Contraception and Sexual Health

Question 1

How does the COCP inhibit ovulation?

Answer 1

Oestrogen and progestogen act on the hypothalamo-pituitary axis, reducing LH and FSH. No surge in LH and FSH to stimulate the ovaries, no ovulation

Question 2

A woman tells you she has been taking the COCP pill but sometimes forgets. She’s heard of the combined transdermal patch. How does this work? How often does she has to change this patch?

Answer 2

How does this work? By inhibiting ovulation. Progesterone in the COCP also stops endometrial hyperplasia by opposing proliferative effect of oestrogen.

How often does she has to change this patch? Change once a week.

Question 3

Name 2 side effects of the COCP

Answer 3

Any from: Nausea, abdominal pain, breast pain and tenderness, break through menstrual bleeding irregularities.

Question 4

Name a drug interaction you would check for before confirming a prescription for the COCP

Answer 4

Liver enzyme inducing drugs, lamtrogine, anti-HTN drugs, antifungals, Abx, anti-DM meds, statins, diuretics, levothyroxine, tacrolimus

Question 5

A woman comes to see you and wants to start some contraception. She is 36 and smokes 15/day. What contraceptive methods would you avoid?

Answer 5

COCP, combined transdermal patch, combined vaginal ring

Question 6

Describe the mode of action of the POP

Answer 6

1) Increases the volume and viscosity of cervical mucus to reduce likelihood of sperm fertilising egg, 2) suppresses LH and FSH to suppresses ovulation, 3) reduces number and size of endometrial glands and so inhibits the number of progesterone receptors in the endometrium so prevent implantation, 4) reduces activity of cilia in Fallopian tube.

Question 7

Who can not use the POP (i.e. what are contraindications)?

Answer 7

Over 55 years old. PMH or current Hx of breast cancer. Severe liver disease. Epilepsy.

Question 8

What ADRs/side effects would you make a woman aware of before prescribing POP? Name 3.

Answer 8

Menstrual irregularities, mood swings, increased acne risk, breast discomfort, fluctuations in weight, ovarian cysts, risk of ectopic pregnancy, changes in libido, headaches, migraines, small increase in breast cancer risk

Question 9

Name an advantage of the copper IUD

Answer 9

Do not need to think about taking every day. Does not affect mood/libido/weight/sex. No increased cancer risk. Can be used as emergency contraception for up to 5 days post-coitus. Can be used if breastfeeding. Easily reversible if want to get pregnant - fertility returns to normal.

Question 10

A woman and her male partner come in to discuss contraception. She does not want to take anything hormonal. What contraception methods could you suggest?

Answer 10

Copper IUD, male or female condom, diaphragm which sits at top of cervix, fertility awareness methods

Question 11

A woman comes in for a review of her POP. What may be present in her Hx which means she is unable to take the COCP?

Answer 11

She may… be over 50, be older than 35 and a smoker, be breastfeeding, have a high BP reading, be at higher risk of VTE, have a PMH of migraines with aura, have DM, have a FH of valvular heart disease.

Question 12

A patient has made an informed decision to try a POP. You prescribe Cerazette which contains 75ug Desogestrel. How long is her time window to take this pill?

Answer 12

12 hour time window each day.

Question 13

Name an indication for the evonergeotrel IUS (Mirena coil)

Answer 13

Any from: Menorrhagia, dysmenorrhea, endometriosis, fibroids

Question 14

How do post coital ‘morning after’ pills work?

Answer 14

Prevent or delay ovulation.

Question 15

Define mental capacity

Answer 15

The ability to make a decision at a given time point.

Question 16

Name a disadvantage of the POP injectable

Answer 16

Works for 8-13 weeks - can’t be removed from the body during this time as has been injected. May continue to work for some time afterwards.

Question 17

A 14 year old books a telephone appointment. She sounds mature on the phone, however confirms her DOB. She says she wants some regular contraception as she is having intercourse frequently and confidently mentions she doesn’t always have time to buy condoms. Her boyfriend asked her to call today. She also mentions she has had inter-menstrual bleeding for 2 weeks now as well as pain when urinating and having sex. What about this Hx concerns you?

Answer 17

Child protection concerns. Pt is 14 and acting like adult. Has knowledge of sex and is confident discussing sex. Mentions she is having sex frequently. Has inter-menstrual bleeding and pain - signs of STI (chlamydia). ‘Boyfriend asked her to call’.