Contraception

Question 1

What are the most common forms of contraception?

Answer 1

Of women using contraception:

• 25% Combined OCP
• 28% sterilized
• 5% POP

Implants & injections only make up 5% and Coil 6%

Question 2

How do we determine the effectiveness of a contraceptive method?

Answer 2

Life Table Analysis or Pearl Index
% of women using a the method who get pregnant anyway.
One % for perfect use and one % for “Typical” use

Question 3

Whats in the Combined OCP?

Answer 3

Ethinyl Oestradial (EE)
Synthetic Progesterone (Progestogen)

3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)

Question 4

Dose for cOCP?

Answer 4

20-35microgram but 50 if on liver enzyme inducers

Question 5

How often is the cOCP taken?

Answer 5

Every day for 21 days then 7 days off

takes 7 days to become effective when you start it

Question 6

How does the cOCP work?

Answer 6

1) Prevents the FSH/LH surge by -ve feedback on the GnRH producing hypothalamus
2) Prevents implantation by providing an inadeqaute endometrium
3) Thickens cervical mucous to Inhibit sperm penetration

Question 7

What are the non contraceptive benefits of the cOCP?

Answer 7

• Regular periods & ~reduce painful, heavy periods and anaemia
• Reduces Functional Ovarian Cysts
• 1/2s OVarian & endometrial cancer
• Reduces Acne, benign breast disease, RA, Colon cancer and Osteoporosis

Question 8

What are the major risks of cOCP?

Answer 8

.Very small increased risk of VTE
Very small increased risk of Ischaemic stroke
Small risk of breast cancer
Doubles Cervical cancer risk if used for 10yrs

Question 9

the cOCP is often blamed for VTEs, how risky is it really?

Answer 9

.The pill triples risk from 5 to 15 per 100,000.

However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant

It just sounds scary if you don’t actually know the numbers

Question 10

What groups might we actually worry about VTEs in if we give them the cOCP?

Answer 10

Major surgery or immobility

Thrombophilias

FH/o VTE <45yrs

BMI > 30

Vascular Disease

first 21 days post-natally

Question 11

How does Depoprovera work?

Answer 11

• Prevents Ovulation by -ve feedback
• Alters cervical mucous preventing sperm penetration
• Renders endometrium unsuitable, preventing implantation

Question 12

What do we properly call the coil?

Answer 12

Long Acting Reversible Contraception (LARC)

Question 13

What are the best forms of Emergency Contraception?

Answer 13

CU-IUD (copper coil)
Levonorgestrel pill
Ella One pill

All less effective than ongoing contraception

Question 14

How long after sex can you use emergency contraception?

Answer 14

Copper coil up to 5 days post sex or 19 day of a cycle

Levonorgestrel - 72 hours
Ella One - 5 days

Question 15

What is the main form of female sterilization?

Answer 15

Laparascopic Tubal Ligation with Filshie clips

Question 16

Describe the course of DepoProvera injections?

What are the pros of Depoprovera injections?

Answer 16

Injection every 12-14 weeks

• Good if you forget to take pills
• Stops periods in 70%
• Oestrogen-free

Question 17

What are the cons of DepoProvera?

Answer 17

• Delayed return to fertility
• Reduces BMD (Reversible)
• Bleeding
• Weight Gain

Question 18

What is used in the Subdermal Implant?

Answer 18

Etonogestrel (ENG) - a progestin

Coated in a rate controlling membrane of EVA

Question 19

How does the subdermal implant work?

Answer 19

Progestogen -

Inhibits ovulation for 3yrs (but can be removed at any time)

Also has some effect on cervical mucus inhibiting sperm entry into upper repro tract

Question 20

What is the main form of female sterilization?

Answer 20

Laparascopic Tubal Ligation with Filshie clips

Question 21

How is Vasectomy done?

Answer 21

Permanent division of vas deferens under local anaesthetic

Then they have to come back for semen analysis before they start having unprotected sex

Question 22

Can you get pain from vasectomy? Testicular cancer?

Answer 22

Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)

No risk of cancer

Question 23

Is vasectomy reversible?

Answer 23

.Low success rate for reversals

Question 24

When is a termination best performed?

Answer 24

<9wks as it reduces complications if its early

Question 25

AT what point do we stop doing terminations?

Answer 25

20wks. then we refer to england who do it till 24wks

Question 26

Why would you terminate a pregnancy?

Answer 26

IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating

• Maternal health
• Social reasons
• Fetal Anomaly

Question 27

What do we do during a clinic consultation on termination?

Answer 27

• Talk about methods
• Advise they may have prolonged bleeding post-TOP
• Offer counselling post-TOP
• Contraception advice
• FBC, Rubella & STI checks
• Certificate A signed

Question 28

Most terminations in Grampian are medical, how are they done?

Answer 28

Mifepristone - then misoprostol

Mifepristone Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix & expels pregnancy

Question 29

What are the risks of Medical TOP?

Answer 29

,Haemorrhage
Uterine Perforation
Cervical Trauma
Failure
Infection
RPOC
Damage to future fertility
Psychological problems

Question 30

Whats the alternative to the Combined OCP?

Answer 30

Progestogen Only Pill (POP)

Question 31

How often do you have to take the POP?

Answer 31

Take the desogestrel pill every day within the same 12 hr window

(Traditional PoPs have only a 3hr window)

Question 32

How does the POP work?

Answer 32

Renders Cervical mucus impenetrable to sperm

Also has some effect inhibititing ovulation

Question 33

What are some common side effects of the cOCP?

Answer 33

Irregular bleeding for first 3 months
Breast tenderness
Nausea
Headaches
~Mood changes

Weight gain - not causal