Contraceptions

Question 1

What is the two type of contraceptions?

Answer 1

One requires ongoing action by the individual.

The other type prevents contraception by default.

Question 2

What are some examples of ongoing contraception?

Answer 2

Oral contraception, barrier methods, fertility awareness, coitus interruption and oral emergency contraception.

Question 3

What are some examples of contraception by default?

Answer 3

IUD, progesterone implant, progesterone injections and sterilisation.

Question 4

Describe the perfect contraception.

Answer 4

The perfect contraception should be 100% reliable and safe. It should be universally usable.

Ideally, it is not related to coitus and visible to women so we know when it is safe.

If there is no ongoing input then you don’t have to worry about it.

It should be completely reversible within 24 hours.

It shouldn’t cause discomfort.

Question 5

What does COCP contain?

Answer 5

Oestrogen and progesterone

Question 6

How does COCP work?

Answer 6

a higher than normal levels of oestrogen and progesterone and acts on the hypothalamic/pituitary/ ovarian axis to provide negative feedback. It tricks the body into thinking it is pregnant and prevent ovulation.

Progesterone also act on the fallopian tube to prevent contraction and peristalsis, the cervical mucus to make it thicker and prevent sperm from entering.

Question 7

what are the names of oestrogen and progestogens that are given in COCPs?

Answer 7

ethinylestradiol is oestrogen.

2nd gen progesterones are norethisterone and levonorgestrel.

3rd gen are desogestrel, gestodene and norgestimate.

Question 8

which type of progestogens have anti-mineralocorticoid effects?

Answer 8

Latest in use of COCP is called drospirenone.

Question 9

What are the benefits of using COCP?

Answer 9

It is reliable and safe.
Unrelated to coitus.
Women is in control
Rapidly reversible - it takes 10 days of no drugs to return to fertility.
half your chance of ovarian and endometrial cancer - due to those cells not proliferating.
also helps wth dysmenorrhoea, menorrhagia.
You can take as long as you want without taking a break.

Question 10

What is the recommended use of COCP?

Answer 10

take it every day for 21 days in a 3 hours window and rest for 7 days for a light bleed.

Question 11

What are the risks of COCP?

Answer 11

1 in 500 women will get pregnant.
Progesterone increase blood pressure and 2% of women develop hypertension.
Oestrogen increase clotting factors so increase the risk of DVT. If you were to develop a DVT it would occur within 6 months and expose women with underlying problems and risk factors.

Question 12

What is the advice for forgetting to take COCP?

Answer 12

use a condom as you are no longer safe. Maybe don’t have the break.

Question 13

What are the contraindications to COCP?

Answer 13

enzyme-inducing drugs such as antiepileptic drugs. enzyme inducing drugs can increase the metabolism of both oestrogen and progesterone.

Broad spectrum antibiotics affect the enterohepatic circulation of oestrogen causing it to be broken down.

Question 14

What is combined vaginal contraception?

Answer 14

IT is a ring that is inserted into the vagina which releases the combined hormones in COCP. You put the ring in for 21 days and take it out for 7.

Question 15

What are some progesterone only methods of contraception?

Answer 15

progesterone implant in the skin in your arm last 3 years.

cerazette is a newer version progesterone only pill. It has better control over bleeding, whereas the older version has trouble with spotting and bleeding. It also has a longer window of 12 hours.

Medroxyprogesterone is an injection which lasts 12 weeks in your buttocks.

It is good when you don’t want oestrogen while breastfeeding.

Question 16

What are the two major types of IUD? And how does it work?

Answer 16

The copper bearing which is used to cause a local inflammatory environment. It kills sperms and prevents implantation. the minimum amount of time is 5 years. The higher amount of copper the longer it lasts.

Marina hormone bearing, it contains progestogens. It runs out after 5 years.

Question 17

Benefits to IUD?

Answer 17

Immediately effective, non-user dependent, long-term and very reliable.
Merina reduces menses.

Question 18

Disadvantages to IUDs?

Answer 18

IT can range from discomfort to hurt unbearably when you are putting it in.

With copper bearing the period can become more heavy and painful, due to the transition from COCP to regular flow then heavier flow.

If te thread i=is too long then it rubs against the vaginal wall, if it is too short then it can stab the guy.
4cm vs 2 cm.

Question 19

Risk to IUD

Answer 19

If the person is pregnant before IUD is put in, chances of miscarriage increase. It is best to take it out in this case.

Overall chances of pregnancy increase, but the risk of ectopic pregnancy increases if the patient were to be impregnated.

If you don’t put it in further enough the cervix push it out if it is put in wrongly or too far it can end up in the abdomen.

Question 20

Contraindications to IUCD

Answer 20

Pelvic inflammatory disease and infections need to be treated first.
never put it in if there is suspected pregnancy.
investigate unexplained vaginal pregnancy.
an abnormal uterine cavity can be a problem.
can’t use it on women with an endometrium fibroid problem.

Question 21

Condoms advantage and disadvantage

Answer 21

The best protection against STIs, no serious health risks except latex allergies.

Must be used during all part of intercourse, people need to be taught how to use it.

Question 22

What are the two types of caps?

Answer 22

Diaphram, which is made up of latex and it fits across the vagina. It needs to be used with spermicide and left in for 6 hours after sex to kill all the sperms.

Suction (cervical) caps, which is made up of plastic. It acts as a vaginal vault. It also needs to be used with spermicide and left for 6 hours.

Question 23

What are some advantage and disadvantages to diaphragm Caps?

Answer 23

The advantage is the women is in control, it can be prepared in advance. It offers protection against cervical dysplasia. It is perceived as natural (diaphragm).

Disadvantage include, you need to teach how it is used, it can be messy, higher failure rate, higher UTI and higher candidiasis which is a fungal infection.

Question 24

What are some advantage and disadvantage to suction caps?

Answer 24

It is suitable for women with poor pelvic muscles and no rubber allergies. It is very nonobstructive and the women are in control.

The disadvantage is it needs a suitable and accessible cervix. It has a higher failure rate than the diaphragm cap. It is also difficult to find an experienced teacher.

Question 25

What is fertility awareness? and how does it work?

Answer 25

7-10 days on either side of ovulation is the dangerous window, don’t have sex during these times.

this is because oocytes can survive for 24 hours and sperm and survive for 5 days in the female tract.

Only works if she has a regular cycle.

Question 26

What are some advantages and disadvantages to fertility awareness?

Answer 26

It is natural and non-medical, which is very useful in the third world. It is also allowed by the catholic church. It can result in closeness between partners.

disadvantages are failure rate are very user dependent, it requires skilled teaching as well as cooperation between partners. Limiting sexual activity may cause a strain on the relationship.

Question 27

What are the two methods of emergency contraception?

Answer 27

Pills and IUD

Question 28

What are the three pills of contraception?

Answer 28

Schering PC4, Levonelle and Ellaone.

Question 29

What is Schering PC4

Answer 29

Schering PC4, this is very old and not used regularly. It contains a high dose of oestrogen and progesterone. This is protected if given up to 72 hours after sex. It has a lower failure rate in the first 24 hours, however, it may cause nausea and vomiting in many women, 1 in 4 in fact. If they vomit then they need to take another.
It is contraindicated during a focal migraine attack.

It acts by postponing ovulation in the first part of the cycle and prevent implantation in the second half of the cycle.

Question 30

What is Levonelle?

Answer 30

This is the go to contraceptive pill, it contains progesterone. It has a safety window of 120 hours but a lower failure rate in the first 24 hours. It delays ovulation in the first half of cycle and prevents implantation in the second half.

It causes very little nausea and only contraindicated in women taking very potent liver medications such as anti-TB.

Question 31

What is Ellaone

Answer 31

it contains ulipristal acetate, which is a selective progesterone receptor modulator, it inhibits or delays ovulation via suppression of LH surges. It can be given up to 120 hours. It can produce GI symptom side effects.

Question 32

How does copper-bearing IUDs work as an emergency contraception?

Answer 32

It can be given up to 5 days after ovulation or 5 days after unprotected sexual intercourse. Failure is extremely rare. It kills sperm in the first half of the cycle and prevents implantation in the second half.

It is the only method which you can sometimes break the 120 hours rule.