Non-Long Acting Reversible Contraception

Question 1

What are some factors that influence contraceptive choice?

Answer 1

Effectiveness, control, long or short term, non-contraceptive benefits, procedure itself

Question 2

What is the typical failure rate of combined hormonal contraception?

Answer 2

9% = perfect rate is 0.3%

Question 3

How should combined hormonal contraception be taken?

Answer 3

Start in first 5 days of period OR at any time in cycle when sure not pregnant plus condoms for 7 days, take daily for 21 days followed by 7 day break

Question 4

What are the factors influencing the effectiveness of combined hormonal contraception?

Answer 4

Impaired absorption = GI conditions
Increased metabolism = liver enzyme induction, drug interaction
Forgetting to take it

Question 5

What are the risks associated with combined hormonal contraception?

Answer 5

Arterial thrombosis, venous thrombosis, adverse effect on some cancers

Question 6

What does the risk of VTE with combined hormonal contraceptive use depend on?

Answer 6

Varies according to EE dose and progestogen type = risk is low but will affect those with other VTE risk factors

Question 7

What are the unwanted circulatory effects of combined hormonal contraceptives?

Answer 7

Systemic hypertension = check BP initially then at 3 months and annually thereafter
Arterial disease = small increase in MI (especially smokers) and ischaemic stroke especially in hypertensives

Question 8

What is a contraindication of combined hormonal contraception?

Answer 8

Migraine with aura

Question 9

When does an aura occur?

Answer 9

5-20mins before onset of headache = may be visual with typical scotoma, also altered sensation/smell/taste, may be hemiparesis

Question 10

What does migraine with aura increase the risk of?

Answer 10

Stroke

Question 11

What age group should the use of combined hormonal contraceptives be given extra thought to?

Answer 11

Consider other risk factors before prescribing if age >35

Question 12

What cancers do combined hormonal contraceptives increase the risk of?

Answer 12

Breast cancer and small risk in cervical cancer associated with use >5 years

Question 13

What cancers are combined hormonal contraceptives protective against?

Answer 13

Ovarian cancer = 20% reduction for every 5 years use

Endometrial cancer = 20-50% reduction

Question 14

What are the benefits of using combined hormonal contraception?

Answer 14

Reduce acne, less bleeding, fewer functional and ovarian cysts, helps premenstrual syndrome and PCOS

Question 15

What are the methods of delivering progestogen only pill?

Answer 15

POP, subdermal implant, DMPA

Question 16

How is the progestogen only pill taken?

Answer 16

Take on day 1-5 of period OR anytime if sure not pregnant plus condoms for 7 days (2 for POP)

Question 17

What are some features of progestogen only pills?

Answer 17

Contraindicated in current breast cancer

Depo Provera lowers oestradiol and suppresses FSH

Question 18

How effective are diaphragms?

Answer 18

71-88%

Question 19

What are some features of vasectomy?

Answer 19

Counselling = risks and benefits, reversal
Methods = local or general anaesthesia, no scalpel technique

Question 20

What are some potential complications of a vasectomy?

Answer 20

pain, infection, bleeding/haematoma, failure

Question 21

What does the post-vasectomy seminal analysis?

Answer 21

Late-motile or >100000 non-motile sperm at 7 months

Question 22

What is the most effective method of emergency contraception?

Answer 22

IUD = 99% effective

Question 23

When must an emergency IUD be fitted in order to be effective?

Answer 23

Within 5 days of earliest possible date of ovulation OR within 5 days after single sexual encounter

Question 24

What is the most popular emergency contraceptive method?

Answer 24

Oral = EllaOne and Lipostelle

Question 25

What is the action of EllaOne?

Answer 25

Progesterone receptor modulator = stops LH surge so delays ovulation

Question 26

When must EllaOne be taken to be effective as emergency contraception?

Answer 26

Can be used up to 5 days after unprotective sex = up to 90% effective if taken within 24hrs but efficacy decreases over time

Question 27

What is the disadvantage of using EllaOne?

Answer 27

Can’t use progesterone immediately prior to or after using EllaOne = my delay starting contraception

Question 28

How does Lipostelle work as emergency contraception?

Answer 28

Delivers large dose of progesterone = aims to inhibit ovulation

Question 29

When is Lipostelle effective as emergency contraception?

Answer 29

Can be used up to 72hrs after sex = up to 90% effective if used within 24hrs but decreases over time

Question 30

What are the disadvantages of Lipostelle?

Answer 30

Not as effective as EllaOne and need to take double dose if weight is >70kg

Question 31

What are the disadvantages of the oral methods of emergency contraception?

Answer 31

Don’t work very well in second half of cycle

Both affected by enzyme-inducing medication and vomiting