Methods of Contraception

Question 1

MOA of emergency contraception
-levonorgestrel (IUS)
-ulipristal
-IUD

Answer 1

Levonorgestrel - inhibits ovulation

Ulipristal - inhibits ovulation

IUD - toxic to sperm and ovum, inhibit implantation

Question 2

COCP
-MOA
-contraindications
-advantages
-disadvantages
-use for contraception
-use in 50+

Answer 2

Inh ovulation

UKMEC 3
-35+ and smoking U15 cigarettes/day
-BMI 35+
-FHx thromboembolic disease in 1st degree relatives U45
-controlled HTN
-immobility
-BRCA1/2
-current gallbladder disease (can cause drug-induced cholestasis)

UKMEC 4
-35+ and smoking 15+ cigarettes/day
-migraine with aura
-Hx thromboembolic disease/mutation, stroke, IHD
-breast feeding U6wks postpartum
-uncontrolled HTN
-current breast cancer
-major surgery + prolonged immobilisation
-APS AB

Pros
-reversible when stopped
-lighter, regular, less painful periods
-reduced risk of ovarian, endometrial, colorectal

Cons
-increased risk of VTE, MI, stroke
-increased risk of breast, cervical cancer
-no STI protection
-must be careful with enzyme inducing ABx (rifampicin)

Use
-21 days, 7 day break
-can have no pill-free interval, tricycling
-effective in 7 days

1 missed
-take last pill, may lead to taking 2 in 1 day
2+ missed
-same advice as above
-use condoms/abstain until 7 days of pills taken

Additional contraception
-If missed in week 1 => EC
-if missed in week 2 and consistent in week 1 => no EC
-if missed in week 3 => finish pack and skip pill free interval

50+ => non-hormonal or progestogen-only method

Question 3

Progestogen only pill (not desogestrel)
-MOA
-use
-SE

Answer 3

Thicken cervical mucus

Same time every day, no pill breaks
If U3hrs late - continue as normal
If 3hrs+ late/diarrhoea/vomiting - take missed pill, continue as normal
-extra precautions taken until pill taking reestablished for 48hrs

If desogestrel
If U12hrs late - continue as normal
If 12hrs+ late - take missed pill, continue as normal
-extra precautions taken until pill taking reestablished for 48hrs

Irregular bleeding

ABx except rifampicin are ok

Question 4

Injectable contraceptive (medroxyprogesterone, Depo Provera)
-MOA
-SE
-CI

Answer 4

12wk depot
Inh ovulation
Thicken cervical mucus

Irregular bleeds
Weight gain
Cannot be reversed once given, potential 12month delay of fertility

CI - Breast cancer

Question 5

Implantable contraceptive (etonogestrel)
-MOA
-SE and issues
-CI

Answer 5

3year implant
Inh ovulation
Thicken cervical mucus

Irregular/heavy bleeding - can be managed with COCP
Need additional contraceptive methods for 1st 7 days if not started on D1-5
Affected by enzyme inducing drugs (AED, rifampicin)

CI
-IHD, stroke
-unexplained, suspicious bleeding
-past and present breast cancer
-severe liver cirrhosis, cancer

Question 6

IUD (copper)
-MOA
-Pros
-Cons

Answer 6

Decrease sperm motility, survival

Immediate protection for 5-10years

Heavier, longer, more painful periods
Risk of perforation, higher when breastfeeding
Risk of pregnancy is reduced but risk of ectopics is higher
Risk of PID higher in first 20 days

Question 7

IUS (levonorgestrel, Mirena)
-MOA
-Pros
-Cons

Answer 7

Prevents endometrial proliferation
Thicken cervical mucus

Protection after 7days
Mirena effective for 5years

Irregular bleeding
Initial frequent uterine bleeding, spotting but gets lighter
Risk of perforation, higher when breastfeeding
Risk of pregnancy is reduced but risk of ectopics is higher
Risk of PID higher in first 20 days

Question 8

Contraception for transgender and nonbinary people
-has uterus + testosterone therapy
-male at birth + sperm reducing treatment
-STI protection

Answer 8

Has a uterus + testosterone therapy
-testosterone therapy is not contraception, and CI in pregnancy
-cannot use estrogen-based, it antagonises testosterone therapy
Can use
-POP, IUS

Male at birth + using estradiol, GnRH (finasteride, cyproterone acetate) => reduction in sperm prod
Use condoms

Condoms, dental dams
Cervical screening, HPV, HepA, B vaccinations, PREP, PEP, HIV tests