Contraception - Other Methods

Question 1

How often is the progestogen injection administered

Answer 1

every 13 weeks

Question 2

What is an ADR of the progestogen injection

Answer 2

Associated with a small loss of bone mineral density

Question 3

What are the guidelines around progestogen injection with regards to the loss of bone density - 4

Answer 3

• Females under 18 may only use if all other options are exhausted
• all females using should be reviewed every 2 years
• should be stopped in females over 50
• not used in females with risk factors for OA

Question 4

What advice should be given about return of fertility after stopping the progeston injection

Answer 4

fertility may take up to a year to return - however, those who dont wish to concieve should still use other contraceptive methods

Question 5

Where is the progestogen implant inserted

Answer 5

• Subdermally
• typically proximal non-dominant arm over the tricep

Question 6

Mechanism of action of implant - 2

Answer 6

• prevents ovulation
• thickens cervical mucus

Question 7

How long does the p implant last

Answer 7

3 years

Question 8

What are the benefits of the P implant -3

Answer 8

• the most effective form of contraception
• doesnt contain oestrogen so can be used if past hx of VTE, migraine, stroke ect
• cam be inserted immediately after a termination

Question 9

What advice should be given surrounding effectiveness when starting the implant

Answer 9

if inserted on day 1 to 5 of cycle, immediate effects

if not, use an additional contraceptive for 7 days

Question 10

ADRs of the P implant - 2

Answer 10

Irregular/heavy bleeding
Progestogen effects - headache, nausea, breast pain

Question 11

DDIs of Implant

Answer 11

Enzyme inducers

Question 12

Contraindications to implant (UKMEC3 - 4, UKMEC4 - 1)

Answer 12

UKMEC3
- IHD, Stroke
- suspicious vaginal bleeding
- past breast cancer
- liver cirrhosis or cancer

UKMEC4
- current breast cancer

Question 13

Name the two types of intrauterine devices

Answer 13

IUD - copper coil
IUS - progesterone releasing

Question 14

Mechanism of action of IUS and IUD

Answer 14

IUD - decreased sperm motility and survival

IUS - prevents endometrial proliferation and thickens cervical mucus

Question 15

How long do the IUD and IUS last

Answer 15

IUD - most are 5 years, some last up to 10

IUS - 5 years

Question 16

When does the IUD and IUS become effective

Answer 16

IUD - immediately after insertion

IUS - becomes effective after 7 days

Question 17

Problems of intrauterine devices - 6

Answer 17

IUDs make periods heavier, longer and more painful

the IUS is associated with initial frequent uterine bleeding and spotting. Later women typically have intermittent light menses with less dysmenorrhoea and some women become amenorrhoeic

uterine perforation

the proportion of pregnancies that are ectopic is increased but the absolute number of ectopic pregnancies is reduced, compared to a woman not using contraception

PID

expulsion is most likely to occur in the first 3 months

Question 18

What are the male and female steriliation procedures and explain them

Answer 18

Vasectomy - vas deferens is snipped and ties to prevent sperm entering the ejaculate

Tubal Ligation – fallopian tubes are occluded to prevent ovum transport

Question 19

Name the 2 emergency contraceptives

Answer 19

Levonorgestrel (progesterone)

EllaOne AKA Ulipristal (a SERM)

Question 20

What is levonorgestrel mechanism of action - 2

Answer 20

• stops ovulation
• inhibits implantation

Question 21

When must levonorgestrel be taken by

Answer 21

Within 72 hours of unprotected sexual intercourse

Efficacy decreases with time

Question 22

what advice around weight should be taken into account when prescribing levonorgestrel

Answer 22

If BMI is over 26 or weight over 70kg, then double the dose

Question 23

Mechanism of action of EllaOne - 1

Answer 23

Inhibits ovulation

Question 24

When should ellaone be taken by

Answer 24

120 hours after unprotected sex

Question 25

Contraindications of EllaOne - 3

Answer 25

• reduces effectiveness of hornomal contraception, barrier methods should be used for 5 days
• caution with severe asthma
• breastfeeding should be delayed after 1 week

Question 26

what is the other method of emergency contraception and how long can it be used for

Answer 26

Copper IUD is most effective method and can be used up to 5 days after unprotected sex

Question 27

when can you start normal contraception again after emergency contraception

Answer 27

EllaOne - 5 days
Levonorgestrel - start immediately