Contraception

Question 1

What is the MOA of the oral contraceptive pill?

Answer 1

1. Inhibits ovulation by suppression of hypothalamic gonadotropin-releasing factors which prevents FSH/LH release
2. Thickens cervical mucous to inhibit sperm migration
3. Renders endometrium atrophic, therefore unfavourable for implantation (results in lighter periods or amenorrhea)
4. Possible effect on secretion and peristalsis within the fallopian tube, which interferes with ovum and sperm transport

Question 2

What are the absolute contraindications to the oral contraceptive pill?

Answer 2

<6 weeks postpartum if breastfeeding
Smoker over the age of 35 (15 cigs or greater)
HTN (sBP greater than 160 and dBP greater than 100)
Current or past history of VTE
Ischemic heart disease
History of cerebrovascular accident
Complicated valvular heart disease
Migraine headache with focal neurological symptoms
Breast cancer (current)
Diabetes with retinopathy/nephropathy/neuropathy
Severe cirrhosis
Liver tumour (adenoma or hepatoma)

Question 3

What are the requirements for lactational contraception?

Answer 3

<6 months postpartum, fully or nearly fully breast feeding, amenorrhea

Question 4

What are the advantages of Depo Provera?

Answer 4

Safe in breast feeding
No increased risk of clots
Estrogen related contraindications do not apply
After you have been on it for 6 months your periods will go away
Delayed return to fertility (disadvantage)

Question 5

What is the most effective form of emergency contraception?

Answer 5

Copper IUD

Question 6

When must emergency contraception be delivered?

Answer 6

Copper IUD = within 7 days
Plan B (levenogesterol) = within 72 hours
Yuzpe = within 72 hours
Ulipristal Acetate = within 5 days 

Time starts from post-coitus