Contraception - hormonal & emergency

Question 1

list the different forms of hormonal contraception available

Answer 1

Combined Oestrogen + Progesterone:

• COCP
• vaginal ring

Progesterone only:

• POP
• IUD: Mirena
• Implant: Implanon
• Injectable DMPA: Dopa Vera
• Emergency Contraception (EC)

Question 2

state the main method of action for each form of hormonal contraception

Answer 2

• COCP: prevents ovulation (E inhibits FSH, P inhibits LH) & thickens cervical mucous
• Vaginal ring: inhibits ovulation
• POP: thickens cervical mucous –> inhibit sperm motility, also endometrial atrophy, variable ovulation (most ovulate)
• DMPA: suppress LH rel pituitary -> suppress ovulation
• Implanon: inhibits ovulation, decrease sperm motility, atrophy endometrium
• Mirena: inhibits sperm motility - prevents fertilisation/implantation (thin uterine wall, thicker mucous)
• EC: delays ovulation (& may effect sperm) - However, it does not affect implantation!! (so may get pregnant if already ovulated)

Question 3

list the main contraindications for combined hormonal contraception, intrauterine systems and implants

Answer 3

CI for COC:
- RF’s thromboembolic dx (hx clots/TIA, thrombophilia, >35 & smoker; migraines w aura; drug interactions; (epilepsy); hormone dep Ca; breast feeding <6m

CI for intrauterine: pelvic infection

CI for implants: temporary contraception (harder to reverse)

Question 4

discuss the advantages and disadvantages of all forms of hormonal contraception

Answer 4

ADV (+) / DISADV (-)
- COCP: (+) reduced bleeding/dysmenorrhoea, easy/convenient/reversible, reduced endometrial cyst & Ca, reduced Ovarian Ca, reduced PID
(-): N/V, change libido & mood, breast tenderness, break through bleed, missed pill issue, CI thromboembolic dx/migraine/early breast feeding

• Nuva ring: (+) no dialy action, avoids 1st pass metabolism
  (-) like COCP - small increase risk stroke/AMI & cervical Ca
• POP: (+) used ST use reduce heavy bleeding, easy/convenient
  (-): breast tenderness, mood changes, GOW, irregular bleeding, ST use only
• DMPA: (+) administered by dr, not daily, doesn’t interfere with sex, reduces PID/endometrial Ca risk, can be used breast feeding
  (-) non-reversible, GOW, mood changes, irreg bleed or amenorrhoea, need to return 3m injection, takes time return fertility
• Implanon: (+) doesn’t interfere w sex, not daily requirement, rapidly reversible
  (-) irregular bleeding/amenorrhoea, needs surgical removal, GOW, breast tenderness, bloating, mood changes
• Mirena: (+) doesn’t interfere with sex, LT 5yrs, amenorrhoea most, less systemic SE, cost effective
  (-) irregular bleeding start, uterine puncture, infection risk, expulsion, ectopic preg

Question 5

discuss the factors that contribute to a difference in efficacy between perfect use and typical use for hormonal contraception.

Answer 5

Perfect use = contraception is used every time female has sexual intercourse & used according to instructions every time

Typical use = contraception not used every time woman has sexual intercourse, & not used according to instructions every time