Contraception

Question 1

Lactational amenorrhoea

Answer 1

98% effective Must be fully breastfeeding on demand <6 months postpartum

Question 2

IUD expulsion rate

Answer 2

1:20

Question 3

>40 y/o contraception

Answer 3

Cu-IUD + rely on it until contraception no longer needed

Question 4

COCP - how it works, SE

Answer 4

Suppresses FH + LSH + prevents ovulation Thickens cervical mucus Thins endometrium SE: headache, nausea, HTN, breast tenderness, mood swings, acne

Question 5

COCP - pros + cons, interactions

Answer 5

Pros: control cycle, improves menstrual problems Cons: side effects, increased risk of VTE, CHD + breast cancer Interactions: antibiotics, enzyme inducers

Question 6

Progesterone only (pill, implant, injection) - how it works

Answer 6

Suppresses follicular growth Thickens cervical mucus Thins endometrium

Question 7

Pros + cons, SE + contraindications of progesterone only

Answer 7

Pros: reduced MB, safe in breastfeeding, no risk of CVD, migraine, VTE Cons: no cycle control, persistent follicular cysts SE: irregular bleeding Contraindications: current breast cancer, unexplained vaginal bleeding, acute liver disease

Question 8

Injection - how long for, action, SE

Answer 8

Depoprovera

Lasts 12 weeks

Suppresses ovulation

Can cause weight gain + reduces bone mineral density

Question 9

Implant - how long for, SE, interactions

Answer 9

Nexplanon 3 years Can get irregular bleeding Most affected by enzyme inducers

Question 10

IUD - how long for, SE

Answer 10

Up to 10 years May cause HMB/ PMB No hormonal side effects

Question 11

IUS - how long for, SE

Answer 11

Lasts 5 years Hormonal side effects + irregular bleeding

Question 12

Male sterilisation - method, risks, tests

Answer 12

Vasectomy - interrupts vas deferens Risks: bleeding, haematoma + infection Semen analysis at 12 weeks

Question 13

Female sterilisation - method, failure rate, risks

Answer 13

Mechanical occlusion of fallopian tubes by Filshie clip Failure rate 1:200 Injuries to bowel, bladder, blood vessels

Question 14

Emergency contraception - options, action, how long after UPSI

Answer 14

IUD - can be given 5 days after UPSI

Effects lining of womb so hostile to sperm

Levonorgestrel - inhibits ovulation, less effective when UPSI occurs around ovulation.

Licensed for 72 hours

Ulipristal acetate - inhibits ovulation, licensed for 120 hours after UPSI

Question 15

Termination of pregnancy - medical + surgical (with time limits)

Answer 15

Medical = mifepristone then misoprostol Surgical = vacuum aspiration (up to 14 weeks), dilatation + evacuation (over 14 weeks) Give misoprostol before surgery to prepare cervix

Question 16

Indications for IVF

Answer 16

Tubal disease Male subfertility Endometriosis Anovulation

Question 17

IVF method

Answer 17

Downregulation of ovaries using GnRH analogues from day 21

Ovarian stimulation with FSH

Follicular maturation by adminstration of hCG

Transvaginal oocyte removal by needle guided aspiration

Fertlisation then embryo transfer through cervix on day 2-3

Progesterones given

Question 18

ICSI - what is it?

Answer 18

Intracytoplasmic sperm injections Single sperm injected into oocyte - for men with severe semen issues Increases rate of success in IVF

Question 19

Causes of subfertility

Answer 19

Ovulation disorder Tubal factor Male factor Unexplained Endometriosis Sexual dysfunction

Question 20

Types of ovulation disorder

Answer 20

Primary: premature ovarian syndrome, Turners, autoimmune, surgery/ chemo Secondary: PCOS, weight change, hypopituitarism, Kallmans/ Klinefelter syndrome, hyperprolactinaemia

Question 21

Investigations for subfertility

Answer 21

STD screen Baseline (day 2-5) hormone profile (FSH high in POF, low in hypopituitarism) Mid luteal progesterone (to confirm ovulation) Semen analysis Assess tubal patency: Hysterosalpingogram Laparoscopy + dye

Question 22

Ovulation induction treatment

Answer 22

Weight loss

Anti-oestrogens (Clomifene days 2-6) - increases FSH levels via negative feedback -

SE: hot flushes, mood swings -limited to 12 cycles max due to ovarian ca risk

Gonadatrophins - Used in clomifene resistant PCOS -Multiple pregnancy risk

Laparascopic ovarian diathermy (ovarian drilling) - restores ovulation in women with PCOS -Effect lasts 12-18 months

Insulin sensitisers - helps in PCOS

Question 23

COCP contraindications

Answer 23

BMI >35 requires expert judgement

Smoking >15 a day in >35 y/o

Breastfeeding <6 weeks PP

Migraine with aura

Hx of VTE

Ca breast currently

Uncontrolled HTN

Major surgery - should stop 4 weeks in advance

Question 24

When can the implant be inserted?

Answer 24

Day 1-5 of cycle Any other point = need to use condoms for 7 days

Question 25

UKMEC categories

Answer 25

1 = no restriction for use of method

2 = advantage of method outweighs risks

3 = risks of method outweigh benefits

4 = unaccapetable health risk

Question 26

Risk of pregnancy (typical + perfect use) for pills vs implant vs coil vs injection

Answer 26

Pills: 9% typical 0.3% perfect

Injection: 6% typical 0.2% perfect

IUS 0.2% both

Implant 0.05% both

Question 27

Missed pill rules for COCP

Answer 27

1 missed pill: take it when you remember but otherwise fine

2 missed pills: take the last pill you missed, leave earlier missed pills, use condoms for 7 days. If in week 1-2, carry on as normal. If in week 3, omit pill free break

May need emergency contraception if 2 or more missed in first week of pack

Question 28

Missed pill rules for POP

Answer 28

If more than 3/12 hours: take pill as soon as you remember, use contraception for 48hrs.

If unprotected sex, may need EC.

Question 29

What are the conception rates with different contraceptions?

Answer 29

Depo injection = 6%

Implant = 0.05%

IUS = 0.2%

Vasectomy = 0.15%

Question 30

How does Ulipristal acetate (Ella One) work?

Answer 30

Selective progestogen receptor modulator

Can’t be given within 5 days of another hormonal method