Contraception

Question 1

What is the definition of contraception?

Answer 1

Contraception is the prevention of pregnancy and potentially the spread of STIs

Question 2

What is the Pearl Index (PI)?

Answer 2

The number of women per 100 using that contraception for a year that will be pregnant by the end of the year.

eg. PI=2, 2 women will be pregnant on that contraception at the end of the year

Question 3

What is the mechanism of the combined oral contraceptive pill?

Answer 3

Contains Oestrogen and Progesterone

Ovulation is inhibited by negative feedback, the endometrium thins and the cervical mucus thickens.

Question 4

How is the COCP taken?

Answer 4

Take 1 every day at the same time for 21 days and then stop for 7 days where vaginal bleeding occurs

Question 5

Give 4 benefits to the COCP

Answer 5

Suitable to many women
Highly effective
Very safe
Helps with menorrhagia, PMS, dysmenorrhoea, acne, hirsutism and ovarian cysts
Decreases risk of ovarian, endometrial and colorectal cancer
Reduces risk of PID
Reduces breast disease

Question 6

Give 4 risks to the COCP

Answer 6

Prothrombotic (increased risk of VTE + MI + TIA
Minor side effects- headaches, weight gain
Decreased absorption if taking Abx or D+V

Question 7

Give 5 contraindications to taking the COCP

Answer 7

Hx of VTE
Hx of stroke/TIA/MI
BMI>40
Diabetes
Pregnancy
Migraine with aura
Active breast/endometrial cancer
Smokers >35 years old
Liver disease
Thrombophilia

Question 8

Give 4 side effects of the COCP

Answer 8

Nausea
Headaches
Weight gain 
Decreased libido 
Acne 
Breast discomfort 
Depression

Question 9

What is the mechanism of the POP?

Answer 9

Progesterone only pill

Makes cervical mucus hostile to sperm and inhibits ovulation in 50% of women.

Question 10

Give 3 advantages of the POP

Answer 10

Can be used by lactating mothers
No increase in VTE risk
Not affected by Abx
Can be taken if BMI >30

Question 11

Give 3 disadvantages of the POP

Answer 11

Functional ovarian cysts
Less effective than COCP
Side effects –> spotting, weight gain, breast pain, PMS symptoms
Cannot take if recent breast cancer

Question 12

Describe the mechanism and how to use the transdermal patch (Evra)

Answer 12

Transdermal patch releases oestrogen and progesterone

1 patch a week for 3 weeks then 1 week without

Question 13

Describe the mechanism and how to use the Vaginal ring (nuvaring)

Answer 13

Combined contraceptive inserted into the vagina for 3 weeks followed by a 1 week break

Question 14

Describe the administration of depo-provera and give 2 advantages and disadvantages

Answer 14

IM injection every 3 months of progesterone only

+ = protects against ovarian cysts + ectopic pregnancy, high efficiency rates, not user dependent, cost effective, can be used during lactation

• = causes irregular bleeding + amenorrhoe, bone density decreases

Question 15

Describe the Nexplanon implant

Answer 15

40mm flexible rod containing progesterone inserted into upper arm. Lasts for 3 years and suppresses ovulation.

Question 16

Give 3 side effects of the Nexplanon implant

Answer 16

Depression 
PMS
Weight gain 
Reduced libio 
Acne 
Irregular bleeding 
Spotting

Question 17

What is Levonelle and when can it be used?

Answer 17

Single 1.5mg dose used as emergency contraception.

Need to take 24-72 hours after unprotected sex.

Works by reducing sperm function and endometrial receptivity.

S/e –> vomiting, menstrual disturbances

Question 18

What is Ulipristal (ellaOne) and when can it be used?

Answer 18

Selective progesterone receptor modulator

Used as an emergency contraceptive for up to 120 hours after unprotected sex. Less effective than Levonelle

Question 19

What is a male condom?

Answer 19

Sheath which wraps around erect penis. Protects from HIV and STI spread as well as preventing pregnancy

Question 20

How is a female condom used?

Answer 20

Fits inside vagina and protects against STIs

Question 21

How is a female diaphragm/cap used?

Answer 21

Fitted inside the vagina before intercourse and must stay in for 6 hours afterwards. Fits over the cervix.

Question 22

What are the 2 intra-uterine devices?

Answer 22

Copper IUD

Hormonal IUD

Question 23

How do copper IUDs work?

Answer 23

Copper is toxic to sperm and device blocks implantation

Can also be used in emergency contraception

Question 24

How do hormonal IUDs work?

Answer 24

Slowly release progesterone over 3-5 years. Reduces menstrual loss and pain.

Question 25

Give 3 advantages to the mirena coil

Answer 25

Very low failure rate
Lack of user dependence
Fertility returns to normal on removal 
Long acting
Fewer systemic effects
Safe

Question 26

Give 3 disadvantages to the mirena coil

Answer 26

Risk of ectopic pregnancies
Increased risk of PID on insertion and removal 
Can get heavy menstrual bleeding 
Pain and cervical shock on insertion 
Can perforate uterine wall on insertion

Question 27

Give 4 contraindications to the mirena coil

Answer 27

Endometrial Cancer
Cervical Cancer
Active PID
Undiagnosed vaginal bleeding 
Hx of ectopic pregnancy 
Multiple partners
HIV positive
Pregnancy

Question 28

How is female sterilisation achieved?

Answer 28

Surgically clip the fallopian tubes so oocytes and the sperm cannot meet. Done laparoscopically and under GA.

Can also be done transcervically by placing micro-inserts into the proximal fallopian tubes which then expand and cause fibrosis of the ducts so in approximately 3 months the ducts are occluded.

Question 29

Give 3 risks of female sterilisation

Answer 29

1 in 200 risk of failure
Irreversible
Risk of ectopic pregnancy
Surgical risks

Question 30

How is male sterilisation achieved?

Answer 30

Vasectomy involves ligation and removal of a small segment of the vas deferens, performed under local anaesthetic. Sterility takes up to 6 months after and needs to be confirmed on 2 semen samples.