Contraception

Question 1

contraception mechanisms of action

Answer 1

1. prevention of ovulation
2. prevention of fertilisation
3. prevention of implantation

Question 2

how can contraception prevent ovulation?

Answer 2

suppress FSH and LH

Question 3

how can fertilisation be prevented?

Answer 3

no contact e.g. condoms, diaphragm, sterilisation, IUD

Question 4

how can implantation be prevented?

Answer 4

create hostile environment

Question 5

classification of contraception

Answer 5

hormonal methods
barrier methods
intrauterine methods
permanent methods
fertility awareness methods
emergency

Question 6

non-contraceptive benefits of contraception

Answer 6

pain
heavy bleeding
irregular bleeding
PMS
breast tenderness
acne hirsutism
ovarian cancer

Question 7

what cancer does contraception protect against?

Answer 7

ovarian

Question 8

LARC methods

Answer 8

1. IUD/IUS

2. implant

Question 9

consequences of using IUD/IUS

Answer 9

painful insertion
perforation
malposition
expulsion

Question 10

when can IUD/IUS not be used?

Answer 10

submucosal fibroids

uterine malformations

Question 11

how long does the IUD last?

Answer 11

up to 10 years

Question 12

action of IUD

Answer 12

non-hormonal but prevents implantation

Question 13

when can IUD be used as emergency contraception?

Answer 13

up to 5 days after sex

Question 14

adverse of the IUD (copper coil)

Answer 14

makes period heavy, longer and more painful in first few months (can co-prescribe NSAIDs)

Question 15

which method of contraception is the only option after breast cancer?

Answer 15

IUD

Question 16

is the IUS hormonal?

Answer 16

yes

Question 17

what are the types of IUS?

Answer 17

mirena
levosert
kyleena
jaydees

Question 18

what is mirena also licensed to treat alongside contraception?

Answer 18

heavy periods

Question 19

adverse of IUS

Answer 19

irregular spotting

PV bleeding in first few months then leads to amenorrhoea around 6 months

Question 20

what is the most effective method of contraception?

Answer 20

implant

Question 21

how long does the implant last?

Answer 21

3 years

Question 22

how does the implant work

Answer 22

hormonal (progestogen only)

Question 23

side effects of implant

Answer 23

invasive procedure with LA

prolonged PV bleeding

Question 24

what is the criteria used for contraception use?

Answer 24

UKMEC

Question 25

examples of combined hormonal contraception

Answer 25

OCP ring patch

Question 26

when to start OCP

Answer 26

first 5 days of period OR anytime in cycle if sure not pregnant and use condoms for 7 days

Question 27

how should the OCP be taken?

Answer 27

21 days then 7 day break (can do tricycling)

Question 28

what factors affect the effectiveness of the OCP?

Answer 28

``` impaired absorption (GI conditions) increased metabolism (liver) forgetting ```

Question 29

adverse of CHC

Answer 29

``` nausea acne bleeding breast tenderness venous and arterial thrombosis breast cancer and cervical cancer (always discuss condoms and smear) hypertension arterial disease ```

Question 30

what to always discuss when prescribing contraception?

Answer 30

smear | CONDOMS

Question 31

what cancers does the CHC increase the chance of?

Answer 31

breast cancer

Question 32

what do migraines with aura risk when on CHC?

Answer 32

ischaemic stroke

Question 33

what is an aura?

Answer 33

a change occurring 5-20 minutes before onset of headache (usually visual e.g. scotoma)

Question 34

what do you need to check before prescribing the CHC?

Answer 34

BP BMI smear other RF (VTE)

Question 35

additional benefits of OCP

Answer 35

``` ovarian and endometrial cancer acne reduction less bleeding less cysts less PMS PCOS ```

Question 36

what cancers do the OCP protect against?

Answer 36

ovarian | endometrial

Question 37

what is the POP called?

Answer 37

cerelle (desogestrel)

Question 38

action of POP

Answer 38

inhibits ovulation

Question 39

when do you start the POP?

Answer 39

begin in first 5 days of period or anytime if sure not pregnant and use condoms for 2 days

Question 40

when do you take the POP

Answer 40

same time everyday (within 12 hours)

Question 41

what to do if miss POP?

Answer 41

doesn't work for 2 days take pill as soon as realise and use condoms for 2 days (or 7 days in OCP)

Question 42

is the POP contraindicated in breast cancer?

Answer 42

yes

Question 43

common adverse of POP

Answer 43

irregular bleeding

Question 44

two forms on the injection?

Answer 44

``` depo provera (DMPA injection) sayana press (self-administered) ```

Question 45

action of injection

Answer 45

prevents ovulation lowering oestradiol and suppresses FSH

Question 46

when can the injection not be used?

Answer 46

OP risk factors good in epilepsy

Question 47

adverse of injection

Answer 47

``` nausea weight gain acne headache bleeding limits peak bone mass ```

Question 48

how to use the diaphragm?

Answer 48

remove and wash before using again no longer really used

Question 49

three options for emergency contraception

Answer 49

1. copper coil 2. ellaOne 3. levonelle

Question 50

when can levonelle be used

Answer 50

within 72 hours (3 days)

Question 51

when can ellaone be used?

Answer 51

within 120 hours (5 days)

Question 52

when can ellaOne not be used?

Answer 52

progesterone contraception

Question 53

action of emergency morning after pills

Answer 53

delays ovulation

Question 54

action of copper coil

Answer 54

toxic so prevents implantation

Question 55

male sterilisation

Answer 55

vasectomy