Contraception

Question 1

What is the Fertility Awareness method?

Answer 1

The awareness of the fertile period during a cycle and either abstaining or using the barrier method during that time

Question 2

State the four subtypes of Fertility Awareness

Answer 2

Standard Days
Cervical Mucous
Basal Body Temp
Sympothermal

Question 3

Describe the ‘Standard Days’ subtype of Fertility Awareness

Answer 3

If your cycle is between 26 and 32 days long, days 8-19 are the most fertile

Question 4

Describe the ‘Cervical Mucous’ subtype of Fertility Awareness

Answer 4

Just prior to ovulation the oestrogen levels increase which makes the mucous thin and stretchy to optimise fertilisation
Be aware that intercourse/breast feeding/female hygiene products can falsely alter

Question 5

Describe the ‘Basal Body Temp’ subtype of Fertility Awareness

Answer 5

Temperature increase of atleast 0.2 degrees with an increase in Progesterone
Fertility peaks a few days before this (so not very efficient)

Question 6

Describe the ‘Sympothermal’ subtype of Fertility Awareness

Answer 6

Combines Cervical Mucous and Basal Body Temperature

Question 7

Describe the Lactational Amenorrhoea method

Answer 7

Full or almost exclusively breastfed
<6 months old
Menses not returned

Question 8

Describe the pathophysiology of Lactational Amennorhoea

Answer 8

Prolactin supresses GnRH release from hypothalamus

FSH and LH decreases and therefore Oestrogen

Question 9

What is the difference between Diaphragms and Caps?

Answer 9

Diaphragms should lie diagonally between pubic bone and posterior fornix
Caps sit directly over the cervix and must be left in place for 6-8 hours

Question 10

What is the pathophysiology of the COCP?

Answer 10

Supresses FSH and LH hence decreasing ovulation

Thickens cervical mucous

Question 11

Describe the two types of COCP

Answer 11

Monophasic - each pill contains the same amount of oestrogen and progesterone
Phasic - levels of hormones vary across the pills, therfore it is important they’re taken in order. Aims to reduce SE

Question 12

Name 5 contraindications to the COCP

Answer 12

BMI>35
Breast Feeding
Hypetensive
Migraines with Aura
Smoker aged > 35

Question 13

What cancers does the COCP decrease the incidence of, and what do they increase the incidence of?

Answer 13

Reduced risk of ovarian/uterine/colon

Increased risk of breast and cervical

Question 14

Give three drug interactions of the COCP

Answer 14

Rifampicin
Anticonvulsants (Carbemazepine)
Antiretrovirals

Question 15

Describe the pathophysiology of the Progesterone Onlly pill

Answer 15

Thickens cervical mucous and thins endometrium

Question 16

State two benefits of POP

Answer 16

Can be used when breast feeding

Avoids CVS risks of Oestrogen

Question 17

State three disadvantages of POP

Answer 17

Menstrual problems (Amenorrhoea and break through)
Taken at exactly the same time
Increased risk of Ovarian Cysts and Breast Cancer

Question 18

State three benefits of Nexplanon

Answer 18

Lasts for three years
Can be used when breast feeding or at high BMI (replaced sooner)
Decreases risk of endometrial cancer

Question 19

State three disadvantages of Nexplanon

Answer 19

Irregular bleeding
Painful
Increased risk of breast cancer

Question 20

Describe 3 Progesterone only injections

Answer 20

Depo-Provera every 12 weeks
Sayana Press every 13 weeks
Noristerat every 8 weeks

Question 21

A benefit of PO injections is that there are no known interactions. Describe 5 disadvantages.

Answer 21

Delayed return in fertility
Increased body weight
Decreased mineral bone density
Persistent bleeding
Increased breast cancer risk

Question 22

What is the IUD?

Answer 22

AKA the Copper Coil
Creates inflammatory reaction within the endometrium rendering it unfavourable for fertilised egg
Can be used as emergency contraception if fitted within 5 days

Question 23

What is the IUS?

Answer 23

AKA Mirena Coil (progesterone releasing)
First line therapy for menorrhagia
Second line therapy for dysmenorrhoea

Question 24

Give 5 contraindications to the Coil

Answer 24

Infection
Less than a month PP
Uterine structure abnormalities
Copper Allergy
Gynae malignancy

Question 25

Give 3 advantages to the Coil

Answer 25

Good ‘non hormonal’ option
Can be used when breast feeding
Fertility returns to normal

Question 26

Give 3 disadvantages to the Coil

Answer 26

Risk of infection/perforation
Irregular bleeding for up to 6 months
Increased risk of Ectopic Pregnancy

Question 27

Give two pill options for Emergency Contraception

Answer 27

Levonorgestrel (able to be used for 72hrs after)
Ulipristil Acetate (SPRM - available for use for 120 hours)

Question 28

Where is Nexplanon inserted?

Answer 28

Subdermally, non dominant arm

Question 29

How does the Depo-Provera and Nexplanon provide contraception?

Answer 29

Inhibits ovulation

Question 30

How long does it take for POP to be effective?

Answer 30

2 days

Question 31

What are the Fraser guidelines?

Answer 31

Specific guidelines to providing contraception to under 16s without parental involvement

Question 32

Describe the Fraser Guidelines

Answer 32

1) The young person understands the advice given to them
2) The young person cannot be persuaded to have their parents informed (either the patient or the doctor telling them)
3) The young person is likely to have sexual intecourse anyway
4) Unless the person receives the contraception, their physical or mental health will suffer
5) It is in their best interest