Contraception

Question 1

What is the pearl index?

Answer 1

Number of unintended pregnancies/100 women for years of use. For example, if 4 women out of 100 get pregnant in 1 year, the PI is 4.0

Question 2

What does a high pearl index indicate?

Answer 2

The higher the pearl index, the less effective the contraception

Question 3

Describe the mode of action of the combined oral contraceptive pill

Answer 3

Oestrogen (EE2) works to inhibit secretion of FSH resulting anovulation (no ovulation) and progestogen works to inhibit LH secretion, resulting in anovulation, changes cervical mucus to interfere with sperm transport, reduces tube motility, shrinks the endometrium and altering so uterine receptivity

Question 4

What are the absolute contraindications of the combined pill?

Answer 4

• IHD
• Arterial/venous thrombosis
• Stroke
• Hyperlipidaemia
• Focal migraine with aura
• Liver disease
• Pregnancy
• Oestrogen-dependent tumours

Question 5

What are the relative contraindications of the combined pill?

Answer 5

• Risk of arterial disease e.g. Increased BP
• Gall stones
• Smoking
• Over 35
• Obesity
• Varicose veins
• Migraine without aura

Question 6

What are the advantages of the combined pill?

Answer 6

If used effectively, nearly 100% effective, there’s a lower incidence of benign breast lumps, functional ovarian cysts and endometriosis and protection from ovarian and endometrial cancer (due to decreased number of ovulation a and atrophy of endometrium)

Question 7

What are the disadvantages of the combined pill?

Answer 7

Venous affect can cause thrombo-embolitic events due to effect on clotting related to oestrogen, can have arterial affect e.g. myocardial infarction, due to progestogen affect, there’s a small increased risk of breast cancer and can have minor side effects e.g. Weight gain, N&V, breast enlargement

Question 8

Why may someone take the progestogen-only pill?

Answer 8

Useful in those who can’t have oestrogen due to contraindications such as hypertension, lactation or diabetes

Question 9

Describe the mode of action of the progestogen-only pill

Answer 9

Suppresses ovulation in 15-40% of cycles, alters cervical mucus to lessen sperm penetration, induces endometrial atrophy –> penetration difficult and may affect tubal motility

Question 10

What are the advantages of the progestogen-only pill?

Answer 10

Can be used by those who can’t use COCP and doesn’t increase risk of venous thrombosis or CVD

Question 11

What are the disadvantages of the progestogen-only pill?

Answer 11

Side effects: Irregular bleeding, headache, breast pain, nausea

Question 12

What is the mode of action of the IUS (mirena coil)?

Answer 12

Releases Levonorgestrel which inhibits implantation, thickens cervical mucus, and stops irregular bleeding pattern (causes amenorrhoea)

Question 13

What are the contraindications of the IUS (mirena coil)?

Answer 13

• STIs
• Congenital uterine abnormality
• Carcinoma of cervix or endometrium
• Copper allergy
• Previous ectopic pregnancy

Question 14

Describe the two types of emergency contraception

Answer 14

• Hormonal emergency contraception (levonelle): licensed up to 72 hours after intercourse
• Cu-IUCD emergency contraception: can be used up to 5 days post-intercourse

Question 15

Describe a vasectomy

Answer 15

At least two sperm-free specimens are required post-vasectomy before the man is deemed to be sterile. The first test should be performed only after a minimum of 12 post-operative ejaculations

Question 16

Outline the methods of permanent contraception in women

Answer 16

Laparoscopic tubal occlusion (tying the tubes), mini-laparotomy , hysteroscopic tubal occlusion