Contraception

Question 1

What is the pearl index?

Answer 1

ThePearl Indexis defined as the number of contraceptive failures per 100 women-years of exposure. It looks at the total months or cycles of exposure from the initiation of the product to the end of the study

Question 2

On what days of a women’s cycle is she most likely to get pregnant?

Answer 2

Days 8-19

Question 3

What kind of combined hormones are available?

Answer 3

Combination of ethinyl estradiol and synthetic progestogen
Pills, rings and patches
Some people have skin reactions to the patch, changed weekly
Rings need to be changed every 3 weeks

Question 4

What are the non contraceptive benefits of combined contraception?

Answer 4

Regulate/reduce bleeding- help heavy or painful natural periods
Stop ovulation- may help premenstrual syndrome
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne / hirsutism
Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

Question 5

What are the serious risks of CHC?

Answer 5

Increased risk venous thrombosis- DVT PE
Avoid if BMI >34, previous VTE, 1st degree relative VTE under 45, thrombophilis eg systemic lupus erythematosus, reduced mobility
Increased risk arterial thrombosis- MI / ischaemic stroke
Avoid in smokers >35, personal history arterial thrombosis, focal migraine, age>50, hypertension>140/90
Avoid if active gall bladder disease or previous liver tumour
Increased risk cervical cancer- data predates HPV vaccine
Increased risk breast cancer- back to normal after 10 years off Rx
NB family history of breast cancer not a contraindication ( unless BRCA positive)
No overall increased cancer risk for CHC users

Question 6

What are two contraindications to the POP?

Answer 6

Personal history of breast cancer

Liver tumour

Question 7

What are the side effects of the POP?

Answer 7

Appetite increase
Hair loss/gain
Mood change
Bloating or fluid retention
Headache
Acne

Question 8

How does the progestogen jag work?

Answer 8

Prevents ovulation
It alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation

Question 9

What are the side effects/risks of the injectable progestogen?

Answer 9

This is the only contraceptive method with a causal effect on weight gain , delayed return of fertility and bone density

Question 10

What are the side effects of the progestogen implant?

Answer 10

60% are almost bleed free but 30% have prolonged / frequent bleeding
May cause mood change more often than other progestogen only methods

Question 11

What are the two different actions of IUD?

Answer 11

Copper-Toxic to sperm, stop sperm reaching egg, may sometimes prevent implantation of fertilised egg
Hormonal- Affect cervical mucus and endometrium most women still ovulate Stop fertilisation of egg- may prevent implantation fertilised egg
Slow release progestogen on stem

Question 12

What are the three forms of emergency contraception?

Answer 12

Copper IUD most effective option-fit before implantation ie within 120 hrs UPSI any time cycle or by day 19 of 28 day cycle
Can keep long term if like the method
If 100 women use emergency IUD there will be < 1 pregnancy

Levonorgestrel pill-’Levonelle’ - take within 72 hrs
If 100 women use will be 2-3 pregnancies

Ulipristal pill ‘ellaone’ – take within 120 hrs
More contraindications eg breast feeding/enzyme inducing drugs/ acid reducing drugs
If 100 women use will be 1-2 pregnancies

Question 13

What is the procedure for a medical abortion?

Answer 13

Mifepristone oral antiprogestogen tablet
36-48 hours later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
- Average 4-6 hours to pass pregnancy under 12 weeks
- Mifepristone helps Misoprostol work better