Contraception

Question 1

What are the only contraceptive options for males?

Answer 1

Condoms

Vasectomy - cut and tie the vas deferens

Question 2

In relation to contraception, what is a method failure?

Answer 2

Pregnancy despite correct use of method by user

Question 3

In relation to contraception, what is a user failure?

Answer 3

Pregnancy because the user hasn’t taken the contraception correctly

Question 4

What types of contraception are Long-acting Reversible contraceptives (LARC)?

Answer 4

IUD

Implant

Question 5

Normal menstrual cycle

Answer 5

28 days normally but this varies. If it is 21-40 but regular then this is a normal variant.

Ovulate 2 weeks before period (around days 12-18)

The egg survives for 24 hours

Question 6

When is the highest chance of pregnancy during a female’s cycle?

Answer 6

Day 8-19

Question 7

Which 2 hormones are in the combined hormonal contraception? And what do they do?

Answer 7

Ethinyl estradiol (an estrogen)

Synthetic Progesterone (a progestogen)

They stop ovulation, also affect cervical mucus and endometrium

Question 8

What is the standard regime of the combined pill? i.e how do you take it?

Answer 8

Take the pill for 21 days with a 7 day break

Question 9

What is tricycling?

Answer 9

There is the option to take 3 packs (so covering 3 cycles) of the pill before having a 7 day break - this helps if you have bad symptoms on your period or if you often forget to restart after a break

Question 10

What different forms can combined hormonal contraception be taken in?

Answer 10

Pill
Patch - changed weekly
Vaginal ring - changed every 3 weeks

Question 11

What are some benefits of combined hormonal contraception?

Answer 11

• Regulate or reduce periods - help with heavy or painful natural periods
• Stop ovulation - may help PMS
• 50% reduction in ovarian and endometrial cancer
• Reduction in functional ovarian cysts - helps PCOS symptoms
• Can improve acne

Question 12

Negative side effects of combined hormonal contraception

Answer 12

Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months
Mood? - hard to tell if it is the pill causing this
Weight gain - not causal

Question 13

What are some serious risks of combined hormonal contraception?

Answer 13

Increased risk of venous thrombosis (DVT or PE) and arterial thrombosis (MI or ischaemic stroke)

Increased risk of cervical and breast cancer - this goes back to normal after you come off the pill for over 10 years

Question 14

What is the ‘mini pill’?

Answer 14

The progestogen-only pill. You take it at the same time every day without a pill-free interval (usually no bleeding). Prevents ovulation and affects cervical mucous. It is Oestrogen free so as a result there are very few contraindications.

There are 2 different types:

• 3-hour progestogen-only pill (traditional progestogen-only pill) – must be taken within 3 hours of the same time each day
• 12-hour progestogen-only pill (desogestrel progestogen-only pill) – must be taken within 12 hours of the same time each day

Question 15

Side effects of the mini pill (progestogenic side effects)

Answer 15

These vary between women and are only troublesome not ‘dangerous’

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

No increased risk of venous or arterial thrombosis

should be avoided if current breast cancer or liver tumour past/present

Question 16

Injectable progestogen ‘the jag’

Answer 16

Progestogen only

Deep intramuscular injection into the upper outer quadrant of the buttock every 13 weeks

Prevents ovulation, alters cervical mucus making it hostile to sperm and makes endometrium unsuitable for implantation

Question 17

Negatives surrounding the ‘jag’

Answer 17

Delay in return to fertility – average 9 months

Problematic bleeding especially first 2 doses

Bone density affected - although this is reversible

Weight gain - the injection is the only contraceptive that has causal effect on weight gain

Question 18

Describe the rod/implant

Answer 18

Releases progestogen into your bloodstream

Lasts for 3 years

60% have no bleeding but 30% have prolonged frequent bleeding

May cause mood change more often than other progestogen only methods

Question 19

Describe the coil/intrauterine device

Answer 19

Device inserted into womb.

2 different types - one releases copper - copper IUD and the other releases progestogen (IUS).

IUD - copper is toxic to sperm and the ovum. It also alters the endometrium and makes it less accepting of implantation.
IUS - ovulation still happens but IUS stops fertilisation by affecting the cervical mucus and endometrium

They last for up to 5-10 years

Effects/side effects immediately reversible when removed

Your periods can be heavier, longer or more painful in the first 3 to 6 months after an IUD/IUS is put in.

Question 20

What are the options for emergency contraception?

Answer 20

Levonorgestrel pill (levonelle) take within 72 hours

Ulipristal pill (ellaone) take within 120 hours - More contraindications

Copper IUD most effective - fit within 120 hours of unprotected sex

Question 21

How soon after delivering a baby can you get pregnant?

Answer 21

21 days

Question 22

How soon after having a miscarriage or abortion can you get pregnant?

Answer 22

5 days

Question 23

Is breast feeding a contraceptive?

Answer 23

Yes but only for the first 6 months and only if the woman is feeding every 4 hours and is not menstruating

Question 24

Irreversible contraceptive options

Answer 24

Female sterilisation
Vasectomy
Abortion