Contraception

Question 1

What are the routes of administration for contraceptives?

Answer 1

• Oral
• Transdermal patch
• Implants
• Nasal
• Vaginal

Question 2

How is sex stored hormone transport influenced?

Answer 2

• Transport bound to Sex Hormone Binding Globulin or SHBG (except progesterone) and albumin. 1-2% is free
• SHBG upregulated by oestrogens to protect them against hepatic metabolism

Question 3

How does storage affect sex steroid hormones?

Answer 3

• Increases the half life
• Sex steroid are easily sotred in fatty tissue because they are lipophilic. They complex into plasma membrane just like cholesterol

Question 4

How are sex steroid hormones excreted?

Answer 4

-Metabolites are excreted through faeces and urine

Question 5

How do sex steroid hormone work?

Answer 5

• ER-alpha and ER-beta for oestrogen
• PR-A and PR-B for progesterone
• AR-1 and AR-2 for testosterone

Question 6

How does liver metabolism affect progesterone?

Answer 6

-Progesterone is almost totally metabolised in one pass through the liver

Question 7

What are the types of oral contraceptive pills?

Answer 7

• COCP (Oestrogen and Progestin)

- POP (progestin only pill)

Question 8

What are some examples of COCP?

Answer 8

1st Gen- Norethynodrel
2nd Gen -Levonorgestrel, Norethisterone
3rd Gen - Desogestrel, Gestodene, Norgestimate
4th Gen - Drospirenone (anti-mineralocorticoid, anti-androgen)

Question 9

What are the effects of COCP?

Answer 9

• Suppression of Ovulation: inhibits FSH, LH
• Hold the hypothalamus and gonadotrophin in the ready to go state
• Holds ovary in non-dominant follicular state
• Makes cervical mucus which makes it more viscous
• Prevents secretory phase on the endometrium so endometrium remains atrophic

Question 10

How does COCP work?

Answer 10

• Tricks the body into thinking that ovulation has already occurred
• Alters the lining of the womb
• Thickens the naturally occurring fluids in the cervix and prevents sperm from traveling into the womb

Question 11

What are some side effects of COCP?

Answer 11

• Venous thromboembolism
• Myocardial infarction
• Hypertension
• Decrease glucose tolerance
• Increase risk of stroke in women with focal migraine
• Headaches
• Mood swings
• Cholestatic jaundice
• Increase incidence of gallstones
• Precipitate porphyria

Question 12

How can drugs reduce the efficacy of COCP?

Answer 12

-Metabolised by CP450. COCP efficacy reduced by enzyme inducing drugs such as they increase production of P450 in liver

Question 13

Which drugs reduce efficacy of COCP?

Answer 13

• Antiepileptics such as carbamazepine or phenytoin
• Antibiotics such as rifampicine and rifabutine
• Natural products such as St John’s Worts

Question 14

How does Soya protein affect COCP?

Answer 14

• Soya protein products enhance oestrogen absorption and reduces its storage in adipose and muscle
• This cause half life to be reduced from 15 to 7 hours

Question 15

What are some examples of progestin only pills?

Answer 15

• Levonorgestrel
• Norethisterone
• Ethynodiol Diacetate
• Desogestrel

Question 16

How does POP work?

Answer 16

• Effecting the cervical mucous and the endometrium
• Needs receptor to work and receptor requitres oestrogen to form
• Works best when started in the follicular phase of menstrual cycle

Question 17

What are some side effects of POP?

Answer 17

• Breast discomfort
• Changes in libido
• Depression
• Disturbance of appetite
• Dizziness
• Headache
• Menstrual irregularities
• Nausea
• Skin disorders
• Vomiting

Question 18

What are the methods of emergency contraception and their period of use?

Answer 18

Up to 72 hours post coitus
-Levonorgestrel

Up to 120 hours

• Ullipristal acetate
• Cu2+ IUD

Question 19

How does copper IUD work?

Answer 19

Prevents blastocyst attachment to endometrium

Question 20

How does ullipristal acetate work?

Answer 20

Selective progesterone receptor modulator

Question 21

How is Progestin Depot administered?

Answer 21

-Given every 12 weeks

Medroxy Progesterone Acetate

Question 22

How does a progestin depot work?

Answer 22

Works by releasing progestin slowly into the body, suppressing oestrogen and other hormone levels

Question 23

How does the progestin depot affect the reproductive system?

Answer 23

• Thickening of mucus from the neck of the womb
• Makes the lining of the womb thinner
• Prevents the ovaries releasing an egg

Question 24

What is the advice given for missing one pill?

Answer 24

• Take the last (missed) pill immediately, even if this means taking two pills in one day.
• Continue taking the rest of the pack as normal.
• Take seven-day pill-free break as normal or, take (inactive) pills

Question 25

What is the advice given for missing two pills anywhere in the pack or starting a pack 2 days late?

Answer 25

• Take the last pill immediately, even if this means taking two pills in one day.
• Continue taking the rest of the pack as normal.
• Use extra contraception for the following seven days

Question 26

What is the advice given if there are seven or more pills left in the pack after the last missed pill?

Answer 26

-Finish the pack and take seven-day pill-free break as normal or, take (inactive) pills

Question 27

What is the advice given if there are less than seven pills left in the pack after the last missed pill?

Answer 27

Finish the pack and start a new pack the next day; this means missing out the pill-free break or not taking your inactive pills