Contraception

Question 1

What are the general advantages of contraception?

Answer 1

Choice 
Control (personal or medical reasons) 
Family planning 
Saves lives globally 
Cost (pharmacological contraception free in UK)

Question 2

What are the general disadvantages of contraception?

Answer 2

Changes in sexual habits
Medical complications
Cost?

Question 3

What needs to be considered in a contraceptive consultation?

Answer 3

Health 
Age 
Desire for fertility 
Social/ religious/ ethical 
Education 
Compliance
Cost

Question 4

What are the types of contraception?

Answer 4

Natural/ physiological
Barrier
Hormonal
Surgical

Question 5

What natural/ physiological methods can be used as contraception?

Answer 5

Rhythm method (keeping in rhythm with natural fertility, avoiding fertility window) 
Coitus interruptus (penile withdrawal before ejaculation)
Lactation (regular and exclusive breastfeeding)

Question 6

What are the advantages and disadvantages of the rhythm method of contraception?

Answer 6

Advantages: cheap; no side effects; no medical contraindications; no religious or ethical conflicts

Disadvantages: limits sexual activity; requires education; high failure rate; no STI protection

Question 7

Why does lactation act as a contraception?

Answer 7

Prolactin inhibits secretion of FSH which suppresses the HPO axis to prevent ovulation

Question 8

What barrier methods are available as contraception?

Answer 8

Condom
Diaphragm
Cervical cap
+/- Spermicide

MoA: prevents sperm-egg interaction

Question 9

What are the advantages and disadvantages of condoms as a form of contraception?

Answer 9

Advantages: cheap; protection against (most) STIs

Disadvantages: latex allergies; some loss of sensation/ interruptions etc.; can rip; requires education (e.g. not using body oil etc.)

Question 10

What are the advantages and disadvantages of using a diaphragm as a form of contraception?

Answer 10

Advantages: professional fitting; can be used with spermicides; reusable

Disadvantages: requires education; must remain in situ for 6 hours; interruptions

Question 11

What is long acting reversible contraception (LARC)?

Answer 11

Intra-uterine device - non-hormonal IUD is made of copper which is a spermicide and mechanically prevents implantation

Question 12

What are the advantages or disadvantages of IUCDs?

Answer 12

Advantages: long term, don’t interrupt sexual activity/ partner can be unaware, copper IUD so no artificial hormones; amenorrhea/ decrease dysmenorrhea. can be used as emergency contraception (within 5 days of unprotected sex)

Disadvantages: decreased libido, irregular bleeding, cost, invasive, side effects (e.g. cramping)

Question 13

What are the possible complications if an IUCD?

Answer 13

Expulsion
Perforation
Infection (e.g. pelvic inflammatory disease)
?Ectopic

Question 14

To what stage of gestation is termination legal to in the UK?

Answer 14

24 weeks (medical before 9 weeks, surgery after)

Question 15

What forms of surgical contraception are possible?

Answer 15

Females: tubal ligation
Males: vasectomy

Question 16

What are the advantages or disadvantages of surgical methods of contraception?

Answer 16

Irreversible - advantage and disadvantage? 
Can be psychologically damaging 
Cost 
Invasive 
Failure rate (0.5% female, 0.05% male)

Question 17

What is the MoA of the combined oral contraceptive pill?

Answer 17

Oestrogen + Progestogen (synthetic hormone mimicking actions of Progesterone)
Act on intracellular transcription factors (ER alpha and ER beta for Oestrogen and PR-A and PR-B for Progesterone)

Hormones diffuse across membrane and bind with receptors to initiate dissociation of HSP90 from the receptor complex - active receptor dimers then form and influence extensive gene expression

Question 18

Why can synthetic steroid hormones easily diffuse across cellular membrane?

Answer 18

Lipid-based molecules so are hydrophobic

Question 19

What is the primary outcome of oral contraceptives?

Answer 19

Suppression of ovulation

[Nb. ovulation is driven by endocrine dynamics and timing of hormone secretion and activity so oral contraceptives taken at appropriate time disrupt critical endocrine events required for ovulation]

Question 20

How does Progesterone act to suppress ovulation?

Answer 20

Inhibits activity of hypothalamus and anterior pituitary by negative feedback, thus suppressing secretion of FSH and LH (and preventing development of follicle cell)

Question 21

What effects does high levels of Progesterone have on the endometrium?

Answer 21

Inhibits endometrial gland development making implantation less favourable and thickens cervical mucus inhibiting sperm motility

Question 22

What are some common adverse effects of oral contraception?

Answer 22

Breakthrough bleeding, nausea, depression
Increased of CV complications (e.g. thromboembolism, stroke, ischaemic heart disease and hypertension) - oestrogen containing contraceptions
Slight increase in breast cancer risk in long term use

Question 23

What benefits can oral contraception have, outside of for the purpose of contraception?

Answer 23

Endometriosis symptom relief
Dysmenorrhea and menorrhagia
Acne in women (oestrogen containing contraceptions)
Reduced risk of endometrial cancer (progesterone)