Contraception

Question 1

What is involved in an ideal contraceptive?

Answer 1

100% Reeversable
100% effective
100% unrelated to intercourse
100% free of side effects
100% protective aginst STI's
Low maintenance
Male and female options

Question 2

What is the most effective method of contraception (both perfect use and typical use)

Answer 2

Progesterone implant

Question 3

What days are the most likely days that a women will become pregnant

Answer 3

Days 8-19 of their menstrual period

Question 4

Described the ingredients combined hormonal contraception?

Discuss the method of action of the OCP

What forms does the OCT come in

Answer 4

Ethinyl estradiol and synthetic progesterone.

Aims to stop ovulation as well as affecting the cervical mucus and endometrium
21 days with hormone free week

can be a pill take daily, patch taken weekly or latex ring changed every 3 weeks (can be taken out for 3 hours every 24)

Question 5

What are the non contraceptive benefits of combined hormonal contraception?

Answer 5

Regulate heavy or painful periods
Stop ovulation
reduce ovarian cysts
reduced chances of ovarian and endometrial cancer
improves acne/hirstutism
Reduces benign breast disease, RA, colon cancer and osteoporosis

Question 6

What are some side effects of combined hormonal contraception

Answer 6

Breast tenderness
Nausea
Headache
Irregular bleeding in the first 3 months
Mood upsets
weight gain
pill- not good if causes GI upset
patch- 5% skin rashes

Question 7

What are some absolute contraindications and serious risks of combined hormonal contraception?

Answer 7

Avoid if BMI>34, previous VTE or FH VTE under 45 due to increased risks of venous thrombosis

Avoid in smoker>35, PMH arterial thrombosis, hypertension due to risks of MI/ischaemic stroke

Avoid if gall bladder disease or liver tumour

Increased risk of cervical cancer

Increased risk of breast cancer (however normalised after 10 without treatment)

Question 8

What is the progesterone only mini-pills mode of action

What are its benefits and contraindications?

Answer 8

Taken at the same time each day without a pill free interval.
Desogestrel pill, prevents ovulation, effects mucus also.

traditional LNG NET pill 3 hour window, mainly mucus 1/3 of times also anovulvant

Oestrogen free- contraindicated to breast cancer, previous liver tumour

Question 9

What are the side effects of the progesterone only pill?

Answer 9

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

NO INCREASED RISK OF VTE OR ARTERIAL THROMBOSIS

Question 10

What is “the jag”

How does it act as a contraceptive?

Answer 10

Injectable progesterone- aqueous solution of a drug. injection into upper outer quadrant of the buttock every week.

Prevents ovulation
Alters cervical mucus
Makes endometrium unsuitable for implantation

Question 11

What are the benefits to the jag

What are disadvantages to the jag

Answer 11

Only need to remember every 12 weeks
70% amenorrhoeic after 3 doses
Oestrogen free so few contraindications

Average 9 month return to fertility
Reversible reduction in bone density
Problematic bleeding especially in first two doses
Weight gain (2-3kg)

Question 12

What is the rod?

What is its mode of action

What are the advantages/disadvantages of the progesterone implant

Answer 12

Progestogen implant-

inhibition of ovulation and effects cervical mucous,

no user input needed, no causal effect on weight gain

Question 13

What are the negative effects of the rod

Answer 13

60% are almost bleed free but 30% have prolonged/frequent bleeding

May cause mood changes more often than other progestogen only methods

Question 14

What is intrauterine contraception?

Answer 14

“the coil” comes as the copper IUD or the levonorgestrel IUS

Question 15

Describe the process of the coil being fitted?

Answer 15

GP/sexual health clinic will fit the device, takes around 10 minutes. Also allows STI testing for all with new partner or all under 25

Question 16

What are the benefits on the coil?

Answer 16

Little user input after fitting (neither woman or partner should be aware of device)
Can be fitted for any age or any parity
Effects/side effects immediately reversible when removed

Question 17

What are the side effects of the coil?

Answer 17

Small infection risk in first three weeks
1:1000 risk perforation
5:100 risk expulsion
If conceives may be ectopic however ectopic risk even lower than condoms

Question 18

Describe the mode of action of the copper IUD

How long does it last?

Answer 18

usual mode of action, toxic to sperm, stops sperm reaching eggs.
May sometimes prevent implantation of fertilised egg, hormone free, makes periods heavier/crampier. Cam last 5-10 years depending on type

Question 19

What is levonorgestrel?

What is its mechanism of action?

Answer 19

Slow release progesterone. Low circulating progestogen levels. reduced menstrual bleeding after 4 months after initial regular bleeding

Affects cervical mucus and endometrium. Most women still ovulate. Stops fertilisation of egg may still prevent implantation.

Question 20

What are the forms of emergency contraception?

Answer 20

Copper IUD- msot effective, fit within 120 hours or by day 19 of a 28 day cycle

Levonorgestrel pill- take within 72 hours

Ulipristal pill- ellaone- take within 120 hours

Question 21

What options of female sterilisation are there?

Answer 21

Laparoscopic sterilisation- filshie clips applied across fallopian tubes

Irreversible, fialure rate. May lead to ectoic, reduces ovarian cancer risk

Salpingectomy- removing Fallopian tubes- can do at planned cesarean if baby seems well and is discussed in advance

Question 22

What is a vasectomy?

Answer 22

Male sterilisation, vas deferens divided and ends cauterised, most done in primary care. Takes 4-5 months to be effective. no increased risk on testosterone or sexual function

Question 23

What are the rights and responsibilities of medical staff when carrying out abortion care

Answer 23

Right to refuse to participate in abortion procedure due to conscientious objection.

Obligation to ensure that woman are still able to access abortion care

Staff have the right to refuse participation of treatment as long as it does not result in serious mental or physical harm of the pregnant woman

Question 24

What are the criteria for an abortion?

Answer 24

Pregnancy has grave risk to mother
Termination is necessary to prevent mental or physical health of the pregnant woman
Under 24 weeks the continuation of pregnancy involves risks greater than if the pregnancy were terminated of injury
There is a substantial risk that if the child were born it would suffer physical or mental abnormalities and be seriously handicapped

Question 25

What is the process of a clinical consultation for an abortion?

Answer 25

Scan for gestational viability
Medical history- risk VTE, bleeding, contraceptive eligibility
Why abortion- no coercion or gender based violence
Discuss methods of abortion, what to expect and when to seek medical advice
Contraception afterwards

FBC/rhesus, STI check