Contraception

Question 1

what methods of contraception require ongoing input form the individual? (x5)

Answer 1

oral contraception
barrier methods
fertility awareness
coitus interuptus
oral emergency contraception

Question 2

what methods of contraception prevent by default? (x5)

Answer 2

IUCD
IUS
progesterone implant
progesterone injection
sterilisation

Question 3

what are the components of the COCP?

Answer 3

oestrogen - combined at different levels with progesterone - desogestrel or drospirenone
between 20-50mcg of oestrogen - usually 30-35

Question 4

why was POP not used in the past?

Answer 4

the progesterones had a similar structure to testosterone so caused a side effect profile with hair growth, oily and spotty skin etc.

now have modified the progesterone so it does not have these side effects.

Question 5

how is compliance increased with pills?

Answer 5

education

labeling the pills with days of the week - also helps with missed pills

Question 6

by what mechanism does the COCP work?

Answer 6

oestrogen turns off the HPG so there is no ovulation
progesterone causes atrophy of the endometrium - so the embryo could not implant
it also causes dedifferentiation of the cilia - so the embryo cannot be transported
it causes thickening of the cervical mucous - so sperm are unable to enter

Question 7

what are the contraindications to the COCP?

Answer 7

liver enzyme inducing drugs - e.g. broadspec antibiotics, anti epileptic

Question 8

what is the combined vaginal contraceptive?

Answer 8

same components as the COCP - however in a vaginal ring which must be removed every 21 days and replaced 7 days later
e.g. Nova Rings

Question 9

what are the benefits to the COCP?

Answer 9

reliable and safe
unrelated to coitus woman is in control
rapidly reversible
protects against ovarian and endometrial cancer

Question 10

what can COCP reduce the symptoms of?

Answer 10

endometritis and fibroids
RA
PMS
dysmenorrhea (painful periods)
menorrhagia (heavy periods)

Question 11

what are the risks to the COCP?

Answer 11

CVS - high BP - DVT and PE
breast and liver cancer
insulin metabolism - makes diabetes worse
acne
psychological

Question 12

what are the progesterone only methods of contraception?

Answer 12

nexaplanon implant
IUS - mirena coit
POP
injectables - e.g. deep proverb, noristat

Question 13

how long does the implant last?

Answer 13

3 years - releases progesterone every day

Question 14

how long does the injectable POC last?

Answer 14

3 months

Question 15

what is the time window for the POP?

Answer 15

12 hours

Question 16

how does the IUCD work? how long does it last?

Answer 16

destroys spermatozoa
prevents implantation through inflammation - prostaglandin secretion - chronic endometritis
mechanical prevention of inflammation

minimum of 5 years - can be removed at any time

Question 17

what are the benefits to the IUCD?

Answer 17

non-user dependany
works instantly - also able to be used retrospecitively
immediately reversible and reliable
unrelated for coitus
no serious medical risks

Question 18

what are the disadvantages of the IUCD?

Answer 18

must be fitted by a trained professional
fitting can cause pain or discomfort
periods may become heavier - especially if coming off a hormone based contraception

Question 19

what are the contraindications to the IUCD?

Answer 19

PID
pregnancy
unexplained vaginal bleeding
abnormalities of the uterine cavity - tight cerix can make it difficult to insert

Question 20

what is the difference between a contraceptive and an abortive device?

Answer 20

after 5 days = abortion