Contraception

Question 1

What contraception shouldn’t be used in women with IBD?

Answer 1

OCP as malabsorption may occur

Question 2

What contraception should be used in breastfeeding women?

Answer 2

Progesterone-only methods
COCP affects breast milk volume
IUD can be inserted 4 weeks post partum

Question 3

What contraception should be used in later life?

Answer 3

Continue 2 years after last period if less than 50
Continue 1 year after last period if older than 50
Can use COCP if none smoker
IUD, IUS

Question 4

What hormonal contraception exist?

Answer 4

POP - mini pill
Depot
CHC - COC, transdermal, vagina ring

Question 5

How does the COCP act?

Answer 5

Negative feedback on gonadotrophin release
Inhibits ovulation
Thins endometrium and thickens cervical mucus

Question 6

What are the different oestrogens the COCP contains?

Answer 6

Ethinyloestradiol - monophasic

Oestradiol valerate - Qlaira
4 phases of dose over 26 days and 2 pill-free days
Better for lipids, migraines and mood swings

Question 7

What is the failure rate of COCP?

Answer 7

0.2/100 woman years

Question 8

What are indications for COCP?

Answer 8

Menorrhagia
Pre-menstrual symptoms
Dysmenorrhoea
Acne/hirsutism
Prevention of simple ovarian cysts

Question 9

When should missed pill instructions be followed?

Answer 9

Diarrhoea
Vomiting within 2hrs of taking the pill
Missing a pill in the last 7

Question 10

What are complications of COCP?

Answer 10

Venous thrombosis
Myocardial infarction
Cerebrovascular accidents
HTN
Cervical and breast carcinoma

Question 11

What are contraindications for the COCP?

Answer 11

BMI>40

Age>35yrs and smokes >15 cigarettes

Question 12

What are side effects of the COCP?

Answer 12

Nausea
Headchaes
Breast tenderness
Suppresses lactation

Change to more potent progesterone

Question 13

How should the POP be taken?

Answer 13

Every day without break

At same time +/- 3 hrs

Question 14

How does the POP work?

Answer 14

Makes cervical mucus hostile to sperm

In 50% women inhibits ovulation

Question 15

What is the failure rate of POP?

Answer 15

1/100 woman years

Question 16

What are side effects of POP?

Answer 16

Breakthrough bleeding
Weight gain
Mastalgia
PMS
Functional ovarian cysts

Question 17

When is POP better than COCP?

Answer 17

Breastfeeding mothers
History of thrombosis
Antibiotic takers

Question 18

How is Cerazette different to other POPs?

Answer 18

Higher dose of progesterone
Inhibits ovulation in 95%
Can be taken in 12hr window

Question 19

What is the failure rate of the injection?

Question 20

What are side effects of the injection?

Answer 20

Irregular bleeding followed by amenorrhoea
Long return to fertility
Decreased bone density - regained after stopping

Question 21

What are contraindications for the injection?

Answer 21

Teenagers - peak bone mass hasn’t been acheived

Older women - osteoporosis

Question 22

What are indications for the injection?

Answer 22

During lactation

Question 23

What is the failure rate for the implant?

Question 24

What are side effects of the implant?

Answer 24

Irregular bleeding in first year
No drop in bone density
Easy removal
Rapid resumption of fertility

Question 25

What and when can emergency contraception be given?

Answer 25

Levonelle - single dose of levonorgesterel - within 72hr - can cause vomiting - 95% success rate Ulipristal (EllaOne) - selective progesterone receptor modualtor - prevents or delays ovulation - within 120hr - reduces effectiveness of progesterone containing contraceptions Copper IUD - prevents implantation - within 5 days after unprotected sex or expected day of ovulation - give antibiotic prophylaxis

Question 26

What is the failure rate of condoms?

Answer 26

2-15/100 woman years

Question 27

What is the failure rate of the diaphragm?

Answer 27

5/100 woman years

Question 28

How does the copper IUD work?

Answer 28

Copper is toxic to sperm | Blocks implantation

Question 29

How does the IUS work?

Answer 29

Changes cervical mucus Produced uterotubal fluid which impair sperm migration Reduces menstrual loss and pain

Question 30

What is the failure rate of the IUD?

Question 31

What are indications for IUD?

Answer 31

IUD can be inserted straight after termination, puerperium and during first half of cycle IUS can be used for menorrhagia or dysmenorrhoea

Question 32

What are complications of IUD?

Answer 32

``` Pain or cervical shock Expelled (within month 1) Perforation - at insertion or later Heavier/painful periods PID from previous STI Ectopic ```

Question 33

If threads of IUD have disappeared what do you do?

Answer 33

USS to look inside uterus | Abdo XR then laparoscopy

Question 34

What are contraindications to the IUD?

Answer 34

Endometrial or cervical cancer Active PID Breast cancer (IUS) Pregnancy Previous ectopic Nulliparity

Question 35

What methods are available for female sterilisation?

Answer 35

Filshie clips - laparoscopy under GA Microinserts in proximal part of tubes

Question 36

What is the failure rate of female sterilisation?

Answer 36

0.5/100 woman years

Question 37

What are complications of female sterilisation?

Answer 37

Pain Ectopic pregnancy Reversal request

Question 38

How is male sterilisation done?

Answer 38

Ligation and removal of part of vas deferens Can be done under LA Sterility is confirmed by two semen analyses and may take up to 6 months

Question 39

What are complications of male sterilisation?

Answer 39

Failure Haematotoma Chronic pain