Contraception

Question 1

What is contraception?

Answer 1

Any method to prevent pregnancy

Question 2

What mechanisms do contraceptions employ?

Answer 2

Blocking transport of sperm to avoid fertilisation of oocyte

Disrupting the HPG axis to interfere with ovulation

Inhibiting implantation of the conceptus into endometrium

Question 3

Outline the ‘Natural’ methods of contraception

Answer 3

Abstinence = 100%

Withdrawal method = some sperm released in pre-ejaculate, no STI protection

Fertility awareness = use of fertility indicators to identify infertile/fertile points, no STI protection, unreliable

Lactation amenorrhoea method = suckling disrupts, release of GnRH delaying return of ovulation, only effective up to 6 month after giving birth, unreliable, no STI protection

Question 4

Describe the ‘Barrier’ types of contraception

Answer 4

Condom = 98% reliable

Female condoms = 98% reliable

Protection from STIs, danger of expiring, allergy/sensitivity

Question 5

Outline the ‘Hormonal Control’ types of contraception

Answer 5

Combined oral contraceptive = prevents ovulation by making the hypothalamus think you are in the luteal phase, 21 days, synthetic oestrogen/progestogen, 98% effective if taken correctly, release menstrual disorder, reduces risk of ovarian/endometrial cancer, increased risk of breast cancer/blood clots (thromboembolic), no STI protection

High dose progestogen (depot/implant) = LARC, inhibit ovulation, thicken cervical mucus, prevent endometrial proliferation, reliable, delay in fertility returning, no STI protection

Low dose progestogen = (mini pill) not going to effect HPG, still get ovulation, thicken cervical mucus, no STI protection, menstrual problems are common

Question 6

Describe the ‘Prevention of implantation’ method of contraception

Answer 6

Coil: intrauterine system = progestogen, 3-5 years, prevents implantation and reduces endometrial proliferation, thickens cervical mucus, insertion unpleasant, no STI protection

Coil: intrauterine device = copper, 5-10 years, copper is toxic to sperm/ovum, endometrial inflam reaction preventing implantation, can cause heavy bleeding, insertion unpleasant, no STI protection

Question 7

Outline ‘Sterilisation’

Answer 7

Vasectomy = vas deferens cut/tied, must confirm success 12-16 weeks after surgery, failure 1 in 2000

Tubal ligation/clipping = fallopian tubes cut/blocked, failure 1 in 200/500 depending on method

Question 8

Outline the options regarding emergency contraception

Answer 8

Emergency IUD = copper

2 pill types

Question 9

Define subfertility

Answer 9

Failure of conception in a couple having regular (every 2/3 days), unprotected sex for 1 year

Primary = never conceived a child

Secondary = preg before, but diff conceiving again

Question 10

How can ovulatory disorders be classified?

Answer 10

1) hypothalamic-pituitary failure
2) hypothalamic-pituitary-ovarian dysfunction = polycystic ovarian dysfunction
3) ovarian failure

Question 11

What uterine/pelvic disorders can lead to infertility?

Answer 11

Uterine fibroids

Endometriosis

Pelvic inflam disease

Developmental abnormality