Contraception

Question 1

What is Pearl index?

Answer 1

Contraceptive effectiveness measurement.
Pearl Index= No of unintended pregnancies/ 100 women

The contraceptive methods with higher PI (Pearl Index) numbers are the **least effective **

Question 2

What type of reversible methods of contraception is there?

Answer 2

Condom, COC (combined orakl contraceptive pill), POP (progesterone pill), IUD, injections, implants and IUS (intrauterine system)

Question 3

What types of irreversible methods is there?

Answer 3

Tubal ligation (female sterilisation) and vasectomy (males can be reversed but longer time passes less likely to be successful)

Question 4

What barrier methods are there for females?

Answer 4

Female condoms and cervical cap or diaphragm (small rubber devices that cover cervix + block sperm physically + w chems) which do not protect against STIs.

Question 5

How does combined pills work? Side effects?

Answer 5

Oestrogen and progesterone which acts on hypothalamic-pituitary axis which inhibits FSH and LH taken for 21 days with a 1 week break.

Side effects include breast cancer, heart attack and venous thromboembolism

Question 6

how does the progesterone only pill work? What are the side effects?

Answer 6

aka POP (progesterone only pill)
Taken when contradiction for oestrogen present.

• Functions by stopping ovulation
• Thickens mucus and degrades endometrium= prevents sperm from swimming past cervix
• Can cause ectopic pregnancy
• Pain in period
• Irregular bleeding
• Acne
• Breast pain

Question 7

What are the side effects of injectables and implants?

Answer 7

Cause weight gain
Loss of fertility up to a year after stopping

Question 8

What are the side effects of copper IUDs?

Answer 8

Copper is very effective but causes chance of ectopic pregnancy and increased menstrual loss, but there is no delay in return of fertility

Question 9

What can progesterone IUds cause?

Answer 9

Irregular bleeding
Fibroids {are non-cancerous growths that develop in or around the womb (uterus)}

Question 10

What are the contra-indications for IUD?

Answer 10

STI, pregnancy, carcinoma, copper allergy, previous ectopic pregnancy

optimum time to fit an IUD is during the 1st hald of the menstrual cycle. Absolute contraindications to IUD use include the presence of active pelvic inflammatory disease, undiagnosed irregular bleeding, a history of ectopic pregnancy or tubal surgery, and a distorted uteine cavity.

Question 11

What must be done before sterilization?

Answer 11

• Counselling exploring alternative methods.
• Make the patient aware of failures and the deemed irreversible nature of the operation.
• Risk of ectopic pregnancy in women,
• If post-partum sterilization, couple must accept 1st year of life is dangerous to the infant.
• Anesthesia and surgical complications.

Question 12

How do you make sure a man is sterile post vasectomy?

Answer 12

2 sperm free specimens performed after a minimum of 12 post op ejaculations.

Question 13

What types of emergency contraception are there?

Answer 13

Hormonal taken 72 hours after intercourse (emergency contraception which can be 1) ulipristal acetate {progesterone antagonist}}, 2) progestin-only pills{thickens cervical mucus}, and 3) combined EC pills {stops ovulation})
Cu-IUD up to 5 days

Question 14

what is spermicide?

Answer 14

Spermicide is a type of contraceptive that kills sperm or stops it from moving. The spermicide licensed in the UK is Gygel®, a surfactant that dissolves lipids in the sperm cell membrane, thus kills the sperms

n.b. Spermicides can be irritant to the vaginal tissue and can lead to urinary tract infections

Question 15

how does the hormonal ring work

Answer 15

progesterone + oestrogen releasing ring inserted deep into vagina (up against cervix)

stopping your ovaries from releasing an egg each month. It also thickens the fluid around the cervix (opening to the uterus or womb). This helps to prevent the sperm from entering.

Question 16

how does contraceptive implant work?

Answer 16

99% effective, small flexible plastic rod fitted under skin on upper arm; it releases progesterone into bloodstream + prevents pregnancy as stops ovulation (once fitted u can have for 3 years)

Question 17

how does the hormonal IUS coil work. What is the difference between IUS and IUD

Answer 17

An IUS prevents pregnancy by releasing progestogen which: prevents you from releasing an egg (ovulating) makes it difficult for sperm to get to an egg. thins the womb lining, so there’s less chance an egg will attach to it

These T-shaped devices have the same goal; to prevent unwanted pregnancy; however, they differ largely in the way in which they prevent pregnancy. To prevent pregnancy: The IUS releases the hormone progestogen. The IUD releases copper that creates a reaction toxic to sperm and eggs.

Question 18

define the following
* dysmenorrhoea
*menorrhagia

Answer 18

dysmenorrhoea= is defined as pain during the menstrual cycle. The pain is usually located in the lower abdomen and may radiate to the inner thighs and back. It is a very common gynecologic problem and can negatively impact a patient’s life

menorrhagia= abnormally heavy menstrual bleeding

Question 19

How reliable is the withdrawal contraceptive method in a typical use?

Answer 19

It typically works 78 percent of the time

Question 20

How many ejaculations does it generally take for a man’s vas deferens to be free of sperm after a vasectomy?

Answer 20

After a vasectomy, it typically takes up to 16 ejaculations for a man’s vas deferens to be free of sperm. However, it’s important to note that the exact number of ejaculations required can vary from person to person.

Question 21

what is the difference between monophasic, biphasic and triphasic birth control pills

Answer 21

Monophasic birth control pills have the same amount of oestrogen and progestin in each active pill in the pill pack

Biphasic birth control pills change the level of hormones one time during the pill pack. Biphasic birth control pills deliver the same amount of oestrogen each day, but the level of progestin is increased about halfway through the pill cycle.

Triphasic birth control pills (i.e., Ortho Tri-Cyclen®) contain three different doses of hormones so the hormone combination changes approximately every seven days throughout the pill pack.

Question 22

what is first-pass metabolism (pharmacology)

Answer 22

is the phenomenon which occurs whenever the drug is administered orally, enters the liver, and suffers extensive biotransformation to such an extent that the bioavailability is drastically reduced, thus showing subtherapeutic action

Question 23

who cannot use combined birth control?

Answer 23

Anyone whose condition meets UKMEC3 or above.
UKMEC is UK Medical Eligibility Criteria for Contraceptive Use:
*BMI over 30
*history of stroke/MI/venous thromboembolism
*smoking
=u basically weigh all factors up and see if benefits outweigh risks

UKMEC 3 – the risks generally outweigh the benefits.

Question 24

what are the 3 ways in which combined contraceptive pill prevents pregnancy?

Answer 24

3 ways in which combined contraceptive pill prevents pregnancy
*It thickens mucus at the opening of the uterus so it is harder for sperm to penetrate
*It prevents the ovaries releasing eggs
*It changes the lining of the uterus so a fertilised egg is less likely to implant and survive

Question 25

For menopausal women aged over 50, when is it safe to stop using contraception?

Answer 25

12 months after last period