Contraception

Question 1

What is the pearl index?

Answer 1

Number of contraceptive failures per 100 women against years of exposure

Question 2

What is a benefit of long acting reversible contraception (LARC)?

Answer 2

Minimises user input and so minimises failure rates

Question 3

What is method failure?

Answer 3

Pregnancy despite correct use of method by user

Question 4

What is user failure?

Answer 4

Pregnancy because method not used correctly

Question 5

When is the highest chance of pregnancy from sex?

Answer 5

Day 10-17

BUT Sperm survival and ovulation is variable so natural methods can fail even if abstain/barrier on most fertile days

Question 6

What is combined hormonal contraception?

Answer 6

Combination of Ethinyl Estradiol (EE) and Synthetic Progesterone
Stops ovulation and affects cervical mucus and endometrium

Question 7

What is the standard regime for combined hormonal contraception?

Answer 7

Pill taken daily
Patch changed weekly
Ring changed every 3 weeks

Question 8

What are some non-contraceptive benefits of combined methods?

Answer 8

Regulate/reduce bleeding
Stopping ovulation may help premenstrual syndrome
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne/hirsutism
Reduce benign breast disease, RA, colon cancer and osteoperosis

Question 9

What are some slight negative side effects of combined method?

Answer 9

Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months
Mood

Question 10

What are some serious risks associated with CHC?

Answer 10

Increased DVT and PE risk
Increased arterial thrombosis risk (MI, Stroke)
Increased cervical cancer risk but data precedes HPV vaccine
Increased breast cancer risk

Question 11

What is one contraindication for the POP?

Answer 11

Frequent GI upset

Question 12

What is the window period for desogestrel pill?

Answer 12

12 hours

Question 13

What is the window period for traditional LNG NET pills?

Answer 13

3 hours

Question 14

List some progestogenic side effects.

Answer 14

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

Question 15

What are the effects of injectable progestogen?

Answer 15

Prevents ovulation
Alters cervical mucus to make it hostile to sperm
Makes endometrium unsuitable implantation

Question 16

What is the regime for injectable progestogen?

Answer 16

Injected into right upper buttock every 13 weeks

Question 17

What are the effects of the progestogen implant?

Answer 17

Inhibition of ovulation
Effect on cervical mucus
No user input needed
No causal effect on weight

Question 18

Is the copper IUD a contraindication to MRI?

Answer 18

No

Question 19

What are some benefits of the copper IUD?

Answer 19

Hormone free

Can last 5-10 years depending on type

Question 20

What is a drawback of copper IUD?

Answer 20

May make periods heavier/crampier

Question 21

How does the copper IUD work?

Answer 21

Toxic to sperm

May sometimes prevent implantation of fertilised egg

Question 22

What is the most effective emergency contraception?

Answer 22

Copper IUD

Fit before implantation ie within 120 hours

Question 23

What are the main emergency contraceptives?

Answer 23

Copper IUD
Levongestrel
Ulipristal (Ellaone/UPA)

Question 24

What is the effect of enzyme inducing drugs on contraception?

Answer 24

Increases metabolism of progestogen and oestrogen

Reduces effect of CHC

Question 25

Name some common enzyme inducing drugs.

Answer 25

Carbamazepine Topiramate Rifampicin St Johns Wort

Question 26

What is female sterilisation?

Answer 26

Laparoscopic sterilisation Usually Filshie clips applied across tube to block lumen Irreversible

Question 27

What is a vasectomy?

Answer 27

Vas deferens divided and ends cauterised

Question 28

Does vasectomy affect testosterone or sexual function?

Answer 28

No

Question 29

Which age group gets the most abortions?

Answer 29

20-24

Question 30

What proportion of UK women will have an abortion at some point?

Answer 30

1 in 3

Question 31

What rights does the 1967 Abortion Act give healthcare workers?

Answer 31

Staff have a right to refuse participation as long as this does not affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman Must ensure woman can access abortion care

Question 32

What criteria must be met to support a woman's request?

Answer 32

2 doctors sign support Under 24 weeks Pregnancy poses greater to risk to physical/mental health of pregnant woman or existing children of the pregnant woman than termination Substantial risk that the child may suffer from physical or mental abnormalities as to be seriously handicapped

Question 33

How does mifepristone work?

Answer 33

Oral antiprogestogen tablet mifepristone | 36-48 hours later misopristol initiates uterine contraction which opens cervix and expels pregnancy

Question 34

Is home abortion legal?

Answer 34

Yes | Misoprostol may be supplied to a healthy woman under 10 weeks gestation for self administration

Question 35

Does abortion affect future fertility, pregnancy or delivery?

Answer 35

No