Contraception

Question 1

What is meant by a ‘99%’ effectiveness with regards to contraception?

Answer 1

That an average person using this method of contraception properly with a regular partner for a single year would only have a 1% change of getting pregnant

Question 2

What is UKMEC used for?

Outline the 4 levels of UKMEC

Answer 2

To assess the safety of different contraceptive methods based on individuals

UKMEC1 = no restriction in use
UKMEC2 = advantages > disadvantages
UKMEC3 = disadvantages > advantages 
UKMEC4 = unacceptable risk, contraindicated

Question 3

What is the effectiveness of the COCP if taken properly?

Answer 3

> 99%

Question 4

What is the main mechanism of action of the COCP as contraception?

State two other actions

Answer 4

Prevents ovulation

Thickens cervical mucus
Thins endometrium

Question 5

What are the different ways to take the the COCP (different types)? (3)

Describe each one

Answer 5

Monophasic - identical pills taken every day for 21 days followed by 7 day gap

Phasic - one pill taken every day for 21 days followed by 7 day gap, but pills contain varying amounts of hormones (need to be taken in correct order)

Every day - pill taken everyday, 7 are inactive placebo pills

Question 6

What are common side effects of the COCP?

Answer 6

Breakthrough bleeding/spotting
Breast tenderness
Headaches/migraines
Changes in libido
Acne

Question 7

What are some risks associated with COCP use?

Answer 7

Stroke
DVT
HTN
Increased risk of breast cancer

Question 8

What effect does COCP use have on cancer risk?

Answer 8

Increased risk - breast cancer

Reduced risk - endometrial, ovarian and colon cancer

Question 9

What are some UKMEC 4 contraindications for COCP use?

Answer 9

Over 35 + smoker
Pregnancy
Previous thrombosis
Previous stroke/heart disease
Uncontrolled HTN
FH thrombosis
Migraine with aura
Breast cancer

Question 10

When should the COCP be started to offer immediate protection?

Answer 10

First day of the cycle (first day of menstrual period)

Question 11

What is the missed pill rule for ONE missed pill?

Answer 11

Take missed pill as soon as possible, no extra protection required

Question 12

If you start the COCP not on the first day of the cycle, what precautions should be taken?

Answer 12

Barrier contraception for 7 days

Question 13

How should switching of combined pill types be done?

Answer 13

Once 21 days of first pill is over, start 21 days of new pill immediately

Question 14

Name two types of COCP

Answer 14

Microgynon

Yasmine

Question 15

How is the POP taken differently to the COCP?

Answer 15

POP is taken continuously

COCP is taken cyclically

Question 16

How does the POP work as contraception? (2)

Answer 16

Thickens cervical mucus

Prevents ovulation

Question 17

What is the effectiveness of the POP if taken perfectly?

Answer 17

> 99%

Question 18

What time of the day should traditional POP be taken?

Answer 18

Within the same 6 hour window every day (3 hours +/- the same time from day before)

Question 19

Name two types of POP

Answer 19

Norethisterone (traditional)
Levonorgestrel (traditional)
Desogestrel (new gen, 24 hr window)

Question 20

What are some side effects of the POP?

Answer 20

Irregular bleeding
Amenorrhoea
Breast tenderness
Headaches
Change in libido
Acne

Question 21

What are the two types of IUD?

What is their effectiveness if inserted properly?

Answer 21

Copper coil

Mirena coil

> 99%

Question 22

What is the mechanism of action of the copper coil?

When is it effective after insertion?

Answer 22

Reduces sperm motility and survival

Effective immediately

Question 23

What is an alternative use for the copper coil other than traditional contraception?

Answer 23

Emergency contraception - inserted up to 5 days after unprotected intercourse

Question 24

What are some of the side effects/complications associated with copper IUD?

Answer 24

Menorrhagia/IMB (improves over time)
Uterine perforation/PID on insertion
Increased risk of ectopic pregnancies

Question 25

What is the mechanism of action of the Mirena coil?

Answer 25

Releases levonorgestrel (progestogen) to thicken the cervical mucus and reduce endometrial thickening

Question 26

How can the Mirena coil affect bleeding?

Answer 26

Can make periods lighter or stop altogether Can cause irregular bleeding

Question 27

What are the side effects associated with the Mirena coil?

Answer 27

Spotting/irregular bleeding PID/uterine perforation (more rare) Increased risk of ectopic pregnancies

Question 28

What is the alternative use of the Mirena coil other than for traditional contraception?

Answer 28

First line treatment for menorrhagia (where pregnancy not desired)

Question 29

What does the Depo-provera injection contain? How often is it taken?

Answer 29

Medroxyprogesterone acetate (progestogen) 3 monthly IM injection

Question 30

How effective is a regular 3 monthly Depo provera injection as contraception?

Answer 30

> 99%

Question 31

What is the mechanism of action of the Depo provera injection? (2)

Answer 31

Prevents ovulation | Thickens cervical mucus

Question 32

How long can it take for fertility to return in women who take the Depo provera injection as contraception?

Answer 32

12 months

Question 33

When should the Depo provera injection be given to provide immediate contraception? What precaution should be taken if started at any other time?

Answer 33

First day of cycle (menstrual period) 7 day barrier contraception

Question 34

What side effects are associated with the Depo provera injection?

Answer 34

``` Amenorrhoea Irregular bleeding WEIGHT GAIN Acne OSTEOPOROSIS ```

Question 35

Which contraceptive method is the only one to have a proven association with weight gain?

Answer 35

Depo provera injection

Question 36

What is the name of the implant used as contraception in the UK? Which hormone does it release?

Answer 36

NEXPLANON Progesterone

Question 37

How long is the progesterone implant effective for?

Answer 37

3 years

Question 38

What is the mechanism of the progesterone implant?

Answer 38

Same as POP - Inhibits ovulation - Thins endometrium - Thickens cervical mucus

Question 39

What side effects are associated with progesterone implant use?

Answer 39

Minor operation required to insert/remove Acne Bleeding changes Reduced libido

Question 40

For how long after giving birth, do all women not require contraception?

Answer 40

21 days after giving birth, no contraception required

Question 41

What contraception is considered safe in breastfeeding? When can it be started?

Answer 41

POP Any time

Question 42

Can the COCP be used whilst breastfeeding?

Answer 42

Should be avoided UKMEC4 before 6 weeks UKMEC2 after 6 weeks

Question 43

Is lactational amenorrhoea (full breastfeeding + no periods) effective as contraception? For how long?

Answer 43

98% effective as contraception for 6 months

Question 44

What contraceptives are contraindicated if mother is not breastfeeding?

Answer 44

Any contraceptive is fine

Question 45

What are three types of emergency contraception?

Answer 45

Levonorgestrel - POP Ulipristal - progesterone receptor modulator Copper IUD

Question 46

How is female sterilisation performed?

Answer 46

Laparoscopically under GA Blockage, tying, cutting or removal of Fallopian tubes

Question 47

How is male sterilisation performed?

Answer 47

Vasectomy, quick procedure under LA Cutting and tying of vas deferens to prevent sperm reaching semen