Contraception

Question 1

Counselling patient on contraception: outline?

Answer 1

1) options
2) Suitability (contraindications and risks)
3) Effectiveness
4) Mechanism of action
5) Instruction on use

Question 2

Counselling patient on contraception: options?

Answer 2

1) Natural family planning (“rhythm method”)
2) Barrier methods (condoms)
3) Coils (i.e. copper coil or Mirena)
5) COCP
6) POP
7) Progestogen injection
8) Progestogen implant
9) Surgery (i.e. sterilisation or vasectomy

Question 3

Counselling patient on contraception: suitability?

Answer 3

CI:

1) brest cancer - avoid hormonal
2) cervical/endometrial - avoid IUS (Mirena)
3) Wilsons disease - avoid copper

COCP RF:
1) prev. VTE
2) migraines - aura?
3) hypertension - control?
4) smoking - >15/day?
5) surgery/ prolonged immobility
Screen disease: 
- stroke, 
- ischaemic HD, atrial fibrillation, cardiomyopathy
- liver cirrhosis/tumour
- SLE, anti-phospholipid syndrome

Question 4

Contraception after childbirth?

Answer 4

After 21 days women are considered fertile, and will need contraception (including condoms for 7 days when starting the combined pill or 2 days for the progestogen-only pill).

1) lactational amenorrhoea - 98% for 6mnths if amenorrhoea + fully breastfeed
2) POP/implant - anytim time after birth
3) coils (copper/mirena) - either before 48hrs after birth or after 4 weeks

Avoid COCP in breastfeeding

Question 5

Starting POP?

Answer 5

if commenced up to and including day 5 of the cycle it provides immediate protection, otherwise additional contraceptive methods (e.g. condoms) should be used for the first 2 days (crevical mucus thickens)

Question 6

Starting COCP?

Answer 6

if not taken on day 1-5 then need additional contraception for 7 days (inhibits ovulation)

Question 7

SE of POP?

Answer 7

The bleeding pattern that a woman will experience with progestogen-only contraception (the pill, implant or injection) is unpredictable. To make it simple to remember I round the risks into thirds, with a third having lighter, less regular or no bleeding, a third having normal bleeding and a third having unscheduled, heavier or more prolonged bleeding. It is not possible to predict how individuals will respond. Irregular or troublesome bleeding often settles after three months, so it may be worth persisting.

Question 8

Potential harms/risks of COCP?

Answer 8

• > 99% effective if taken correctly (91% typical use)
• small risk of blood clots
• very small risk of heart attacks and strokes
• increased risk of BREAST cancer and CERVICAL cancer

Question 9

Which contraceptives inhibit ovulation?

Answer 9

1) Injection (medroxyprogesterone acetate)
2) implantable contraceptive (etonogestrel)
3) levonorgestrel (as an emergency contraceptive)
4) ulipristal (as an emergency contraceptive)
5) desogestrel-only pill
6) COCP

Question 10

mechanism of action of cocp?

Answer 10

Inhibits ovulation

Question 11

mechanism of action of POP (excl. desogesterol)?

Answer 11

thickens cervical mucus lining

Question 12

MOA of coils?

Answer 12

IUD (copper coil) = Decreases sperm motility and survival

IUS (Mirena) = Prevents endometrial proliferation

Question 13

time until effective: after 7 days (if not started on 1st day of menstrual cycle)?

Answer 13

• COCP
• IUS (Mirena)
• depo provera
• nexplanon (implant)