Contraception

Question 1

Why use contraception?

Answer 1

• Able to control number of children
• Reduce need for TOP
• Women + girls more freedom of activity
• Reduce rate of STIs
• Manage menstrual Sx

Question 2

What is Gillick competency?

Answer 2

Child <16YO is able to consent to their own treatment if the clinician deems them competent (decision and time specific)

Question 3

COCP contains? MoA?

Answer 3

Oestrogen and progesterone

Suppress hypothalamo-pituitary-gonadal axis, prevent ovulation

Question 4

Pros COCP?

Answer 4

Reversible
Control menstrual Sx
Reduce endometrial and ovarian cancer incidence

Question 5

COCP cons?

Answer 5

Increased risk of VTE, MI.

Beware of interaction with other medication and liver disease

Question 6

Why may POP be prescribed as oppose to COCP?

Answer 6

Recently pregnant or breastfeeding

Age >35, obese, smoker, migraine with aura

Question 7

POP MoA?

Answer 7

Primary to thicken cervical mucous. Ovulation variable inhibited and endometrium thinned

Question 8

POP CI?

Answer 8

Active breast cancer, liver failure

Question 9

POP cons?

Answer 9

Dysfunctional bleeding
Unforgiving - small window must be taken in (3 hours)
Increase risk of breast cancer, ectopic pregnancy
Functional ovarian cysts

Question 10

Depot progesterone injection MoA?

Answer 10

Inhibits ovulation, thins endometrium, thickens cervical mucous

Question 11

Progesterone injection cons?

Answer 11

Small risk of bone mineral density decrease - need a DEXA scan if use >1 year.
Weight gain
Menstrual irregularities
Not quickly reversible

Question 12

Implant - contains and MoA?

Answer 12

Progesterone

Inhibits ovulation, thins endometrium, thickens cervical mucous

Question 13

Implant cons?

Answer 13

Irregular bleeding that can last a year (really common and really quite problematic)
Changes to weight, mood, libido

Question 14

Implants pros?

Answer 14

<0.1% failure
Long acting and easily reversible
Reduce menstrual problems

Question 15

IUCD (copper coil) MoA?

Answer 15

Fertilization inhibited by action of copper on egg and sperm
Endometrial inflammation inhibits implantation

Question 16

IUCD pros?

Answer 16

10 years and reversible

Avoids hormones risk

Question 17

IUCD cons?

Answer 17

Unpleasant insertion

Pain/bleeding - 6 months possibly - note very problematic

Question 18

What must you have before IUCD fitted?

Answer 18

STI - do not want chlamydia or gonorrhoea in the cervix being pushed into the uterus

Question 19

Mirena coil MoA?

Answer 19

Thin endometrium and prevents implantation. Thickens cervical mucous.

Question 20

IUCD pros and cons?

Answer 20

Similar to copper coil: lasts 5 years, reduce menstrual bleed
Risk of expulsion, pain and dysfunctional bleed up to 6 months, ectopic pregnancy, PID

Question 21

Why condom failure?

Answer 21

Split, fall off, fat soluble lubricant

Question 22

Problems with female sterilisation?

Answer 22

Irreversible on NHS, abdominal surgery risks, ectopic pregnancy

Question 23

Vas-ectomy problems?

Answer 23

Irreversible on NHS, not immediately effective, complications (failure, sperm granuloma, sperm antibodies, pain late recanalization)

Question 24

Cycle counting - what is the fertile window of a woman?

Answer 24

5 days prior to ovulation and one day following

Question 25

Give examples of emergency contraceptive methods?

Answer 25

Levonorgestrel
Ullipristal
Copper IUD

Question 26

What is key when giving emergency contraception?

Answer 26

When was the date of the last ovulation

Question 27

What is required to be referred infertile?

Answer 27

Been trying for pregnancy for 1 year and still been unable to become pregnant

Question 28

When is peak progesterone?

Answer 28

Always 7 days before the start of the next period

Question 29

How many days from the start of ovulation to menstruation?

Answer 29

14 days

Question 30

If have a uterus, what should not be used in conjunction with HRT and why?

Answer 30

Oestrogen as causes proliferation of the endometrium and increase the risk of endometrial cancer vastly