Contraception

Question 1

Contraceptive Options

Answer 1

• Long acting, reversible
  
  • Implant
  • Injection
  • Intrauterine (hormonal and non-hormonal)
• Long acting, permanent
  
  • Vasectomy
  • Sterilisation
• Regularly taken
  
  • Hormonal pills, patches or rings
  • Condoms (male and female)
  • Diaphragms

Question 2

Implant

Answer 2

• Small flexible rod lies under skin in upper arm
• Contains progestogen - stops egg being released, mucus thicker, think lining womb
• Duration - 3 years
• Failure - 0.05%
• Side effects
  
  • No periods
  • Regular period
  • Unpredictable bleeding

Question 3

Hormonal intrauterine

Answer 3

• Progestogen - thins endometrium, mucus thicker, 10% inhibitis ovulation
• Duration - 3-5 years (Jaydess or Mirena)
• Failure - 0.2%
• Side effects
  
  • Periods lighter and less painful
  • Irregular bleeding common in first 6 months

Question 4

Non-hormonal intrauterine

Answer 4

• Copper - kills sperm, stops implantation, mucus thicker
• Duration - 5-10 years
• Failure - 0.8%
• Avoids hormones
• Can be used as emergency contraception
• Side effects
  
  • Heavier periods
  • Pain

Question 5

COCP

Answer 5

• Oestrogen and progestogen - inhibits ovulation, alters mucus and endometrium
• How to take
  
  • 21d/7d off
  • 12 hours to remember
  • Missing pills, vomiting and diarrhoea reduce effectiveness
• Failure - 9%
• Benefits
  
  • Reduces bleeding and period pain
  • Can help premenstrual symptoms
• Risks
  
  • Small increased risk of VTE/PE
  • Migraine with aura is contraindications
  • Small increased risk or Br Ca

Question 6

POP

Answer 6

• Progestogen - thickens mucus, thins endometrium (Desogestrel POP also inhibits ovulation)
• How to take
  
  • Daily - no breaks
  • 3-12 hours to remember
  • Missing pills, vomiting or diarrhoea reduce effectiveness
• Failure - 9%
• Benefits
  
  • Can be used by people who smoke and >35 years, or those breastfeeding
• Side effects
  
  • Break through bleeding

Question 7

Sterilisation

Answer 7

• Tubes cut, sealed or blocked
• Failure
  
  • 0.5% women
  • 0.15% men

Question 8

Condoms

Answer 8

• Thin layer of latex or synthetic rubber
• Failure - 18%
• Reduce risk of STIs

Question 9

Emergency contraception

Answer 9

• Best within 72 hours but can be up to 5 days
• Gold standard is copper intrauterine
• Oral hormonal method
  
  • Ulipristal acetate (ellaOne)
  • Levonogestrel EHC