Contraception

Question 1

What are some examples of barrier contraception?

Answer 1

Condoms, caps, cervical sponge, female condoms

Question 2

What are some advantages of barrier contraception?

Answer 2

Prevent STIs, some can be inserted any time before intercourse

Question 3

Describe some natural contraceptive methods:

Answer 3

Fertility awareness: physiological monitoring to find fertile times (6 days prior to ovulation to 2 days after). Monitor cervical mucus thickness and basal body
temp.
Lactational amenorrhoea: breastfeeding delays return of ovulation

Question 4

Describe the method of action of the IUCD:

Answer 4

Inhibits fertilisation as its toxic to sperm and ovum, also prevents implantation and sperm penetration of cervical mucus

Question 5

What are some potential problems related to the IUCD?

Answer 5

Expulsion
PID following insertion
Dysmenorrhoea 
Risk of uterine perforation on insertion
Increased risk of ectopic if woman does become pregnant

Question 6

What is the mechanism of action of the IUS?

Answer 6

Has a local effect (reversible endometrial atrophy) which makes implantation less likely and periods lighter and less painful

Question 7

What is the mechanism of action of the combined hormonal contraceptive?

Answer 7

Inhibits ovulation, reduces endometrial receptivity to implantation and thickens cervical mucus

Question 8

What are some side effects of combined hormonal contraception?

Answer 8

Breast tenderness, nausea, weight gain, bloating, discharge
Mood swings, vaginal dryness, decreased libido
Headache

Question 9

What are some additional benefits of being on the combined hormonal contraceptive?

Answer 9

Improvement in acne, relieves menstrual disorders, decreased risk of ovarian, endometrial and bowel cancers

Question 10

What are some contraindications to combined hormonal contraception?

Answer 10

VTE
CVD including stroke, TIA, IHD, peripheral vascular disease
Active liver disease
Breast cancer
Migraine with aura or severe migraines

Question 11

What is the mechanism of action of progestogen only contraception?

Answer 11

Thicken cervical mucus and reduce receptivity of the endometrium to implantation, with high dose progesterone (depot/implant) inhibiting ovulation

Question 12

Which progestogen only pill has a large window (12h) to take the pill within?

Answer 12

Cerazette (desogestrel)

Question 13

What are some side effects of the PoP?

Answer 13

Higher failure rate than COCP 
Menstrual irregularities
Breast tenderness
Depression
Acne
Reduced libido
Weight change

Question 14

How long does the depot progestogen provide contraception for?

Answer 14

8-12 weeks

Question 15

What are some adverse effects of depot progestogen?

Answer 15

Menstrual disturbance including amenorrhoea
Increased risk of osteoporosis
Weight gain
Delay in return of ovulation

Question 16

How long does the progestogen implant provide contraception for?

Answer 16

Up to 3 years

Question 17

What are the failure rates for male and female sterilisation respectively?

Answer 17

Male: 1/2000
Female: 1/200

Question 18

Describe the process of female sterilisation:

Answer 18

Laparoscopically with GA – Filshie clip occlusion with LA for tubes

Question 19

Describe the process of male sterilisation:

Answer 19

Vas deferens is ligated and excised or lumen cauterised

Question 20

What are some complications of male sterilisation?

Answer 20

Bruising, haematoma, chronic testicular pain

Question 21

What are the 3 methods of emergency contraception? And within what timeframe should each be used?

Answer 21

Emergency IUCD (within 120h of unprotected sex)
Ullipritsal acetate (within 120h)
Levonorgestrel (within 72h)

Question 22

What contraceptive methods can be used in over 50s?

Answer 22

Non-hormonal or progestogen only method (implant, PoP, IUS)