missed COC up to 48hrs late?

Answer 10

Missed pill taken as soon as remember
Remaining pill continued at usual time
Emergency contraception NOT required

Question 11

What happens if you’ve missed COC more than 48hrs?

Answer 11

Most recent pill missed should be taken as soon as possible
Remaining pill should be continued as normal
Condoms used until 7 consecutive active pills taken

Question 12

How are POPs different?

Answer 12

Have higher failure rate
No pill free interval
Must be taken within 3hr window
Good for breast feeding
Fewer adverse reactions

Question 13

What are the adverse effects of POPs?

Answer 13

Menstrual irregularities
Breast tenderness
Ovarian cysts
Ectopic pregnancy
Increased risk of cancer

Question 14

What happens if you miss a POP?

Answer 14

Take pill as soon as you remember
Take next pill at usual time
Additional method of contraception

Question 15

What are the 3 emergency contraception available?

Answer 15

Cu-IUD
Levonelle
EllaOne

Question 16

What is the licensed use within for EllaOne?

Answer 16

120hrs

Question 17

What is the licensed use within for Levonelle?

Answer 17

72hrs

Question 18

What is the dose of EllaOne?

Answer 18

1 tablet with 120hrs

Question 19

What is the dose of Levonelle?

Answer 19

1 tablets within 72hrs

Question 20

When is EllaOne not recommended?

Answer 20

Taken CYP3A4 enzyme inducing medicine in last 4 weeks
People with severe asthma taking oral glucocorticoids
Weight over 70kg

Question 21

When is Levonelle not recommended?

Answer 21

Taken CYP3A4 enzyme inducing medicine in last 4 weeks
Severe malabsorption syndrome
Less effective in over 70kg

Question 22

Can breast feeding be continued with EllaOne?

Answer 22

NO = have to wait a week

Question 23

Can breast feeding be continued with Levonelle?

Answer 23

YES

Question 24

When do you repeat doses of emergency contraception?

Answer 24

Vomiting occurs within 3hrs of taking tablet

Question 25

When do you continue oral contraceptives after emergency contraceptive?

Answer 25

Levonelle = continue normally
EllaOne = should not be restarted until 5 days after