Contraception (Non-LARC)

Question 1

What factors may affect a patient’s choice of contraception?

Answer 1

• Effectiveness
• Feeling of being “In Control”
• Long/Short term
• Non-contraceptive benefits
• Procedure

Question 2

What are the 3 methods of combined hormonal contraception?

Answer 2

• Combined pill
• Patch (Evra)
• Vaginal Ring

Question 3

Describe the failure rate of the combined oral contraceptive pill in both perfect and typical use?

Answer 3

Perfect  = 0.3% (=> 0.3 per 100 people get pregnant)
Typical = 9% (=> 9 people per 100 get pregnant)

Question 4

When is a combined oral contraceptive usually started in relation to a females period cycle?

Answer 4

Start in first 5 days of period
OR
At any time in cycle when reasonably sure not pregnant, (PLUS use condoms for 7 days)

Question 5

How is a combined oral contraceptive pill normally taken ?

Answer 5

Usually taken daily for 21 days followed by a 7 day break

can be tricycled (extended use) or taken continuously BUT this is currently “off license”

Question 6

What may affect the effectiveness of the combined pill?

Answer 6

Impaired absorption
=> GI conditions (e.g. Crohn’s/UC)

Increased metabolism
=> Liver enzyme induction => Drug interaction

Forgetting !!!

Question 7

What are the main risks of the combined oral contraceptive pill?

Answer 7

• Venous thrombosis
• Arteria+ l thrombosis
• Slight increase in risk of some cancers (Breast, cervical)

Question 8

What can affect a females VTE risk on the combined pill?

Answer 8

• Type of progestogen in the pill (i.e. newer generation = higher risk)
• level of oestrogen in the pill

Question 9

Does VTE risk go up or down in pregnancy and the post-partum period?

Answer 9

UP - even higher than that of patients on the pill

Background Risk - 2/10,000
COCP - 5-7/10,000
Pregnancy - 21-30/10,000
Post-Partum - 130-140/10,000

Question 10

How should VTE risk be counselled in patients starting the COCP?

Answer 10

• inform patient of typical DVT/PE symptoms

- prompt return to doctor

Question 11

What arterial risks come with the COCP?

Answer 11

Slight increase in

• BP
• MI
• Ischaemic stroke

Question 12

What medical condition is a contraindication to the COCP?

Answer 12

Migraines WITH AURA => increased stroke risk!

if patients have migraines without aura be cautious but don’t rule this out as a potential treatment option

Question 13

Above what age are contraceptives rarely given and why?

Answer 13

Above 35

- due to risk benefit analysis

Question 14

What cancers does the COCP protect females against?

Answer 14

ovarian and endometrial cancers

Question 15

What are the non-contraceptive benefits of COCP?

Answer 15

• Acne treatment
• Less bleeding
• Fewer ovarian cysts (due to less cyclical folllicle development)
• Less Premenstrual syndrome (PMS)
• Useful in pts with Polycystic Ovarian Syndrome PCOS

Question 16

What are the most common side effects of the combined oral contraceptive pill?

Answer 16

Nausea
Spots/acne
bleeding
breast tenderness

Question 17

What methods of contraception are progestogen ONLY?

Answer 17

• Progestogen Only Pill
• Subdermal implant (Nexplanon)
• DMPA (Depo-Provera/Sayana Press)

Question 18

How is the progestogen only pill started?

Answer 18

Day 1 – 5 of period
OR
Anytime if reasonably certain not pregnant PLUS condoms for 2-7 days

Question 19

What are the effects of the low estradiol and suppressed FSH levels that females experience on the hormonal contraceptive injections?

Answer 19

Depo-Provera/Sayana Press cause low oestrogen/FSH

=> predispose to osteopenia

Question 20

How can patients manage the osteopenia that may result from hormonal contraceptive injections?

Answer 20

Weight bearing exercise
high calcium intake
(Refer for DEXA scan if worried)

Question 21

How effective is a diaphragm (+ spermicide) as a contraceptive method (typical use)?

Answer 21

71-88% effective

Question 22

How should a diaphragm and spermicide typically be used?

Answer 22

• Spermicide applied to rim
• Diaphragm folded longitudinally and inserted into vagina, positioned over cervix
• Must be left in up to 6 hours after sex
• Spermicide must not be applied >3 hours before sex or else reapplication is required

Question 23

What should be covered when counselling patients on a vasectomy?

Answer 23

• Risks and benefits
• female sterilisation VS other methods (not as effective as implant, IUD etc => 2-3/1000 failure rate)
• Regret – reversal? (Everyone’s situation changes)

Question 24

Local or general anaesthetic can be used to complete a vasectomy. TRUE/FALSE?

Answer 24

TRUE

Question 25

Male vasectomy can be completed with a “no-scalpel” approach. TRUE/FALSE?

Answer 25

TRUE

Question 26

What complications can arise from having a vasectomy?

Answer 26

• Anaesthetic
• Pain
• Infection
• Bleeding /haematoma
• failure (early/late)

Question 27

How can a female vasectomy be carried out and which of these methods is usually used in the UK?

Answer 27

• Banding
• Banding and removal
• Essure (coiled wire)
• Clip (USED IN UK)

Question 28

What is meant by “Natural Family Planning”?

Answer 28

Patients use the “rhythm method” and try to have sex when they are least fertile

• some older patients use this method as they want a space between kids, but aren’t too bothered about getting pregnant again soon

Question 29

How effective is the “Natural Family Planning” method with typical use?

Answer 29

76% effective

=> 24% get pregnant