Contraception

Question 1

what is the Pearl Index?

Answer 1

number of contraceptive failures per 100 women years of exposure

Question 2

contents of the COC

Answer 2

• Ethinyl oestradiol and progestogen
• Usual dose 20-35 micrograms EE (50 if on liver enzyme inducers)
• Second generation – levonorgestrel and norethisterone
• Third generation – gestodene and desogestrel

Question 3

mechanism of COC

Answer 3

• Prevents ovulation
• Alters FSH and LH = no surge
• Prevents implantation by providing an inadequate endometrium
• Inhibits sperm penetration of the cervical mucus by altering quality and character of mucus
• Negative Feedback

Question 4

how to take COC

Answer 4

21 days then pill free week

Question 5

formulations of COC

Answer 5

pill
ring
patch

Question 6

how to start COC

Answer 6

• Start days 1-5 without barrier contraception
• Takes 7 days to switch off ovaries
• Start anytime if not pregnant but use condoms for 7 days

Question 7

non contraceptive benefits of COC

Answer 7

o Reduction in functional ovarian cysts – stops ovulation therefore no follicles form
o 50% reduction in ovarian and endometrial cancer
o Improvement in acne
o Reduction in benign breast disease, RA, colon cancer, osteoporosis

Question 8

risks associated with COC

Answer 8

VTE
ischaemia stroke
focal migraines
breast cancer 
cervical cancer

Question 9

contents of the POP

Answer 9

• Cerelle/Cerazette – desogestrel pill with 12-hour window

Question 10

mechanism of POP

Answer 10

• New POPs – Cerazette inhibits ovulation in 97% of cycles and although ha not been shown to be different from other POP in terms of its PI is likely to be more effective
• Mode of action
o Cervical mucus is rendered impenetrable by sperm
o A maximum effect about 48hrs after ingestion
o In older pills the effect is lost if more than 3 hours late
o Ovulation – spectrum of events

Question 11

contents of depot medroxyprogesterone acetate

Answer 11

• Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate

Question 12

how to take the depo contraceptive

Answer 12

150mg deep IM injection every 12 weeks

Question 13

mechanism of depo injection

Answer 13

o High doses of progestogen
o Prevents ovulation
o Alters cervical mucus making it hostile to sperm
o Prevents implantation by rendering the endometrium unsuitable

Question 14

consequences of depo injection

Answer 14

o No reduction in fertility but there is a delay of up to a year in return
o Reversible reduction in bone density
o Problematic bleeding
o Weight gain

Question 15

subdermal implant contents

Answer 15

• Core – 68mg etonogestrel (ENG)
• Membrane – ethinyl vinyl acetate (EVA)
• Progesterone

Question 16

mechanism of implant

Answer 16

inhibits ovulation

alters cervical mucus

Question 17

after how long do you replace the implant

Answer 17

3 years

Question 18

how long does the copper coil last

Answer 18

5-10 years

Question 19

how does the copper coil work

Answer 19

spermatotoxic

Question 20

what does the hormonal IUD contain

Answer 20

progesterone

Question 21

what is the 1st line for heavy menstrual bleeding?

Answer 21

hormonal IUD

Question 22

describe emergency contraception

Answer 22

• Copper IUD most effective option
• Levonorgestrel – within 72hrs
• Ella one – within 120hrs
• Less effective than ongoing contraception

Question 23

describe female sterilisation including failure rates

Answer 23

• ESSURE local anaesthetic permanent
o Failure rate 1 in 500 lifetime risk
o Discontinued in UK for commercial reasons
• Filshie clips – traditional tube ligation
o 1 in 200

Question 24

describe male sterilisation including failure rates

Answer 24

• Permanent division of vas deferens under local anaesthetic
• Failure rates 1 in 2000
• Pain due to sperm granuloma, a mass of degenerating spermatozoa surrounded by
macrophages
• Irreversibility
o Anti-sperm antibodies are implicated in the low success rates of vasectomy reversals
• No evidence of reduction in testosterone and semen the same colour and volume
• No evidence that vasectomy predisposes to testicular cancer or prostatic cancer
• Individuals should be informed that vasectomy carries a lower failure rate, in terms of post
procedural pregnancies, and that there is less risk associated with the procedure than
sterilisation carried out by laparoscopy or laparotomy

Question 25

social reasons for abortion

Answer 25

The pregnancy has not exceeded its 24th week and continuation of the pregnancy would cause greater harm to the physical or mental health of the woman and/or her existing children than if the pregnancy were terminated

Question 26

medical reasons for abortion

Answer 26

o Foetal anomaly

o Maternal health

Question 27

describe medical termination of pregancy

Answer 27

o Mifepristone (anti-oestrogen) switches off pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow
o 48hrs later prostaglandin initiates uterine contraception which opens cervix and expels pregnancy

Question 28

complications of termination: medical

Answer 28

§ Failure 6 in 1000
§ Haemorrhage <5 in 100
§ Infection (screen)
§ Prolonged bleeding <5 in 100

Question 29

complications of termination: surgical

Answer 29

§ Uterine perforation – 1-4 per 1000
§ Cervical trauma <1%
§ Failed termination 2.3 per 100