Contraception

Question 1

Name 3 reasons for taking contraception

Answer 1

Stop babies
Reduce STI transmission (for some options)
Reduce symptoms associated with menstrual cycle (for some options)

Question 2

Name 3 types of behavioural contraceptive methods, and how effective they are (typically and perfectly)

Answer 2

Withdrawal (73 - 96% effective)
Periodic abstinence (no sex or condom from 5 days before to 2 days after ovulation - 74 - 88% effective)
Lactational amenorrhoea (95 - 98% effective) - has to breastfeed exclusively, and only up to 6 months postpartum and if completely amenorrheic.

Question 3

Name 3 types of barrier contraceptives

Answer 3

Male condom
Female condom
Diaphragm/cervical cap

Question 4

Name 4 non-contraceptive benefits to hormonal contraception

Answer 4

Improve menorrhagia and dysmenorrhoea
Improve symptoms of endometriosis
Improve menstrual migraines
Improve Fe-deficiency anaemia

Question 5

Name 3 other non-contraceptive benefits specific to the combined OCP

Answer 5

Can improve acne, hirsutism, PCOS, osteoporosis and some cancers (ovarian, endometrial, colorectal)

Question 6

How does the combined OCP work as a contraceptive?

Answer 6

Contains oestrogen (suppresses FSH = reduced ovulation) and progesterone (suppresses LH and thickens cervical mucus to stop sperm getting to egg)

Question 7

Go through the missed pill rule for the OCP

Answer 7

If the pill is less than 24 hours late (less than 48 hours from last pill), then take it immediately and then take the next one at the usual time

If it’s more than 24 hours late, then still take it straight away, and the next one at the usual time.

BUT

If it’s been less than 7 days since the last placebo break, consider taking the emergency contraceptive if you’ve had sex in the last 5 days (because the cumulative oestrogen levels from less than 7 days of pills isn’t enough to guarantee contraception)

And, if it’s less than 7 days until next placebo break, skip the placebos and go straight to the active pills (otherwise there’s a chance of getting pregnant during the placebo window)

Question 8

What is 1 other situation where the missed pill rule applies, even if they haven’t missed a pill?

Answer 8

If they have gastro (vomiting and diarrhoea = less pill absorbed)

Question 9

Name 5 SE of combined OCP

Answer 9

Breakthrough bleeding and nausea, usually only when first starting
Mild weight gain (1-2kg max)
Drug interactions (especially anti-convulsants, increases hepatic metabolism of oestrogen)
Increased risk of VTEs, cervical and breast cancer

Question 10

Name 7 absolute C/I to combined OCP

Answer 10

Current breast cancer
Severe HT (> 160/100)
Undiagnosed vaginal bleeding (? cervical Ca)
Past or current IHD, stroke, valvular heart disease, DVT
Severe liver pathology (cirrhosis, cancer)
Over 35 and > 15 cigs/day
APLS antibodies - clot risk
Migraine with aura

Question 11

How does the progestin only contraceptive pill work? Is it’s primary action on ovulation? Why/why not?

Answer 11

Mostly by thickening cervical mucus, and by thinning lining of endometrium (decreases egg implantation). Has variable affect on ovulation - 40% of women will continue to ovulate on progestin-only pill

Question 12

What is the rule for missing a progestin-only pill?

Answer 12

Cervical mucus starts to thin after 27 hours = can only delay taking pill by 3 hours

Question 13

Name 3 SE of progestin-only pill

Answer 13

Spotting, headaches, hair/skin change, depression, poor libido

Question 14

Name 2 other forms of progestin contraceptive (besides pill and Mirena)

Answer 14

Depo-Provera (injection)

Implanon (implant)

Question 15

What is the main SE of the Implanon?

Answer 15

Unpredictable bleeding - can become amenorrhoeic (20%), irregular bleeds (60%) or heavy menstrual bleeding (20%)

Question 16

How do IUDs work? Name 2 benefits of any IUD over the combined OCP. Name 3 general SEs of any IUD

Answer 16

Prevents fertilisation (sperm and egg meeting)
Benefits - long acting, reversible, able to be used if oestrogen C/I
SE - uterine perforation, expulsion, infection

Question 17

What is the non-hormonal IUD? How long does it last? Main SE?

Answer 17

Copper IUD - 10-12 years. SE - heavier, painful periods

Question 18

What is the hormonal IUD? How long does it last? Name 1 other potential benefit over contraception. Name 3 C/Is

Answer 18

Mirena (progestin) IUD - 5-7 years, replaced after 5. Benefit - amenorrhoea in 50% of people. C/I if current STI, hormone dependent Ca,

Question 19

What is the emergency contraception option? How long after unprotected sex does it work?

Answer 19

High dose (1.5g instead of 30mg) progestin-only pill (levonogesterol). Works for 5 days after, but gets less effective each day