Contraception - Fertility control

Question 1

what is the most common form of contraception in the UK?

Answer 1

Combined hormonal contraception CHC - 25%

Question 2

what would make the ideal contraceptive?

Answer 2

100% reversible, effective, free of side effects, sti protection, low maintainance

Question 3

define what the pearl index is…

Answer 3

the number of contraceptive failures per 100 women-years of exposure. It looks at the total months or cycles of exposure from the initiation of the product to the end of the study

Question 4

what is Life table analysis?

Answer 4

provides the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure

Question 5

define LARC

Answer 5

long acting reversible contraception - this minimises user input and thus minimised user failure rates (the coil)

Question 6

on what days is there the highest chance of pregnancy?

Answer 6

sex on days 8-19, however sperm survical and ovulation is variable.

Question 7

What is in the COC (combined oral contraceptive)?

Answer 7

combination of 2 hormones: ethinyl estradiol (ee) and synthetic progesterone (progestogen), 20-30mgs, taken for 21 days with a hormone free week

Question 8

what is the mode of action of COC?

Answer 8

stops ovulation, alters FSH and LH, prevents implantation by making the endometrium inadequate and alters the character and quantity of the mucus thus inhibiting sperm penetration

Question 9

what are the different mediums of the COC?

Answer 9

Pill - takenn daily, Patch - changed weekly, Ring - changed every 3 weeks)

Question 10

What are the non-contraceptive benfits of COC?

Answer 10

regulates bleeding to reduce painful heavy menstruation and anaemia, reduction in ovarian cysts, 50% reduction in ovarian and endometrial cancer, improves acne reduction in benign breast disease

Question 11

What are the side effects of COC?

Answer 11

3 times increased risk of dvt (venous thromboembolism) or arterial thrombosis leading to MI or ischaemic stroke, headache, nausea, breast tenderness, weight gain and mood swings, Increased risk of breast cancer and cervical cancer. Avoid giving to patients with reactive gall bladder disease or a previous liver tumour. irregular bleeding for the first 3 months.

Question 12

How does one take the Progesterone only pill (POP)

Answer 12

take at the same time everyday without a pill-free interval - desogestrel pill; can have a 12 hour window period

Question 13

What is the mode of action of a POP?

Answer 13

cervical mucus made impenetrable by sperm, maintains regularity of ovulaiton

Question 14

contraindications of POP

Answer 14

Breast ca, Liver tumours

Question 15

What are the side effects of the POP?

Answer 15

increase in appetite, hair loss, mood swings, bloating or fluid retention , acne, headache.

Question 16

What is the mode of action of the Injectible progesterone ‘depoprovera’

Answer 16

Prevents Ovulaiton, alters cervical mucus so its more hostile to sperm and makes the endometrium unsuitable for implantation.

Question 17

What are the side effects of depoprovera?

Answer 17

delay in return to fertility once off it, reduction in bone density, problematic bleeding, weight gain.

Question 18

What is the mode of action of the subdermal progesterone implant - The Rod?

Answer 18

inhibition of ovulation and effect on cervical mucus to prevent sperm reaching the upper reproductive tract. This implant can last 3 years or be removed at any time.

Question 19

IUD (coil) - how long can It last for?

Answer 19

5-10 years

Question 20

IUD method of action?

Answer 20

Toxic to sperm -stop sperm reaching egg- may sometimes prevent implantation of fertilised egg

Question 21

How does the Levonorgestrel IUS work?

Answer 21

Affect cervical mucus and endometrium most women still ovulate. Stop fertilisation of the egg- may prevent implantation the fertilised egg, Slow release progestogen on stem, Low circulating progestogen levels compared with pill/implant/injection, Reduce menstrual bleeding after up to 4 months initial irregular bleeding Mirena TM- 5 years contraception, 85% women almost bleed free by 1 year, also licensed to treat heavy menstrual bleeding and as the progestogenic part of HRT.

Question 22

Emergency contraception - what aer the options available?

Answer 22

a) Levonelle (LNG), 0-72 hours (85% risk reduction) or 73-96 hours – off licence (64% risk reduction) – ineffective thereafter b) Ullipristal/Ella One (UPA), 0-120 hours (60-80% risk reduction – different studies) c) Cu IUD, 0-120 hours after first episode of UPSI or up to 5 days after expected ovulation (>99% risk reduction)

Question 23

name some barrier methods of conntraception

Answer 23

1. Male condoms 2. Female condoms (FEMIDOM) 3. Diaphragm/cap

Question 24

outline female sterilisation…

Answer 24

Laparoscopic Sterilisation- Usually Filshie clips applied across tube to block tube lumen. Risks of GA and laparoscopy: Irreversible- risk regret, Failure rate 1 in 200 lifetime risk – could be ectopic, No effect on periods / hormones, Reduces ovarian cancer risk ( ? Even more reduction if salpingectomy but more complex surgery). May do salpingectomy at planned caesarean section if baby seems well and discussed in advance ESSURE- hysteroscopic sterilisation, local anaesthetic- No longer available for commercial reasons

Question 25

outline Vasectomy’s…

Answer 25

Vas deferens divided and ends cauterised small incision midline scrotum, Takes 4-5 months to be effective, Failure rate after x 2 clear samples 1 in 2000 lifetime, Irreversibility – Anti-sperm antibodies even if vas reconnected, < 1:100 risk long term testicular pain, No effects on testosterone or sexual function, No increased risk testicular or prostate cancer.

Question 26

outline the 1967 UK abortion act…

Answer 26

Continuing the pregnancy has grave risk to the life of the pregnant woman- greater than if pregnancy terminated Termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman Under 24 weeks and continuation of pregnancy involves risk greater than if the pregnancy were terminated of injury to the physical or mental health of the pregnant woman or any existing child(ren) of the pregnant woman. There is a substantial risk that if the child were born it would suffer physical or mental abnormalities as to be seriously handicapped

Question 27

what to discuss in a clinic consultation for abortion

Answer 27

Scan for gestation and viability, Medical history- risk VTE/bleeding/ from GA/ contraceptive eligibility, Circumstances – reasons for considering abortion- see alone, language line, check no coercion or gender based violence. Discuss methods of abortion: What to expect and when to seek medical advice, Contraception for afterwards. FBC/Rhesus Group, Vaginal swab for Chlamydia and gonorrhoea, STI bloods offered.

Question 28

Surgical abortion…

Answer 28

upto 12 weeks, Cervical priming- misoprostol 3 hrs preop helps dilation and reduces risk perforation/ haemorrhage OR GA or LA cervical block OR Transcervical - 6-10mm suction catheter.

Question 29

Medical abortion…

Answer 29

upto 24 weeks, Mifepristone oral antiprogestogen tablet, 36-48 hours later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy, Average 4-6 hours to pass pregnancy under 12 weeks, Mifepristone helps Misoprostol work better.

Question 30

complicaitons of abortions…

Answer 30

failure, infection, loss of blood, perforation

Question 31

what are the longterm effects of abortion?

Answer 31

No effect on future fertility or pregnancy or delivery, No effect on cancer risks, Emotional effects depend on reasons for abortion/ pre-existing mental health issues.

Question 32

COCP

Answer 32

Question 33

CC - VAGINAL RING

Answer 33

Question 34

Barrier methods

Answer 34

Question 35

POP

Answer 35

Question 36

LARC’s

Answer 36