Contraception

Question 1

What types of contraception are available?

Answer 1

• Non-hormonal (barrier methods)
• Hormonal
• Surgical interventions

Question 2

What are permanet contraceptive approaches?

Answer 2

• Steralisation

1. Male - Vasectomy
2. Female - Surgery

Question 3

What are non-hormonal contraceptives?

Answer 3

• Behavioural methods (highest failure rate)
• Barrier methods:
  1. Condoms
  2. Diaphragms
• Copper-bearing IUD
• Heat/pH treatments (modulators)

Question 4

What are hormonal contraceptives?

Answer 4

Two main types:

1. Combined pill:
   * Combo of Oestrogen and progesterone
2. Progesterone only pill (mini pill)
   * Taken daily
   * Weekly transdermal pathch
   * Monthly faginal ring

Question 5

Explain the combined pill

Answer 5

• Taken for 21 days with 7 days placebo
• Contains Oestrogen
  1. E.g. Mestranol
  2. 50 ug is optimum
  3. Can reduce to 20-35
  4. Inhibits FSH release, suppresses dev of ovarian follicle
• Contains Progesterone
  1. E.g. Gestodene
  2. Prevents LH surge to inhib ovulation
  3. Alters cervical mucous to make sperm passage less likely
• Both alter lining of endothelium to prev implantation
• At day 22 removal of progesterone triggers mensturation

Question 6

What is the mini pill?

Answer 6

• Can have breakthrough bleeding
• Can be taken every day without breaks
• Does not affect lactation
• Less evidence of link to breast cancer - (combined pill inc risk once stopped)

Question 7

What is the mechanism of oral contraceptives?

Answer 7

• Manipulate menstural cycle
• FSH and LH are needed to develop a mature follicle
• After which progesterone and Oestrogen levels are high
• This action is mimicked by contaceptive pill
• Pills lie to gland and say women is already pregnant therefore no ovulation or conception

Question 8

What are the negatives of oral contaceptives?

Answer 8

• Weight gain
• Irregular bleeding
• Nausea
• Flushing
• Dizziness
• Skin changes
• Amenorrhea and loss of fertility
• POC linked with impairment of glucose tolerance

Question 9

What are some emergency contraceptives?

Answer 9

Morning after pill
* Oestrogen (100ug) and levonorgestrel (250ug)
* Can be taken within 72 hours of sexual intercourse
* Further dose 12 hours later
* E.g. Levonelle

Single dose of Mifepristone
* Can be taken 72 hours post sex

Question 10

What are some long term contraceptives?

Answer 10

Medroxyprogesterone
* Delivered intramuscularly
* Also as skin patches
* Adverse effects including menstural irregularities
* Short-term infertility can remain after removal

Levonorgestrel
* Impregnated IUD or subcutaneously
* Also used as emergency contraceptive
* Can be in place for 3-5 years
* Can cause irregular bleeding and headache

Question 11

What progress has been made in Male contraceptive

Answer 11

1. Vasectomy
   * Reversal is costly and not always successful
2. ** Testosterone and progesterone based hormonal drugs**
   * Transdermal gel
   * Phase II clinical trials
3. Kisseptin based HPT suppression
4. Thermal treatment
5. Adrenoreceptor antagonists
   * Unwanted side effects