Contraception

Question 1

what are natural/surgical methods of contraception?

Answer 1

• male and female condoms
• caps and diaphragms
• sterilisation
• vasectomy
• natural family planning

Question 2

what are hormonal contraception?

Answer 2

• combined oral contraceptives
• progesterone only pill
• transdermal patch
• implant
  -injection
• IUD
• IUS
  -EHC

Question 3

how long is the combined pill taken for ?

Answer 3

3 weeks then have one week break

Question 4

what pill is recommended post partum?

Answer 4

progesterone only

Question 5

how often is the vaginal ring replaced?

Answer 5

every 4 weeks (worn for 3 follows by a week off)

Question 6

what may affect absorption of contraceptive patch

Answer 6

if person is sweating or unwell

Question 7

what does the implant contain?

Answer 7

progesterone

Question 8

what hormone does the injection have?

Answer 8

progesterone

Question 9

how often do people get the injection

Answer 9

8, 12 or 13

Question 10

how long can it take for ovulation to return after injection?

Answer 10

up to 15 months

Question 11

What is IUS

Answer 11

small T shaped plastic device that contains progesterone which lasts 3-5 years

Question 12

what is the IUD

Answer 12

• similar to IUS but does not release hormones it releases copper into the womb and can stop a fertilised egg from implanting (lasts 5-10 years)
• acts as a spermicide (prevents sperm reaching egg)

Question 13

what does monophasic mean?

Answer 13

fixed amount of oestrogen and progesterone in each tablet

Question 14

what is phasics

Answer 14

varying amounts of the two hormones

Question 15

how do combined oral contraceptives work?

Answer 15

inhibition of ovulation
effects on endometrium
effect on cervical mucus

Question 16

what percentage of woman still ovulate on progesterone only pill?

Answer 16

60%

Question 17

what are methods of failure of contraception?

Answer 17

patient failure
method failure
episode of vomiting/diarrhoea
drug interactions

Question 18

what is the EHC options available?

Answer 18

Levonorgestrel 1.5mg tablet
Ulipristal 30 mg tablet

Question 19

what is the fraser guidelines?

Answer 19

giving advice on contraception to a young person under the age of 16 without parental consent

Question 20

what are things to consider before supply of EHC

Answer 20

how long since
how old are they
other medications (enzyme inducers eg anti-epilepic drugs interact with EHC so a double dose may be required)
any other medical conditions

Question 21

how long is levonelle and ella one effective for?

Answer 21

levonelle - 3 days
ella one - 5 days

Question 22

what happens if vomiting occurs within 2 hours of taking contraceptive?

Answer 22

take another dose

Question 23

what effect can contraceptive have on menstural cycle?

Answer 23

can be early or late

Question 24

when must contraceptive be taken?

Answer 24

before ovulation, if patient has already ovulated then copper coil has to be inserted

Question 25

how many levonelle are required?

Answer 25

1 or 2 tabs if over 70kg

Question 26

what’s the minimum age to sell contraceptive as a P

Answer 26

16

Question 27

what should the patient do if they have been given ella one and they already take progesterone only pill?

Answer 27

should wait 5 days until taking progesterone only pill to prevent interaction

Question 28

when is progesterone secreted?

Answer 28

luteal phase and makes the endothelium suitable for implantation of the fertilised egg

Question 29

what happens in the follicular phase of the menstrual cycle

Answer 29

- secretion of gonadotrophin - releasing hormones from hypothalamus which causes stimulation of anterior pituitary and release of gonadotrophic hormones - development of the graafian follicle which contains an ovum and secretes oestrogen

Question 30

what is oestrogen responsible for in the follicular phase?

Answer 30

regeneration of the endometrium

Question 31

what does high oestrogen secretion before mid-cycle of the follicular cycle cause?

Answer 31

- sensation of LH releasing cells to the action of the GnRH - Mid-cycle increase of LH secretion - Rupture of the graafian follicle - ovulation

Question 32

what happens during the luteal phase of the menstrual cycle

Answer 32

-Stimulation of LH - formation of corpus luteum from ruptured follicle, which produces progesterone and estrogen - progesterone makes the endometrium suitable for implantation of fertilised ovum - negative feedback exerted by progesterone on hypothalamus and pituitary - decrease in release of LH

Question 33

what happens when there is a fall in oestrogen and progesterone?

Answer 33

- stimulation of the degeneration of the endometrium - menstruation

Question 34

where does synthesis of oestrogens occur?

Answer 34

ovaries and placenta

Question 35

what is the starting substance of oestrogens?

Answer 35

cholesterol

Question 36

what are the main oestrogens?

Answer 36

-oestradiol - oestrome -oestriol

Question 37

what is progestogens secreted by?

Answer 37

corpus luteum and placenta

Question 38

what is the starting substance of progestogens?

Answer 38

cholesterol

Question 39

what is the mode of action of oestrogen and progestogen?

Answer 39

oestrogen: inhibition of the secretion of FSH - suppression of the development of the ovarian follicle Progestogen: inhibition of the secretion of Lh - inhibition of ovulation and thickening of the cervical mucus thinning of the endometrium caused prevention of fertilised ovum

Question 41

advantages of the contraceptive pill

Answer 41

- chemical, physical and microbiological stability - accurate dosing - convenient route - reliable - reversible

Question 42

what are disadvantages of contraceptive pill?

Answer 42

problem of poor bioavailability of natural oestrogens and progestogens due to unfavourable drug properties

Question 43

what’s an advantage of progesterone only pill?

Answer 43

- used by mestruators with contra-indications to the combined pill

Question 44

what is a disadvantage of progestogen only pill?

Answer 44

action mainly on alteration of cervical mucus ovulation is inhibited in about 60% of cycles less reliable than combined

Question 45

what is an advantage of suspensions?

Answer 45

- slow release and long lasting effect - avoidance of first pass - accurate dosing of drug - very effective and convenient - can be used during breast feeding

Question 46

what are disadvantages of suspension for injection?

Answer 46

delayed return of fertility risk of weight gain (up to 3kg in one year)

Question 47

what are advantages of the patch?

Answer 47

- slow release and long lasting effect - avoidance of first pass - accurate dosing - oestrogen level remains steady without peak or fluctuation

Question 48

what are disadvantages of the patch?

Answer 48

both components are lipophillic - absorption affected by the adiposity of the skin

Question 49

what are advantages of the implant?

Answer 49

slow release and long lasting avoids first pass very effective and convenient reversible

Question 50

what are disadvantages of the implant?

Answer 50

local reaction: bruising, itching weight gain headache and acne

Question 51

what are advantages of vaginal ring?

Answer 51

slow release and long lasting effects avoids first pass

Question 52

what is a disadvantage of vaginal ring?

Answer 52

discomfort

Question 53

where is the drug from intra-uterine device delivered to?

Answer 53

uterine cavity

Question 54

what are advantages of intra-uterine administration?

Answer 54

- local contraception - rapid return to fertility - very effective and convenient - reduces blood loss and dysmenorrhea - does not significantly interact with other drugs

Question 55

what are disadvantages of intra-uterine administration?

Answer 55

- menstural irregularities - progestogenic side effects - need for fitting