Contraception

Question 1

What is the mode of action of the combine oral contraceptive pill (COC)

Answer 1

Prevents ovulation
Alters FSH and LH
Prevents implantation due to inadequate endometrium
Inhibits sperm penetration of cervical mucus by altering quality and character of mucus

Question 2

What are the 2 hormones in the COC?

Answer 2

Ethinyl oestradiol (EE) 
Progesterone

Question 3

What is true failure in terms of contraception?

Answer 3

If a contraceptive is taken perfectly, how many pregnancies will occur

Question 4

How is the COC taken?

Answer 4

Taken for 21 days then stopped for 7 days
If started during menstruation, no barrier protection needed
If started whilst not menstruating, barrier protection needed for 7 days
Can use for 3 months continuously then pill free week

Question 5

What are the non contraceptive benefits of the COC?

Answer 5

Regularly bleeding, potential reduction in heavy menstruation and anaemia
Reduction in functional ovarian cysts
Improvement in acne
50% reduction in ovarian and endometrial cancer
Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

Question 6

What groups of women are at an increased risk for venous thromboembolism?

Answer 6

Major surgery and immobility 
Thrombophilias 
Family history of VTE 
BMI over 30 
Underlying vascular diseases 
Postnatally within 21 days

Question 7

What are the risks of the COC?

Answer 7

Increased risk of VTE, ischaemic stroke and cervical cancer

Question 8

How is a vaginal ring used?

Answer 8

Inserted for 3 weeks then removed for 1 week to allow a break for menstruation

Question 9

How are progesterone only pills (POP) taken?

Answer 9

12 hour window period to take
No pill free interval
If started whist not menstruating, barrier protection for 2 days

Question 10

What is the mode of action of the POP?

Answer 10

Cervical mucus is rendered impenetrable by sperm

Inhibits ovulation in 97% women

Question 11

What is depot mediroxyprogesterone acetate (DepoProvera)?

Answer 11

Intramuscular injection given into the upper quadrant of the buttock every 12 weeks

Question 12

What is the mode of action of depoprovera?

Answer 12

Prevents ovulation
Alters cervical mucus making it hostile to sperm
Prevents implantation by rendering the endometrium unsuitable

Question 13

What are the side effects associated with depoprovera?

Answer 13

Delay in return to fertility
Reversible reduction n bone density
Problematic bleeding
Weight gain

Question 14

What is the subdermal implant?

Answer 14

Small plastic rod containing progesterone

Question 15

What is a common side effect of the subnormal implant?

Answer 15

Irregular bleeding

Question 16

What is the mode of action of the subdermal implant?

Answer 16

Inhibition of ovulation

Effect on cervical mucus, stops sperm entering upper reproductive tract

Question 17

How long does intrauterine contraception last?

Answer 17

5-10 years

Question 18

What is a vasectomy?

Answer 18

Permanent division of vas deferens under local anaesthetic

Question 19

How is the medical termination of pregnancy carried out?

Answer 19

Mifepristone switches off pregnancy hormone

48 hours later prostaglandin initiates uterine contraception which opens cervix and expels pregnancy

Question 20

What are the complications of a medical termination of pregnancy?

Answer 20

Failure
Haemorrhage
Infection
Prolonged bleeding