Intro to Contraception

Question 1

What is Contraception?

Answer 1

Any method used to prevent a pregnancy

Can range from Blocking Sperm transport to Interrupting HPG axis to prevent ovulation and/or implantation

Question 2

What are the 6 categories of Contraception

Answer 2

• Natural
• Hormonal (Short and long acting reversible)
• Barrier
• Prevention of implantation/ The Coil (IUD/ IUS)
• Sterilisation
• Emergency contraception

Question 3

List 4 types of Natural Contraception

Answer 3

• Abstinence
• Withdrawal/ Coitus Interruptus
• Fertility awareness
• Lactational Amenorrhea

Question 4

What is the only reliable method of contraception?

Answer 4

Abstinence

Question 5

Describe the Fertility Awareness method of Natural contraception

Answer 5

• Avoiding intercourse around ovulation

Monitoring and recording fertility indicators;

• Basal body temperature
• Cervical mucus

(Unreliable, requires education, no STI cover)

Question 6

Describe the Lactational Amenorrhea method of Natural contraception

How long is this effective for?
What are 3 disadvantages?

Answer 6

• Suckling response lowers GnRH release due to high PRL levels, thus lactation delays ovulation onset
• 6 months
• Relies upon exclusive breastfeeding
• No STI cover
• Unreliable

Question 7

Barrier contraception prevents sperm entering cervix.

Give 3 examples
Give 3 disadvantages

Answer 7

• Male condoms
• Female condoms
• Diaphragms/ Cervical caps

(May involve spermicide use)

• Disrupts intercourse
• Risk of dislodging (Cap becomes loose)
• Allergy to latex

Question 8

What are the 2 types of Hormonal Contraception?

Gives 2 examples of each type

Answer 8

Short acting reversible;

• POP (Progesterone Only Pill)
• COCP (Combined Oral Contraceptive Pill)

Long acting reversible;

• Progesterone injection
• Progesterone implant

Question 9

Describe mechanism of the POP as a Short-acting reversible method of Hormonal contraception

How often is it taken and what effect does it have on period control?

Answer 9

• Low progesterone dose
• Not enough to inhibit ovulation, but thickens Cervical mucus
• Taken daily with no breaks, no effect on controlling periods

Question 10

Why does usage of the POP pose a higher risk of Ectopic Pregnancy?

Answer 10

Does not inhibit ovulation and reduces function of Cilia-> Increased chance of ectopic pregnancy

Question 11

Describe mechanism of the COCP as a Short-acting reversible method of Hormonal contraception

(Contains both Oestrogen and Progesterone)

How is it taken?

Answer 11

• Primary aim: Makes hypothalamus think it is in Luteal Phase, preventing Ovulation
• Secondary aims: Reduce endometrial receptivity, thicken cervical mucus
• Taken for 21 days with a 7 day break OR 21 days with 7 placebo pills

Question 12

List 4 advantages of using COCP

Answer 12

• Reliable (Up to 99%)
• Can alleviate menstrual symptoms (Menorrhagia, Dysmenorrhea, Irregular periods)
• Reduce acne severity in some people
• Reduce risk of endometrial + ovarian cancer

Question 13

How does COCP reduce the risk of ovarian and endometrial cancer

Answer 13

• Reduced number of times ovulation occurs

- Reduced endometrium proliferation

Question 14

What are 5 disadvantages of using the COCP

Answer 14

• Interaction with other medications
• Increased risk of breast cancer
• Side effects (Breast tenderness, mood disturbance)
• User dependant
• Contraindications in those at risk of MI, Stroke (Oestrogen is thromboembolic, so must be stopped before surgery)

Question 15

What do you tell a patient if they have missed 1 pill or stated a pack 1 day late?

Answer 15

• Take the last pill you missed even if it means taking 2 in one day
• Take the rest of the pack normally
• Do not need to use extra contracteption

Question 16

What do you tell a patient if they have missed 2 pills or stated a pack 2 days late?

What if there are less than 7 pills left at the end of the pack?

Answer 16

• Take the last pill you missed, even if this means taking 2 pills in a day
• Leave any earlier missed pills
• Take the rest of the pack normally and use extra contraception
• Start the next pack the next day with no breaks

Question 17

Compare Short and Long acting reversible contraception in terms of reliability on user

Answer 17

Unlike SARC, LARC is not reliable on user as they have a longer lasting effect so don’t need to remember to take a pill every day

Question 18

Describe the Progesterone Injection

Answer 18

High IM dose of Progesterone every 12 weeks;

• Prevents ovulation
• Thickens cervical mucus
• Thins endometrial lining

Question 19

Give 2 advantages and 3 disadvantages of the Progesterone Injection

Answer 19

• No known interactions with other medications
• Can be used if COCP is contraindicated
• Not rapidly reversible
• Delay in fertility returning
• Injection may be unpleasant

Question 20

Describe the Progesterone Implant

How long does it last?

Answer 20

Small Subcutaneous tube inserted into arm, releases high progesterone;

• Thins endometrial lining
• Thickens cervical mucus
• Prevents ovulation

Can last up to 3 years

Question 21

Give 2 advantages and 2 disadvantages of the Progesterone Implant

Answer 21

• Can be used if COCP is contraindicated
• Fertility returns faster than with injection
• Complications with insertion and removal
• Can cause menstrual irregularities (Amenorrhoea, Heavy periods, Spotting/ irregular bleeding)

Question 22

Prevention of implantation using the coil is a long term, reversible method.

What are 2 types of intrauterine coil contraception?

Answer 22

Intrauterine System and Intrauterine Device (IUS and IUD)

Question 23

Describe the IUS

How is ovulation affected?
In what patients is this method useful?

Answer 23

Coil releases progesterone locally;

• Prevents implantation
• Thins endometrial lining to prevent proliferation
• Thickens cervical mucus
• Ovulation usually continues
• Useful in patients with menorrhagia (as it thins endometrial lining)

Question 24

Describe the IUD

Is it effective in those with menorrhagia?

Answer 24

Coil made of copper;

• Physical barrier to implantation
• Toxic to sperm and ova
• No, as it doesn’t contain progesterone to thin endometrial lining

Question 25

What are the 3 disadvantages of using an IUD

Answer 25

• Can be difficult to insert
• Can displace/ cause perforation
• No STI protection

Question 26

Sterilisation is generally irreversible.

What are 2 types

Answer 26

• Vasectomy

- Tubal ligation/ clipping

Question 27

Describe a Vasectomy

Answer 27

• Vas Deferens snipped/ tied to prevent sperm entering ejaculate
• Samples must be provided afterwards to ensure effectiveness

Question 28

Describe Tubal Ligation

Answer 28

• Fallopian tubes clipped to prevent Ovum entering uterus

- Slightly higher failure rate than vasectomy

Question 29

What are 2 occasions Emergency contraception can be used

What are 3 types?

Answer 29

After Contraceptive Failure or UPSI (Unprotected Sexual Intercourse)

• Morning after pill/ Levonorgestrel
• Ulipristal acetate
• Copper IUD

Question 30

Up to how many hours after UPSI can the ‘morning after pill’ be used?

Answer 30

Up to 72 hours, but most effective within 12 hours

Question 31

Up to how many hours after UPSI can Ulipristal Acetate be used?

Answer 31

120 hours (5 days)

Question 32

Up to how many hours after UPSI can a Copper IUD be used?

This is the most effective form of emergency contraceptive

Answer 32

120 hours (5 days)