Contraception

Question 1

• Withdrawal: adv, dis
• Fertility awareness: adv, dis
• Barrier: adv, dis

Question 2

COCP:

• Main action
• Adv vs dis (contraind, SE)
• Indications
• contraindications

Answer 2

COCP:

• Main action : inhibits ovulation. if started after day 5 need 7 days of contracep
• Adv vs dis (SE)
  Adv: dec risk ovarian/endomet ca/colorectal ca
  Dis: vte, inc risk cvs, inc risk breast/cervical cancer
• Indications : painful periods, acne
• contraindications: 4 weeks before surgery (unless minor surgery with short duration anaesthesia), hx dvt, migraine with aura, hx stroke/ihd, >35 + >15 cigs day, breast feeding <6 weeks pp, + antiphospholipid syndrome, uncontrolled htn, breast cancer. Relative: bmi >35, fx dvt <45, immobility, gb disease
• missed pills: if missed 1 ok. if missed 2 use condoms for 7 days of taking the pill take emergency contacep in week 1, or if in week 3 omit pill free period

Question 3

POP:

• Main action
• Adv vs dis (SE)
• Contraindications
• Missed pill

Answer 3

POP:

• Main action: takes 2 days to work (less started on day 1-5)!! thickens cervical mucus
• Adv vs dis (SE)
  Dis: irreg bleeding, inc risk ectopic, strict timing, acne/breast tender/dry vagina
• Contraindications: breast cancer, liver disease, unexp bleeding
• Missed pill
  if traditional pop like noriday/micronor then if >3 hours take missed pill + take next one normal time + contracep 48 hours
  If cerazette (desogestrel) if >12 hours do the same

Question 4

Progesterone injection:

• Main action
• Adv vs dis (SE)
• Contraindications

Answer 4

Progesterone injection (depo provera)

• Main action: given every 12 weeks, inhibits ovulation
• Adv vs dis (SE)
  Adv: travelling, can be used if raised bmi
  Dis: delayed fertility up to 12 months, irregular bleeding, weight gain, inc risk osteoporosis
• Contraindications: breast cancer

Question 5

Progesterone implant (nexplanon):

• Main action
• Adv vs dis (SE)
• Contraindications

Answer 5

Progesterone implant:

• Main action: prevents ovulation
• Adv vs dis (SE)
  Adv: lasts 3 years, can be inserted immediately after abortion
  Dis: need contracep for 7 days if not inserted on day 1-5, irreg bleeding (can give 3 months of cocp), headache/nausea/breast pain, interacts with inducers antiepilpeitcs/rifampicin
• Contraindications: breast cancer, ihd/stroke, vaginal bleeding, liver cirrhosis/ca

Question 6

Coil

• Main action IUS vs IUD
• Adv vs dis (SE)
• Contraindications

Answer 6

Coil

• Main action IUS vs IUD: iud (5 years) toxic to sperm so dec motility + survival. IUS 5 years) prevents implantation via stopping endometrial proliferation
• Adv vs dis (SE)
  IUS: initial bleeding/spotting then intermittent light periods
  IUD: can cause bleeding
  Dis: perforation, ectopic, infection, expulsion
• Contraindications: pelvic issues, unexplained bleeding

Question 7

Emergency contraception:

• Types (3) + mechanism of actions + timing

Answer 7

• levonorgestrel: within 72 hours. double dose if >70kg/bmi >26/enzyme inducing drugs. Repeat if vomit within 3 hours. Then start hormonal contraception immediately.
• ulipristal (ellaone): inhibits ovulation. Within 120 hours. Careful is asthma, Delay breastfeeding for 1 week. Reduces effectiveness of hormonal contraception so restart after 5 days
• IUD most effective, within 5 days (or within 5 days post ovulation) with prophylactic abx if high risk sti.

Question 8

Combined evra patch:

Answer 8

wear patch for 3 weeks changing weekly and then not during 4th week so can bleed. If patch off >48 hours need extra protection for 7 days if end of week 1 + 2 + 4 (not if 3)