contraception

Question 1

law around contraception

Answer 1

the legal age for consent is 16

however, no restriction on prescribing contraception to under 16s without parental consent

informed consent relies on competence

Question 2

define contraception

Answer 2

a method of preventing pregnancy via interference with ovulation, fertilisation or implantation

Question 3

define interceptive

Answer 3

an agent which prevents implantation rather than preventing fertilisation

Question 4

define long acting reversible contraception (LARC)

Answer 4

define by NICE as a method of contraception which needs to be administered less than once a month

Question 5

UK MEC (medical eligibility criteria)

Answer 5

evidence based guidance for providers of contraception

MEC1 - no restriction on use
MEC2 - advantages of use of method generally outweigh the disadvantages
MEC3 - disadvantages of use generally outweigh advantages
MEC4 - dont use

Question 6

how does the OCP work

Answer 6

1. suppresses ovulation
2. reduces sperm transport in the upper genital tract
3. alters the endometrium, inhibiting implantation
4. thickens cervical mucus

Question 7

advantages of the OCP

Answer 7

easily available
stop whenever
decreases risk of ovarian and endometrial cancer
affordable

Question 8

disadvantages of OCP

Answer 8

9% failure risk
complicated to take and remember
cant take if you get focal migraines or epilepsy
not ideal in patients with high BMI or smoke

Question 9

progesterone only pill action

Answer 9

thickens cervical mucus

Question 10

advantages and disadvantages of POP

Answer 10

advantages
- can take if you get migraines or are breastfeeding

disadvantages
- have to take at the same time everyday, error high

Question 11

how does the depo provera work

Answer 11

• suppresses hormones responsible for ovulation
• thickens cervical mucus to block sperm

12 weekly injection

Question 12

advantages and disadvantages of depo provera

Answer 12

prolonged amenorrhoea, weight gain
delayed return to fertility
E2 free - fewer restriction than OCP
- doesnt matter if you have DVT or focal migraines

Question 13

how does jadelle work

Answer 13

1. alters endometrium. prevents womb lining by thinning it
2. thickens cervical mucus to prevent sperm from reaching uterus
3. prevents ovulation

Question 14

disadvantages of jadelle

Answer 14

main side effect = bleeding

Question 15

copper IUD

Answer 15

• non-hormonal version of contraception
• last 10yrs
• reversible
• cheap
• spermotoxic
• implantation cant occur due to inflammatory response
• placed in uterus

Question 16

how does copper IUD work

Answer 16

• creates an unfavourable environment for sperm in the uterus and fallopian tubes so fertilisation is prevented
• thins endometrium
• makes cervical mucus thicker so sperm cant pass

Question 17

mirena IUS

Answer 17

• unfunded in NZ unless special authority

- releases P4 everyday into uterus

Question 18

copper IUD as emergency contraception

Answer 18

• can be used up to 5 days after ovulation
• weight not a factor
• efficacy approx 99.9%
• can provide ongoing contraception
• has anti implantation and anti fertilisation effects
• however lack of training to carry this out in clinic