Progestogen only contraception and coils

Question 1

Progesterone only pill (1)
1) What are the 2 types of POP?
2) Which type cannot be delayed by more than 3 hours and which can be taken up to 12 hours late and still be effective?

Answer 1

1) Traditional progestogen-only pill and desogestrel-only pill
2) Traditional = cannot be delayed by more than 3 hours. Desogestrel = can be taken up to 12 hours late

Question 2

Progesterone only pill (2)
1) How does the traditional POP work (3)?
2) How does the desogestrel work (4)?

Answer 2

1) Thickening the cervical mucus, altering the endometrium and making it less accepting of implantation, reducing ciliary action in the fallopian tubes
2) Inhibiting ovulation, thickening the cervical mucus, altering the endometrium, reducing ciliary action in the fallopian tubes

Question 3

Progesterone only pill (3)
Name 2 side effects of the POP

Answer 3

• Unscheduled bleeding
• Breast tenderness
• Headaches
• Acne

Question 4

Progestogen-only injection (POI) (1)
1) The POI is also known as what?
2) How is it given (2)?
3) How often is it given?
4) It can take up to how many months for fertility to return after stopping the injections?

Answer 4

1) Depot medroxyprogesterone acetate (DMPA)
2) Intramuscular or subcutaneous injection
3) 12-13 week intervals
4) 12

Question 5

Progestogen-only injection (POI) (2)
1) Name the main MoA, and 1 other
2) What is the two side effects that are unique to the progestogen injection?
3) Name 2 other side effects

Answer 5

1) Inhibit ovulation by inhibiting FSH secretion by the pituitary gland, preventing the development of follicles. Also thickens cervical mucus and alters the endometrium making it less accepting of implantation
2) Weight gain and osteoporosis
3) Irregular bleeding, acne, reduced libido, mood changes, headaches, flushes, hair loss, skin reactions at injection site

Question 6

Progestogen only implant (1)
1) What is the implant?
2) How long does it last before needing replacing?
3) What is the implant used in the UK, and what does it contain?

Answer 6

1) Flexible plastic rod that’s placed in the upper arm, beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the circulation
2) 3 years
3) Nexplanon, etonogestrel

Question 7

Progestogen only implant (2)
1) Name 2 MoA
2) Name an advantage of this method compared to the POI
3) Name an advantage of this method compared to the COCP
4) Name a downside of this method

Answer 7

1) Inhibiting ovulation, thickening cervical mucus, altering the endometrium making it less accepting of implantation
2) No weight gain and no effect on BMD
3) No increase in thrombosis risk and
no restrictions for use in obese patients
4) Minor operation with a local anaesthetic to insert and remove the device, can lead to worsening of acne, no protection against STIs, can cause problematic bleeding

Question 8

Coils (1)
1) What are the 2 types of coils?
2) Name 2 contraindications for coils

Answer 8

1) Copper coil (Cu-IUD) and levonorgestrel intrauterine system (LNG-IUS)
2) PID or infection, immunosuppression, pregnancy, unexplained bleeding, pelvic cancer, uterine cavity distortion (e.g. by fibroids)

Question 9

Coils - IUD (2)
1) What is the range of time the IUD can be inserted for?
2) How does it work?
3) Name a notable contraindication for the copper IUD
4) Name a benefit
5) Name a downside

Answer 9

1) 5-10 years
2) Wilson’s disease
3) Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation
4) Reliable contraception, effective immediately, contains no hormones (safe for women at risk of VTE or with a history of hormone-related cancers), may reduce the risk of endometrial and cervical cancer
5) A procedure is required to insert and remove the coil, it can cause heavy or intermenstrual bleeding, can cause pelvic pain, does not protect against STIs, increased risk of ectopic pregnancies, can fall out

Question 10

Coils - IUS (3:1)
1) The 4 types of IUS - Mirena, Levosert, Kyleena, Jaydess - all contain what?
2) Which of these 4 can be used for menorrhagia (2)
3) Which of these can be used for HRT?
4) Which of these 4 is effective for 3 years?
5) The other 3 are effective for how long?

Answer 10

1) Levonorgestrel
2) Mirena and Levosert
3) Mirena
4) Jaydess
5) 5 years (Mirena is only licensed for 4 years for HRT)

Question 11

Coils - IUS (3:2)
1) What is the MoA?
2) Name a benefit of the IUS
3) Name a downside of the IUS

Answer 11

1) Thickening cervical mucus, altering the endometrium making it less accepting of implantation, inhibiting ovulation in a small number of women
2) Can make periods lighter or stop altogether, may improve dysmenorrhoea or pelvic pain related to endometriosis, no effect on BMD, no increase in thrombosis risk, no restrictions for use in obese patients
3) A procedure is required, can cause spotting or irregular bleeding, some women experience pelvic pain, does not protect against STIs, increased risk of ectopic pregnancies, increased incidence of ovarian cysts, can be systemic absorption causing side effects of acne, headaches, or breast tenderness