Contraception

Question 1

What are the common methods of contraception and what is the mechanism of each one?

Answer 1

Combined hormonal contraception: pill daily, patch weekly, ring 3 weeks. Ethinyl Estradiol and synthetic progesterone. Stops ovulation and affects cervical mucus and endometrium.

Progesterone only pill: affect cervical mucus, pill taken once daily

Implant/injection: jag 13 weeks, prevents ovulation, cervical mucus, unsuitable implantation endometrium

Intrauterine eg coil: copper is toxic to sperm, hormone free. Hormone affect mucus, and endometrium, most still ovulate, stop fertilisation of egg. Slow release of progesterone

Sterilisation

Question 2

What are the side effects associated with the common methods of contraception?

Answer 2

COC: improve acne, reduce chance of cancer, reduces bleeding, breast tenderness, nausea, headache, irregular bleeding

POP: appetite increase, hair loss/gain, mood change, bloating or fluid retention, headache, acne

Jag: delay in return to fertility, reversible reduction in bone density, weight gain

Implant: possible prolonged, frequent bleeding. Mood changes

IUD: copper - heavy bleeding

Question 3

What are the methods of male and female sterilisation, when are they indicated and what are the failure rates?

Answer 3

Female

• laparoscopic (clips across the tubes). No effects on hormones. Reduces ovarian cancer risk. Failure rate 1 in 200.
• may do salpingectomy at planned caesarian section
• ESSURE, hysteroscopic sterilisation no longer available commercially

Male
- vasectomy (vas deferens divided) 4-5mn to be effective. 2 in 100 failure rate. If get clear samples post vasectomy failure rate is 1 in 2000. Irreversible. No effects on testosterone or sexual function, or increased risk of cancer.

Question 4

What are the main issues involved during counselling a couple prior to sterilisation?

Answer 4

X

Question 5

What is the abortion act and the common medical and surgical methods of termination?

Answer 5

2 doctors have to sign for the following reasons

• risk to life of women
• to prevent permanent injury to physical or mental health
• <24wk & continuation would involved risk greater than if pregnancy terminated (physical and mental health)
• <24wk & continuation would involved risk greater than if pregnancy terminated for health and well-being of current children
• if baby born would suffer mental or physical abnormalities as to be seriously handicapped

Methods:

• surgical (5-12wk): suction catheter
• medical (5-24wk): mifepristone to help the misoprostol (36-48 hours later) to expel pregnancy