Sexual and Reproductive Health 1

Question 1

What are different natural method of family planning?

Answer 1

lactation - major contraceptive role in the world
rhythm method - avoids fertile period around ovulation
withdrawal - removal of penis before ejaculation

Question 2

What are the drawbacks of natural contraception methods?

Answer 2

less reliable
offers no protection against STIs
only suitable for monogamous women who would not be concerned by pregnancy

Question 3

What are the different barrier methods of contraception?

Answer 3

male condom
female condom
diaphragms and caps

Question 4

What are the advantages of the male condom?

Answer 4

best protection against disease including HIV

Question 5

What are the cons of barrier methods of contraception?

Answer 5

can affect sex
may split or burst

diaphragms have to be fitted before intercourse and remain in place for 6+ hours

Question 6

What are the chemical fertility control methods?

Answer 6

spermicides
used in conjunction with barrier methods in form of jelly, cream or pessary

not very effective

Question 7

How does the combined oral contraceptive pill work?

Answer 7

Negative feedback effect on gonadotrophin release, inihibiting ovulation
Thin endometrium + thicken cervical mucus
Single tablet every day for 3 weeks and then stopped for 1 week (vaginal bleeding)
Most contain synthetic oestrogen ethinyloestradiol or natural oestrogen oestradiol
valerate (metabolised in body to naturally occurring oestradiol)

Question 8

What are the common side effects of the combined oral contraceptive pill?

Answer 8

depression 
bleeding 
acne 
breast discomfort
weight gain 
reduced libido 
nausea
headaches
bleeding 
occasionally HTN
increased mucus

Question 9

What are the rare major complications of the COCP?

Answer 9

Venous thrombosis and MI are most important

Risk increased with smoking, increased age and obesity

Question 10

What are the advantages of the COCP?

Answer 10

contraception
more regular, less painful and lighter menstruation
protection against simple ovarian cysts, benign breast cysts, fibroids and endometriosis
improve hirsutism and acne
reduction in ovarian, endometrial and bowel cancer

Question 11

How should someone starting the pill be counselled?

Answer 11

advise of major complications and benefits
advise to stop smoking
advise to see if doctor if major complications
advise poor absorption with abx and sickness
stress importance of follow up and BP measurement

Question 12

What is the combined transdermal patch?

Answer 12

transdermal adhesive patch that releases oestrogen and progesterone
new patch applied for 3 weeks in a row and then one week patch free
similar SEs to COCP

Question 13

How is the progesterone only pill/mini pill used?

Answer 13

taken continuously without a break
must be taken in a 3 hour window at the same time daily
makes cervical mucus hostile to sperm and inhibits ovulation in 50%

Question 14

What are the SEs of POP?

Answer 14

vaginal spotting 
weight gain 
mastalgia 
premenstrual symptoms 
functional ovarian cysts

Question 15

What the advantages of the POP?

Answer 15

can use when breast feeding
rapid return to fertility
used when COCP contraindicated

Question 16

What is the nuvaring?

Answer 16

vagina ring
releases oestrogen and progesterone
ring inserted into vagina and worn for 3 weeks and removed for 7 days#
lower systemic SEs

Question 17

What is Depo-Provera?

Answer 17

administered IM every 3 months

Question 18

What are the disadvantages with using Depo-Provera?

Answer 18

causes irregular bleeding in first 3 weeks but followed by amenorrhoea
other progesterone SEs
prolonged amenorrhoea after cessation so warn women if they are considering pregnancy
bone density decreases over first 2-3 years use but regained after stopping

Question 19

What is Nexplanion?

Answer 19

subdermal implant

lasts 3 years

Question 20

How do Depo-Provera and Nexplanion prevent pregnancy?

Answer 20

prevent ovulation
thicken cervical mucus
thin endometrium

Question 21

What are the pros of the implant?

nexplanion

Answer 21

no user failure

immediate return to fertility

Question 22

What are the cons of the implant?

nexplanion

Answer 22

50% irregular bleeding

procedure to remove

Question 23

What is female sterilisation?

Answer 23

interruption of fallopian tubes so sperm and egg cannot meet
clips can be applied laproscopically to occlude them
Usually done under GA

Question 24

How should you counsel a woman for female sterilisation?

Answer 24

woman and man must be certain
discuss alternative contraception
reversible not possible and not guaranteed with clips
risks of surgery

Question 25

What does male sterilisation involve?

Answer 25

ligation and removal of small segment of the vas deferens
performed under LA
not sterile until two confirmed semen analysis have confirmed azoospermia

Question 26

What are the complications of male sterilisation?

Answer 26

failure
post operative haematomas and infection
chronic pain

Question 27

How does an IUD/IUS work as contraception?

Answer 27

device put into uterine cavity
copper or progesterone
thin strings pulled through cervix

Question 28

What are the benefits of IUD?

Answer 28

safe effective and reversible
menstrual loss reduced
can be used as emergency contraception

Question 29

What are the complications of an IUD?

Answer 29

pain or cervical shock
can be expelled in the first month
perforation of the uterine wall can occur
threads can be cut too short and US scan needs to be performed
heavier and more painful menstruation can occur
risk of infection

Question 30

How should women be counselled before IUD insertion?

Answer 30

advise of major risks
advise to inform doctor if bleeds intermenstrually, pelvic pain or vaginal
discharge or poss pregnant
advise to check strings after each period

Question 31

How does the copper coil (IUD) work as contraception?

Answer 31

by preventing fertilisation
copper ion is toxic to sperm
blocks implantation

Question 32

How does the hormone containing IUS work?

Answer 32

contains progesterone which is slowly released over 5 years 
local contraceptive effect 
reduces menstrual loss and pain 
systemic SE are low 
fertility returned after removal

Question 33

What are the disadvantages of the copper coil?

Answer 33

heavy or painful periods