Contraception

Question 1

What is the most accepted MoA of levonorgestrel?

Answer 1

Levonorgestrel most accepted mechanism is that it delays ovulation.
It also interferes with corpus luteum function, thicken cervical mucous making it more difficult for sperm to get through, alter tubal transport of sperm, egg or embryo and directly inhibits fertilisation-clinical evidence is lacking.

Question 2

Important features to remember when giving levonorgestrel

Answer 2

If a person vomited the morning after pill within 2 hours, then another pill is needed.
The morning after pill might also cause an irregularity in the cycle.
If the next period is light or more than 3 days late, she’d need a pregnancy test.

Question 3

What are other options for emergency contraception?

Answer 3

Copper coil IUD

EllaOne (Ulipristal acetate 30mg)

Question 4

What is the most effective form of emergency contraception?

Answer 4

Most effective form of emergency contraception is IUD and can prevent pregnancy when fitted up to 5 days (120 hours) after unprotected sex or up to 5 days since the earliest time of ovulation.

Question 5

Important features about the copper coil IUD

Answer 5

It can be left in place for ongoing contraception for up to 10 years.
It requires a trained medical professional to fit it, which involves a procedure similar to a smear where the coil is inserted through the cervical os.
The pharmacist generally would not be able to fit this. This is associated with a small risk of infection and perforation.
If used for ongoing contraception, it can affect periods, generally making them heavier and/or more painful.

Question 6

MoA of EllaOne

Answer 6

This is a newer oral emergency contraceptive pill than levonorgestrel.
It binds with high affinity to progesterone receptors, and delays ovulation.
It has a license to be used up to 120 hours after unprotected sex.
Due to this binding to progesterone receptors, consideration needs to be made if an oral contraceptive is going to be used following this morning after pill.

Question 7

Effectiveness of contraceptive injection

Answer 7

With perfect use, over 99% effective; fewer than 1 in 100 injection users will get pregnant in a year. With typical use, around 94% effective; around 6 in 100 injection users will get pregnant in a year.

Question 8

MoA of contraceptive injection

Answer 8

Releases the hormone progestogen which stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus (womb) to prevent a fertilised egg implanting.

Question 9

Advantages and disadvantages of contraceptive injection

Answer 9

Advantages- Lasts for 13 weeks (DepoProvera and Sayana Press) or 8 weeks (Noristerat).
You don’t have to think about contraception for as long as the injection lasts. May reduce heavy, painful periods for some people.
Disadvantages- Periods may stop, be in regular or last longer.
Periods and fertility may take time to return after stopping the injection.
Some people gain weight.

Question 10

Important features of contraceptive injection

Answer 10

The injection can’t be removed from the body so any side effects may continue for as long as it works and for some time afterwards. Not affected by other medicines, diarrhoea or vomiting.

Question 11

Effectiveness of contraceptive implant

Answer 11

100 percent effective once fitted. Fewer than one in 100 implant users will get pregnant in a year.

Question 12

MoA of contraceptive implant

Answer 12

Small flexible rod put under the skin of the upper arm . Releases the hormone progestogen Come on which stops ovulation, thickens some cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus [womb] to prevent a fertilised egg implanting.

Question 13

Advantages and disadvantages of contraceptive implant

Answer 13

Advantages- works for three years but can be taken out. You don’t have to think about contraception for as long as the implant is in place. When the implant is removed your periods and fertility were returned to normal.
Disadvantages-periods may stop or be irregular or last longer. It requires a small procedure to fit and remove it.

Question 14

Important features of contraceptive implant

Answer 14

Put in using a local anaesthetic and no stitches are needed. Tenderness, bruising and some swelling may occur. You should be able to fill the implant with your fingers, but it can’t be seen. Some medicines may stop the implant from working.

Question 15

Effectiveness of intrauterine system (IUS)

Answer 15

Over 99% effective once fitted. Fewer than one in 100 IUS users will get pregnant in the year.

Question 16

MoA of IUS

Answer 16

A small T shaped plastic device, which slowly releases the hormone progestogen is put into the uterus [womb]. It thins the lining of the uterus to prevent a fertilised egg implanting and thickens the cervical mucus which makes it difficult for sperm to meet an egg.

Question 17

Advantages and disadvantages of IUS

Answer 17

Advantages- works for three to five years depending on type, but can be taken out sooner. You don’t have to think about contraception for as long as the IUS is in place. With the Mirena IUS, periods usually become lighter, shorter and sometimes less painful. When the IUS is removed your fertility will return to normal.
• Disadvantages- irregular bleeding or spotting is common in the first six months . Very small chance of getting an infection during the first 20 days after insertion. Some people get ovarian cyst. Insertion can be uncomfortable.

Question 18

Important features of IUS

Answer 18

You are taught to check the IUS is in place. Periods may stop altogether. A check for any existing infection may be advised before an IUS is put in. Not affected by other medicines. If fitted after 45, the Mirena IUS can stay in place until menopause.

Question 19

Effectiveness of intrauterine device (IUD)

Answer 19

Over 99% effective once fitted. Fewer than one in 100 IUS users will get pregnant in the year.

Question 20

MoA of IUD

Answer 20

A small plastic and copper device is put into the uterus. It stops sperm reaching an egg and may also stop a fertilised egg implanting in the uterus.

Question 21

Advantages and disadvantages of IUD?

Answer 21

• Advantages- Works as soon as it’s put in. Works for 5-10 years depending on type but can be taken out sooner. You don’t have to think about contraception for as long as the IUD is in place. When the IUD is removed your fertility will return to normal.
• Disadvantages- May not be suitable if you’re at risk of getting a sexually transmitted infection. Periods may be heavier or longer and more painful. Very small chance of getting an infection during the first 20 days after insertion. Insertion can be uncomfortable.

Question 22

Important features of IUD

Answer 22

You are taught to check the IUD is in place. Periods may stop altogether. A check for any existing infection may be advised before an IUD is put in. Not affected by other medicines. If fitted after 40, it can stay in place until menopause.

Question 23

Effectiveness of tubal occlusion

Answer 23

The overall failure rate is about one in 200. Hysteroscopic sterilisation has a failure rate of around one in 500 over 5 years. This is a permanent method, suitable for people who are sure they never want children or don’t want more children.

Question 24

MoA of tubal occlusion

Answer 24

The fallopian tubes are cut, sealed or blocked either by an operation or with a procedure called hysteroscopic sterilisation. This stops the egg and sperm meeting.

Question 25

Advantages and disadvantages of tubal occlusion

Answer 25

Advantages- it can’t be easily reversed. Hysteroscopic sterilisation can’t be reversed at all. Once the sterilisation has worked, you don’t have to think about contraception. Periods are unaffected.
Disadvantages - you need other contraception until the sterilisation is effective. All operation carry some risk, but risk of serious complications is low. There is a small increased risk of ectopic pregnancy if the sterilisation fails. You may need a general or local anaesthetic.

Question 26

Important features of tubal occlusion

Answer 26

shouldn’t be chosen if in any doubt, and counselling is important. You may experience discomfort or some pain for a short time after sterilisation. It’s important to rest and avoid strenuous activity for a while after the procedure.

Question 27

Effectiveness of vasectomy

Answer 27

About one in 2000 vasectomies fail. This is a permanent method, suitable for people who are sure they never want children or don’t want children.

Question 28

MoA of vasectomy

Answer 28

The tubes [vas deferens] that carries sperm from the testicles to the penis are cut, sealed or tied.

Question 29

Advantages and disadvantages of vasectomy

Answer 29

Advantages - It can’t be easily reversed . Once the sterilisation has worked, you don’t have to think about contraception. Usually performed on the local anaesthetic.
Disadvantages - contraception must be used until a semen test shows that no sperm are left. This can take at least eight weeks. Some people may experience ongoing testicle pain, but this isn’t common. Treatment for this is often unsuccessful.

Question 30

Important features of vasectomy

Answer 30

Shouldn’t be chosen if in any doubt, and counselling is important. you may experience discomfort or some pain for a short time after sterilisation. It is important to rest and avoid strenuous activity for a while after the procedure.

Question 31

Effectiveness of contraceptive vaginal ring

Answer 31

Over 99% effective if always used according to instructions (perfect use); fewer than 1 in 100 ring users will get pregnant in a year. With typical use, around 91% effective; around 9 in 100 ring users will get pregnant in a year.

Question 32

MoA of contraceptive vaginal ring

Answer 32

A small, flexible plastic ring is put into the vagina releases oestrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Question 33

Advantages and disadvantages of contraceptive vaginal ring

Answer 33

Advantages- You don’t have to think about it every day. It’s not affected if you vomit or have diarrhoea. It usually makes period regular, lighter and less painful. It’s easy to insert and remove. It improves acne for some women.
Disadvantages- Not suitable if you’re very overweight or a smoker aged over 35. A low risk of serious side effects such as blood clots, breast and cervical cancer. Can be temporary side effects such as increased vaginal discharge, headaches, nausea, mood changes and breast tenderness.

Question 34

Important features of contraceptive vaginal ring

Answer 34

you must be comfortable with inserting and removing it. Ring is used for 3 weeks out of 4. Some medicines can make it less effective. Breakthrough bleeding and spotting may occur in the first few months.

Question 35

Effectiveness of contraceptive patch

Answer 35

Over 99% effective if always used according to instructions (perfect use); fewer than 1 in 100 patch users will get pregnant in a year. With typical use, around 91% effective; around 9 in 100 patch users will get pregnant in a year.

Question 36

MoA of contraceptive patch

Answer 36

A small patch stuck on the skin releases 2 hormones, oestrogen and progestogen. It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg, and thins the lining of the uterus to prevent a fertilised egg implanting.

Question 37

Advantages and disadvantages of contraceptive patch

Answer 37

Advantages- you don’t have to think about it every day. It’s not affected if you vomit or have diarrhoea. It usually makes periods regular, lighter and less painful. It improves acne for some women.
Disadvantages- Not suitable if you’re very overweight or a smoker aged over 35. A low risk of some risk of serious side effects such as blood clots, breast and cervical cancer. Can be temporary side effects such as headaches, nausea, mood changes and breast tenderness. Possible skin irritation.

Question 38

Important features of contraceptive patch

Answer 38

May be seen. New patch is used each week for 3 weeks out of 4. Some medicines can make it less effective. Breakthrough bleeding and spotting is common in the first few months.

Question 39

Effectiveness of combined pill

Answer 39

Over 99% effective if always taken according to instructions (perfect use); fewer than 1 in 100 pill users will get pregnant in a year.
With typical use, around 9 in 100 pill users will get pregnant in a year.

Question 40

MoA of combined pill

Answer 40

Contains 2 hormone (oestrogen and progestogen). It stops ovulation, thickens cervical mucus to prevent sperm reaching an egg and thins the lining of the uterus to prevent a fertilised egg implanting.

Question 41

Advantages and disadvantages of combined pill

Answer 41

Advantages- It usually makes periods regular, lighter and less painful. Reduces risk of cancer of the ovary, uterus and colon. Suitable for healthy non-smokers up to the age of 50. When you stop using the combined pill your fertility will return to normal.
Disadvantages- Not suitable if you’re very overweight or a smoker aged over 35. A low risk of serious side effects such as blood clots, breast and cervical cancer. Can be temporary side effects such as headaches, nausea, mood changes and breast tenderness.

Question 42

Important features of combined pill

Answer 42

Missing pills, vomiting or severe, long-lasting diarrhoea can make it less effective.
Some medicines can make it less effective. Breakthrough bleeding and spotting is common in the first few months

Question 43

Effectiveness of progestogen only pill (POP)

Answer 43

Over 99% effective if always taken according to instructions (perfect use); fewer than 1 in 100 pill users will get pregnant in a year. With typical use, around 9 in 100 pill users will get pregnant in a year.

Question 44

MoA of POP

Answer 44

Contains the hormone progestogen, which thickens cervical mucus to prevent sperm reaching an egg. In some cycles it stops ovulation.

Question 45

Advantages and disadvantages of POP

Answer 45

Advantages- It usually makes periods regular, lighter and less painful. Reduces risk of cancer of the ovary, uterus and colon. Suitable for healthy non-smokers up to the age of 50. When you stop using the combined pill your fertility will return to normal.
Disadvantages- Not suitable if you’re very overweight or a smoker aged over 35. A low risk of some risk of serious side effects such as blood clots, breast and cervical cancer. Can be temporary side effects such as headaches, nausea, mood changes and breast tenderness.

Question 46

Important features of POP

Answer 46

Missing pills, vomiting or severe, long-lasting diarrhoea can make it less effective. Some medicines can make it less effective. Breakthrough bleeding and spotting is common in the first few months.

Question 47

Effectiveness of male condoms

Answer 47

98% effective if always used according to instructions (perfect use); 2 in 100 women will get pregnant in a year. With typical use, around 82% effective; around 18 in 100 women will get pregnant in a year.

Question 48

MoA of male condoms

Answer 48

Made of very thin latex (rubber), polyurethane (plastic), or polyisoprene (synthetic latex). It’s put over the erect penis and stops sperm from entering the vagina.

Question 49

Advantages and disadvantages of male condoms

Answer 49

Advantages- Free from contraception and sexual health clinics and young people’s services, and some general practices and GUM clinics, and sold widely. Can help protect from sexually transmitted infections. No serious side effects. Additional spermicide is not needed or recommended.
Disadvantages- May slip off or split if not used correctly or is the wrong size or shape. The penis needs to be withdrawn from the vagina straight after ejaculation before the penis goes soft, being careful not to spill any semen.

Question 50

Important features of male condoms

Answer 50

Must be put on before the penis touches a partner’s genital area. Oil-based products damage latex condoms but can be used with polyurethane condoms. Available in different shapes and sizes. Use extra lubricant when using condoms for anal sex.

Question 51

Effectivness of female condoms

Answer 51

95% effective if always used according to instructions (perfect use); 5 in 100 women will get pregnant in a year. With typical use, around 79% effective; around 21 in 100 women will get pregnant in a year

Question 52

MoA of female condoms

Answer 52

Made of soft thin polyurethane which loosely lines the vagina. It covers the area just outside and stops sperm from entering the vagina.

Question 53

Advantages and disadvantages of female condoms

Answer 53

Advantages- Can be put in any time before sex. Can help protect from sexually transmitted infections. Oil-based products can be used with internal condoms. No serious side effects. Additional spermicide is not needed or recommended.
Disadvantages- Need to make sure the penis enters the condom and doesn’t go between the vagina and the condom. May get pushed into the vagina. Not as widely available as external condoms.

Question 54

Important features of female condoms

Answer 54

Use a new condom each time and follow the instructions carefully. Sold online and in some pharmacies and free from contraception and sexual health clinics and young people’s services, and some general practices and GUM clinics.

Question 55

Effectiveness of natural family planning

Answer 55

up to 99% effective if used according to teaching and instructions (perfect use); up to 1 in 100 users will get pregnant in a year. With typical use, around 76% effective; around 24 in 100 users will get pregnant in a year.

Question 56

MoA of natural family planning

Answer 56

The fertile and infertile times of the menstrual cycle are identified by noting the different fertility indicators. This shows when you can have sex without risking pregnancy.

Question 57

Advantages and disadvantages of natural family planning

Answer 57

Advantages- No physical side effects, gives you a greater awareness of your body and menstrual cycle, can also be used to plan a pregnancy.
Disadvantages- Need to avoid sex or use a condom at fertile times of the cycle. It takes 3-6 menstrual cycles to learn effectively. You have to keep daily records.

Question 58

Important features of natural family planning

Answer 58

• Persona is a small monitor with urine test sticks to measure hormonal changes. It predicts your fertile days. If used correctly it can be 94% effective.

Question 59

Effectiveness of diaphragm/cap with spermicide

Answer 59

• Diaphragms and caps are 92–96% effective when used with spermicide, according to instructions (perfect use); between 4 and 8 in 100 diaphragm or cap users will get pregnant in a year. With typical use, around 71-88% effective; between 12 and 29 in 100 users will get pregnant in a year.

Question 60

MoA of diaphragm/cap with spermicide

Answer 60

A flexible latex or silicone device, used with spermicide, is put into the vagina to cover the cervix (neck of the womb). This stops sperm from entering the uterus (womb) and meeting an egg.

Question 61

Advantages and disadvantages of diaphragm/cap with spermicide

Answer 61

Advantages- Can be put in up to 3 hours before sex, or earlier as long as you then add more spermicide before having sex. You only have to use it when you have sex. No serious side effects.
Disadvantages- Extra spermicide is needed if you have sex again. Some people can be sensitive to spermicide. Can take time to learn how to use correctly.

Question 62

Important features of diaphragm/cap with spermicide

Answer 62

You need to use the correct size. You may need a different size after you’ve had a baby, miscarriage or abortion, or if you gain or lose more than 5kg (7lb) in weight. Needs to be left in for 6 hours after sex.