Lecture 7 - Contraception and HRT

Question 1

What is effectiveness in terms of contraception and how is it measured?

Answer 1

Effectiveness is a measurement of failure in contraception. It is measured using the pearl index, a score of 4 means that 4 in 100 women using it will be pregnant by the end of the year.

Question 2

What are some features of an ideal contraceptive?

Answer 2

100% safe
100% effective
Independent of intercourse
Reversible
cheap
simple and painless

Question 3

Which part of the menstrual cycle is constant and which part can vary in length?

Answer 3

The length from ovulation to menstruation is always 14 days whereas the time before ovulation (follicular phase) can vary in length.

Question 4

What are the main types of contraception?

Answer 4

Hormonal - COC, POP etc.
Intrauterine - copper coil, Mirena
Barrier - condoms
Natural methods - family planning
Sterilisation

Question 5

What are the three main methods of natural family planning?

Answer 5

Rhythm method - have sex around the time of ovulation
Billing’s method - uses changes in cervical mucus, thick and sticky during luteal phase
Lactational ammenhorrea

Question 6

What are the types of Hormonal contraceptives?

Answer 6

Combined hormonal contraceptives e.g. pills, patch
Progesterone only contraceptives e.g. progesterone only pill
Long acting reversible contraceptives e.g. injectables, intrauterine, implants

Question 7

What is the mechanism of action of combined hormonal contraceptives?

Answer 7

They cause negative feedback to HPO axis so prevent ovulation.

Question 8

What are the side effects of combined oral contraceptive?

Answer 8

Headaches, weight gain, breast tenderness.

Question 9

What are the disadvantages of the combined oral contraceptive?

Answer 9

Small increase in breast cancer risk, circulatory disease and venous thromboembolism risk

Question 10

What are the evra patch and Nuva ring?

Answer 10

Both combined oral contraceptives. transdermal patch and vaginal ring.

Question 11

What are the disadvantages of the progesterone only pill?

Answer 11

It can cause menstrual irregularities, ectopic pregnancy and functional ovarian cysts.

Question 12

What is the injectable contraceptives?

Answer 12

Same as progesterone only pill

Question 13

How do implants work?

Answer 13

They inhibit ovulation through production of etonogestrel which is a steriodal progestin

Question 14

How does the mirena coil work?

Answer 14

Prevents ovulation through release of levonorgestrel which is a steroid.

Question 15

How does the intrauterine device (copper coil) work?

Answer 15

It is spermicidal and also stops the embryo from implanting. This is due to a foreign body type reaction.

Question 16

What are the three main types of emergency contraception?

Answer 16

Levonelle one step is progesterone only (nausea and vomiting).
EllaOne is synthetic progesterone receptor modulator (not as effective but less side effects)
IUD (copper coil) can be inserted up to 5 days after intercourse to prevent implantation.

Question 17

before how many weeks can you have an abortion?

Answer 17

24 (6 months) if section 1

Question 18

What is the result of oestrogen deficiency after menopause?

Answer 18

It causes osteoporosis, alzheimers and increased insulin release.

Question 19

Why must unapposed oestrogen not be given to women with a uterus and what must be given instead?

Answer 19

It causes endometrial hyperplasia and cancer. Instead must be given combined HRT (oestrogen and progesterone).

Question 20

What is the disadvatage of the combined HRT?

Answer 20

This slightly increases the risk of breast cancer, whereas oestrogen only does not