Contraception

Question 1

What are the two types of intrauterine products?

Answer 1

1. copper intrauterine contraceptive device

2. levonorgestrel releasing intra-uterine device

Question 2

Give 2 examples of IUS?

Answer 2

MIRENA

jaydess

Question 3

How does the IUS work?

Answer 3

T shaped device

prevents endometrial thickening and thickens cervical mucus

Question 4

List the benefits of the IUS?

Answer 4

99% effective
long term
redices dysmenorrhoea

Question 5

List the limitations and possible side effects of the IUS?

Answer 5

frequent uterine bleeding and spotting
painful insertion 
infection (but smaller risk than IUD)
ectopic pregnancy 
dysfunctional ovarian cysts 
expulsion

Question 6

How does the copper IUD work?

Answer 6

T shaped device made of copper

decreases sperm motility and survival

Question 7

What are the benefits of IUD?

Answer 7

99% effective
long term - no worries regarding compliance
reversible
can be used as emergency contraception as effective immediately

Question 8

When does the IUS start working as a contraceptive?

Answer 8

7 days after insertion

Question 9

What are the limitations of IUD?

Answer 9

painful insertion
heavier, longer, more painful periods 
infection - PID 
uterine perforation
ectopic pregnancy 
expulsion

Question 10

Name an example of the progestogen only subdermal implant

Answer 10

Nexplanon

Question 11

How does the progestogen only implant work?

Answer 11

inhibit ovulation * by slowly releasing progestogen hormone etonogestrel
thicken mucus
thinning of the endometrium
prevent implantation

Question 12

How/when is the progestogen only implant inserted?

Answer 12

inserted in the proximal non dominant arm, overlying the tricep

insert in day 1-5 of womens cycle - if not, need contraception

can be inserted immediately after termination of pregnancy

Question 13

What are the benefits of the progestogen only implant?

Answer 13

highly effective
convenient
no oestrogen so can be used in patients with a history of VTE

Question 14

What are the possible side effects with the progestogen only implant?

Answer 14

irregular/heavy bleeding *
‘progestogen effects” - headache, nausea breast pain
changes in weight
change in mood and libido

Question 15

List the contraindications for the progestogen only implant?

Answer 15

ischaemic heart disease
breast cancer
liver cirrhosis or liver cancer
enzyme inducing drugs e.g. anti-epileptic, rifampicin

Question 16

Name examples of progestogen only injectable contraceptives

Answer 16

Depo provera
savana press
noristerat

Question 17

How do progestogen only injectable contraceptives work?

Answer 17

inhibits ovulation *
thickens cervical mucus
endometrial thinning

Question 18

How are progestogen only injectable contraceptives administered?

Answer 18

IM injection every 12 weeks (14 weeks without precautions)

synthetic progesterone (medroxyprogesterone acetate) slowly released into systemic circulation

Question 19

What are the benefits of progestogen only injectable contraceptives?

Answer 19

convenient
highly effective
decrease risk of ectopic pregnancy
decrease risk of endometrial cancer

Question 20

What are the problems with progestogen only injectable?

Answer 20

not reversible
potential delayed return to fertility - up to 1 year 
weight gain
irregular bleeding
increased risk of osteoporosis

Question 21

Name examples of the oral progestogen only contraceptive pill

Answer 21

micronor
noriday
nogeston
femulen

Question 22

What is the progestogen only contraceptive pill mechanism of action?

Answer 22

thickens cervical mucus*
transport of ovum delayed
endometrium unsuitable for implantation

Question 23

What are the benefits of the progestogen only contraceptive pill?

Answer 23

effective when taken correctly
easily reversible
convenient
avoids oestrogen risks

Question 24

What is the main side effect of the progestogen only contraceptive pill?

Answer 24

irregular, breakthrough bleeding *

Question 25

What does progestogen only contraceptive pill increase the risk of?

Answer 25

functional ovarian cyst

breast cancer

Question 26

When should the progestogen only contraceptive pill be started?

Answer 26

day 1- 5 of cycle

if not use additional contraception for 48 hours

Question 27

When should the progestogen only pill be taken?

Answer 27

same time every day with no break

must be within 3 hours of same time

Question 28

What happens if <3 hours of not taking the progestogen only pill?

Answer 28

take pill ASAP!

no extra action required

Question 29

what happens if >3 hours of not taking the progestogen only pill?

Answer 29

1. take pill ASAP!
2. take the next pill due at normal time (even if 2 in 1 day)
3. take extra precautions for next 48 hours
4. continue pack as normal

Question 30

How does the COCP work?

Answer 30

inhibit ovulation *
thicken cervical mucus
reduce endometrial receptivity

Question 31

What are the benefits of the COCP?

Answer 31

effective
large 12 hour window to be taken
reversible
relief from menstrual problems as lighter, painless, shorter periods

Question 32

How is the COCP protective?

Answer 32

reduce risk of ovarian, endometrial and colorectal cancer
protect against PID
reduce risk of ovarian cyst and benign breast disease

Question 33

What are the possible side effects of the COCP?

Answer 33

breakthrough bleeding
headache
breast tenderness
no protection against STIs

Question 34

Which diseases does COCP increase the risk of?

Answer 34

breast cancer
VTE
stroke and MI

Question 35

What are the contraindications of the COCP?

Answer 35

breast cancer - or have gene mutation
migraine with aura *
smoking + >35 y/o
previous history of VTE 
>35 BMI
breastfeeding <6 weeks post partum 
immobility - surgery, disabled

Question 36

What should you do if 1 COCP missed?

Answer 36

no action needed

take missed pill immediately and continue with packet

Question 37

What should you do if 2 COCP missed and in first week?

Answer 37

take ASAP!
use extra precautions for next week
if in first week = emergency contraception