Session 5 - Contraception And Infertility

Question 1

What is contraception?

Answer 1

Any method of preventing pregnancy:

• blocking transport of sperm
• disrupting the HPG axis to interfere with ovulation
• inhibiting implantation of the conceptus into the endometrium

Question 2

What are the six broad categories of contraception?

Answer 2

Natural
Barrier
Hormonal control
Prevention of implantation
Sterilisation 
Emergency contraception

Question 3

What are the natural methods of contraception?

Answer 3

Abstinence
Withdrawal
Fertility awareness - cervical secretion, basal body temp, length of menstrual cycle
Lactational amenorrhoea - breastfeeding delays the return of ovulation after birth

Question 4

Explain the lactational amenorrhoea method of contraception.

Answer 4

Suckling disrupts the HPG axis by affecting the feedback cycle. This prevents ovulation.

Question 5

What are the barrier methods of contraception?

Answer 5

Male/female condoms

Diaphragm/caps

Question 6

What are the hormonal control methods of contraception?

Answer 6

Combined oestrogen and progestogen:
- combined oral contraceptive pill (COCP)
- vaginal ring
- patches
Progesterone depot or implant (long acting reversible contraception):
- high dose progesterone 
Low dose progesterone:
- progestogen only pill (POP)

Question 7

What is the role of progesterone in contraception?

Answer 7

Progesterone has effects in the HPG axis:

• at moderate/high doses, progesterone enhances the negative feedback of natural oestrogen, this reduces LH and FSH secretion.
• at moderate/high doses, progesterone inhibits the positive feedback of oestrogen (when oestrogen is high), meaning there is no LH surge and therefore no ovulation.
• at lower doses, progesterone doesn’t inhibit the LH surge so ovulation can still occur, but it does thicken cervical mucus

Question 8

What is progestogen?

Answer 8

Synthetic progesterone

Question 9

What are the actions of the combined oral contraceptive pill (COCP)?

Answer 9

Principal action:
- prevents ovulation

Secondary action:

• reduces endometrial receptivity, therefore inhibiting implantation
• thickens cervical mucus, inhibiting penetration of sperm

Question 10

What are some of the advantages and disadvantages of the combined oral contraceptive pill?

Answer 10

Advantages:

• can relieve menstrual disorders (e.g. heavy bleeding, pain, irregular periods)
• reduces risk of ovarian cancer and endometrial cancer (reduced damage to ovaries and endometrium)

Disadvantages:

• user dependent
• no protection from STIs
• interacts with other medications
• some effects
• increased risk of recast and cervical cancer
• increased risk of venous thromboembolism, MI and stroke