Contraception

Question 1

Combined oral contraceptive pill (COCP) contains?

Answer 1

Oestrogen and progesterone

Question 2

Mechanism of COCP?

Answer 2

Prevent ovulation
Thickens cervical mucus
Thins the endometrium

Question 3

Types of COCP?

Answer 3

Monophasic
Phasic
Daily

Question 4

Monophasic COCP?

Answer 4

Microgynon
Yasmine
Same pill for 21 days, 7 day gap for withdrawal bleed

Question 5

Phasic COCP?

Answer 5

Logynon
Pill for 21 days, 7 day gap for withdrawal bleed
Hormonal levels vary to match changes in menstrual cycle
Must be taken in order

Question 6

Daily COCP?

Answer 6

Microgynon ED
21 pills and 7 sugar pills
Take the pill every day and accounts for withdrawal bleed

Question 7

Common side effects of COCP?

Answer 7

Headaches
Breakthrough bleeding
Improving/worsening acne
Changes in libido
Breast tenderness

Question 8

Risks of COCP?

Answer 8

Hypertension
Thrombosis
Increased risk of breast cancer (but reduced risk of endometrial, ovarian and cervical cancer)

Question 9

Contraindications of COCP?

Answer 9

Over 35 and smoker
Pregnancy
Previous DVT/PE
Previous stroke/MI
Uncontrolled hypertension
Family history of thrombosis
Migraine with aura
Breast cancer

Question 10

Progesterone only pill, minipill, examples?

Answer 10

Cerazette

Older - micronor, norgeston

Question 11

Side effects of POP?

Answer 11

Acne
Headache
Breast tenderness
Irregular bleeding
Change in libido

Question 12

Two types of intrauterine devices?

Answer 12

Copper coil

Levonorgestrel-releasing coil (Mirena coil)

Question 13

Copper coil mechanism?

Answer 13

Prevents fertilisation

Copper is spermicidal

Question 14

Benefits of copper coil?

Answer 14

Can be inserted at any time during menstrual cycle
Hormone free
Can be used as emergency contraception up to 5 days after unprotected sex

Question 15

Drawbacks on copper coil?

Answer 15

Can increase periods
Uterine perforation (rare)
Increased risk of ectopic pregnancies
Can occasionally fall out

Question 16

Mirena coil mechanism?

Answer 16

Prevent fertilisation
Thickens cervical mucus
Reduces endometrial thickening

Question 17

Benefits of Mirena coil?

Answer 17

Can make periods lighter or stop altogether
Most bleed free after 1 year
(1st line treatment of menorrhagia where pregnancy is not desired)

Question 18

Drawbacks of Mirena coil?

Answer 18

Irregular bleeding

Alternative contraception is required for 7 days

Question 19

Depo-provera?

Answer 19

3 monthly injection of medroxyprogesterone acetate

Question 20

Depo-provera mechanism?

Answer 20

Prevents ovulation

Thickens cervical mucus

Question 21

Side effects of depo-provera?

Answer 21

Amenorrhoea
Irregular bleeding
Weight gain
Acne
Osteoporosis risk, affects bone density
Can take 12 months for fertility to return

Question 22

Progesterone implant?

Answer 22

Nexplanon, lasts for 3 years

Question 23

Implant mechanism?

Answer 23

Inhibits ovulation
Thickens cervical mucus
Thins the endometrium

Question 24

Benefits of implant?

Answer 24

No need to remember to take a pill every day
Can improve dysmenorrhoea
Does not affect bone mineral density

Question 25

Drawbacks of implant?

Answer 25

Mood changes
Acne
Reduced libido
Surgical insertion/removal

Question 26

Emergency contraception methods?

Answer 26

Copper coil (within 5 days)
Levonorgestrel pill (within 72 hours)
Ulipristal pill, morning after pill (within 120 hours, more contraindications)

Question 27

Contraindications of ulipristal pill ‘ellaone’ as emergency contraception?

Answer 27

Breastfeeding
Enzyme inducing drugs
Acid reducing drugs

Question 28

Termination of pregnancy methods?

Answer 28

Surgical or medical

Question 29

Surgical termination of pregnancy?

Answer 29

Misoprostol 3 hrs before

Transcervical suction catheter

Question 30

Medical termination of pregnancy?

Answer 30

Mifepristone (antiprogestogen)

36-48 hours later Misoprostol initiates uterine contraction

Question 31

Which drug can be taken at home as part of a medical termination of pregnancy?

Answer 31

Misoprostol