Contraceptives

Question 1

What factors would you have to assess for when finding a suitable method?

Answer 1

Age?
Pregnant?
Current medication?
-HAART, antiepileptics
Comorbidities?
-CVD, VTE, STI, PID, migraines, T2DM
Reasons for contraception
Sexual activity?

Question 2

How do combined hormonal contraceptives work (CHC)

• forms
• mechanism of action
• what 2 ways can you use this
• pros and cons

Answer 2

Oral, transdermal patch, vaginal ring

Inhibit ovulation

• O, P inhibits FSH, LH release
• P opposes endometrial growth stimulated by O

Can have a 7 day free interval to mimic menstruation but you can take CHC continuously

Pros => many options to fit patient preference
Con => increased VTE risk so avoid in patients with high QRISK score (35+ smokers, T2DM, HTN, hypertriglyceridemia)

Question 3

How do interuterine methods of contraception work

• forms
• mechanism of action
• pros and cons

Answer 3

MUST EXCLUDE PREGNANCY IF USED
Offer alternative in breast cancer, PID, unexplained vaginal bleeding, symptomatic STI
Be careful in distortion of uterine cavity from fibroids

Levonorgestrel IUS => P inhibits ovulation, cervical mucus thickening
Copper IUD => inhibits fertilisation due to toxic effects on gametes

Pros
-no medication to remember taking

Cons

• pain on insertion
• expulsion of device
• bleeding, perforation of uterine wall
• ectopics, risk of PID

Question 4

How does the progesterone only method work

• types
• mechanism of action
• pros and cons

Answer 4

Used when CHC is CI
Oral, implant, injectable
-contains either levonorgestrel, norethisterone, desogestrel

Thickening cervical mucus => prevent sperm penetration
Inhibit ovulation
Thins endometrial lining

Pros

• sex is uninterrupted
• may reduce endometrial, ovarian cancer, PID, ectopics
• fewer/no periods

Cons

• irregular periods
• no protective action of estrogen (decreased HDL, osteoporotic)