Fertility Control

Question 1

What is method failure ?

Answer 1

Pregnancy despite correct use of the method by user

Question 2

What is user failure ?

Answer 2

Pregnancy because method not used correctly by user.

Question 3

What is long acting reversible contraception (LARC) ?

Answer 3

Minimizes user input so minimizes user failure ?

Question 4

When is a normal female 26-32 day cycle (not on hormonal Rx) most likely to ovulate ?

Answer 4

Ovulate day 12-18 (2 weeks before next period)

Question 5

How any days/hours does an egg survive ?

Answer 5

24 hours

Question 6

How long does a sperm cell survive ?

Answer 6

Less than 4 days

Question 7

When is the highest chance of pregnancy if a woman is on a 26-32 day regular cycle ?

Answer 7

Day 8-19 but sperm survival and ovulation are variable so natural methods can fail.

Question 8

In what forms does the combi-pill come in ?

Answer 8

Pill
Patch
Vaginal ring

Question 9

The combi-pill (contraceptive pill) is a combination of which 2 hormones ?

Answer 9

Athinyl estradiol (EE) Synthetic progesterone (progestogen)

Question 10

What do the hormones in the combi-pill do ?

Answer 10

Stop ovulation and affect cervical mucous

Question 11

What is the standard regime for the combination contraception?

Answer 11

21 days with a hormone free week.

One pill taken daily/Patch changed weekly/Ring changed every 3 weeks.

Question 12

What are the non-contraceptive benefits of the combi-therapy for contraception?

Answer 12

Regulate /reduce heavy bleeding.
Stop ovulation.
Reduction in ovarian cysts.
Improve acne/hirsutism.

Question 13

What are some of the troublesome side effects of the combi-therapy for contraception ?

Answer 13

Breast tenderness
Nausea
Headache
Irregular bleeding for first 3 months

Question 14

What are some of the serious risks associated with CHC ?

Answer 14

Increased risk of DVT/PE

Increased risk of arterial thrombosis

Question 15

Who would you avoid prescribing CHC for?

Answer 15

If BMI >34
Previous VTE
Thrombophillia
Reduced mobility

Hx MI or stroke
Smoker >55
Focal migraine
Hypertension

If active gallbladder disease
Increased cancer risk

Question 16

What hormone is used in the mini-pill ?

Answer 16

Progestogen only (POP)

Question 17

What is the routine for the POP mini-pill ?

Answer 17

Pill taken at the same time every day without a pill free interval

Question 18

What is the mechanism of action of the POP ?

Answer 18

Anovulant
Affects mucous
Bleed free

Question 19

What are the side effects of the POP ?

Answer 19

Appetite increase
Hair loss/gain
Mood change
Bloating/fluid retention
Headache
Acne

No increase of venous or arterial thrombus.

Question 20

What is the routine for the depot contraception injection ?

Answer 20

Aqueous solution of progestogen.

150mg/ml deep IM injection every 13 weeks.

Question 21

What are some of the cons of the depot contraception injection ?

Answer 21

Delay in return to fertility.
Reversible reduction to bone density.
Problematic bleeding.
Weight gain (The only contraceptive method with a causal effect on weight gain)

Question 22

What kind of hormone is found in ‘The rod’ ?

Answer 22

Subdermal progestogen implant (Nexplanon)

Question 23

How much progestogen is found inside the rod ?

Answer 23

68mg of progestogen in a matrix of ethinylvinylacetate (EVA)

Question 24

What is the mechanism of action of the rod ?

Answer 24

Inhibition of ovulation and effects cervical mucous.

Question 25

What are the 2 main forms of intra-uterine contraception ?

Answer 25

Copper IUD and Levonorgestrel IUS

Question 26

What is the mode of action in a copper IUD?

Answer 26

Copper is toxic to sperm - stops sperm reaching the egg. Hormone free.

Question 27

How many years does a copper IUD last ?

Answer 27

5-10 years

Question 28

What is the mode of action of Levonorgestrel IUS ?

Answer 28

Affects cervical mucous and endometrium - most women still ovulate but it stops fertilisation of egg and prevents implantation of fertilised egg.

Question 29

How does the hormones present in the levongestrel IUS compare to that of the combi-pill and the POP ?

Answer 29

IUS has low circulating progestogen levels compared to pill/implant/injection .

Question 30

What are the 2 types of Levongestrel IUS ?

Answer 30

Mirena

Kyleena

Question 31

What are the 3 main types of emergency contraception ?

Answer 31

Copper IUD
Levonelle Pill
Ellaone Pill

Question 32

What is the time frame for use of the copper IUD as emergency contraception ?

Answer 32

Fit before implantation i.e. 120 hours UPSI any time in cycle or by day 19 of 28 days cycle.

Question 33

What is the time frame for the levonelle emergency contraceptive pill ?

Answer 33

Take within 72 hours

Question 34

What is the time frame for the ellaone emergency contraceptive pill ?

Answer 34

Take within 120 hours

Question 35

When can a women become pregnant after delivery ?

Answer 35

21 days after delivery

Question 36

What occurs in female sterilization ?

Answer 36

Clips across tubes to block tube lumen

Question 37

What occurs in a vasectomy ?

Answer 37

Vas deferens divided and cauterised.

Question 38

What are the 2 forms of pregnancy termination ?

Answer 38

Surgical and medical

Question 39

Between what weeks can a surgical termination of pregnancy be carried out ?

Answer 39

5-12 weeks

Question 40

Between what weeks can a medical termination of pregnancy be carried out ?

Answer 40

5-24 weeks

Question 41

What is the process of a surgical termination of pregnancy ?

Answer 41

1. Cervical priming misoprostol 3 hours pre-op help dilation and reduces risk of perforation/hemorrhage.
2. GA or LA cervical block
3. Trans-cervical

Question 42

What is the process of a medical termination of pregnancy ?

Answer 42

1. Mifepristone PO anti-progestogen tablet.
2. 36-48 hours later, Misoprostol initiates uterione contraction which opens cervix and expels pregnancy.
3. Average 4-6 hours to pass pregnancy under 12 weeks.
4. Mifepristone helps misoprostol work better