Week 2 (Day 5) - Contraceptive methods Tutorial

Question 1

When condoms are used perfectly, what is the pregnancy rate within a year?

Answer 1

Pregnancy rate is about 2% in a year if used perfectly

Used “typically” though the pregnancy rate is 18% per year.

Question 2

What is the most effective contraception method worldwide today?

Answer 2

This would be the subdermal progesterone only implant

Question 3

How long does the implant last for? What is the brand name of the implant? What is the most common side effect women on the implant complain of?

Answer 3

The implant lasts for three years - known as nexplanon Most common side effect women complain of is bleeding

Question 4

When is bleeding common after the initial beginning of contraceptive use? What is the diagnoses of bleeding when caused by contraception?

Answer 4

Bleeding with hormonal contraceptives is common in the first 3 months of use Diagnosing - problematic bleeding with hormonal contraception

Question 5

How does the implant work? What is the failure rate in the first year of use?

Answer 5

It works by inhibiting ovulation and also thickens the cervical mucus 0.05% failure rate in the first year of use

Question 6

Depo-Medroxy Progesterone Acetate (DMPA) injection - this is the progesterone injection These methods require an intramuscular injection in the buttock or subcutaneous injection (which can be self-administered) every 13 weeks.

• * How long does the contraception provided by the injection actually last?
• * DMPA has three main disadvantages women might worry about. Which are they?

Answer 6

The injection actually provides 14 weeks of contraception

Three disadvantages

• * There is weight gain
• * Cannot be stopped once injected
• * May delay return of fertility for up to one year after use

Question 7

Why are many women in the UK on a combined hormonal method (CHC) (pill, patch or vaginal ring) despite the fact that they carry a higher risk of serious side effects or complications (CVD*- MI/TIA/stroke, VTE, breast ca etc.) ?

Answer 7

Very effective method of contraception if used perfectly Lighter, less painful periods Reduces PMS Improves acne

Question 8

What cancers does CHC protect against? Which does it increase the risk of?

Answer 8

Protective against, endometrial, colorectal and ovarian carcinomas Increase risk of breast and cervical cancers

Question 9

How much does the CHC decrease the risk of endometrial and ovarian cancers?

Answer 9

Endometrial - 20-50% decrease in risk of this cancer Ovarian - decreases risk of this cancer by 20% every 5 years - max of 50% after 15 years use

Question 10

A patient was recently started on a (COC). Which SE are more typically progestogenic, which are more typically estrogenic and which can be both? * Irregular PV bleeding * Nausea/ vomiting * Headache * Weight gain * Acne * Tender breasts * Reduced sex drive - Amenorrhoea

Answer 10

Progestogenic side effects - weight gain more common, acne, amenorrhea Oestrogenic side effects – irregular PV bleeding, nausea/vomiting, headache, tender breasts, Reduced sex drive can be oestoregn or progesterone

Question 11

A 17 year old patient had unprotected sexual intercourse 10 hours ago. She is not on any contraceptive method and did not use condoms either. As she does not want to become pregnant she is seeking emergency (post-coital) contraception (EC). What are the mehthods available? (which can you get from local pharmacy)

Answer 11

LNG -EC (LevoElle - Levenogestrel) - use up to 72 hours post coitus UPA - EC (EllaOne - Ulipristal acetate) - use up to 120 hours post coitus These are both available at the local pharmacy Copper IUD - not available at local pharmacy

Question 12

A 17 year old patient had unprotected sexual intercourse 10 hours ago. She is not on any contraceptive method and did not use condoms either. As she does not want to become pregnant she is seeking emergency (post-coital) contraception (EC). What method would probably be started on and why? The most effective method is the copper “coil” (IUD). Why might this patient not choose the most effective method?

Answer 12

Would probs give her Levonelle as it has the same efficacy has ellaone if used within 24 hours and can start contraception on the same day Copper coil seems invasive and can cause heavier bleeding

Question 13

If the patient is breast feeding, what emergency contraception should not be given? If the patient is on a liver enzyme inducer or on drugs reducing gastric pH , what emergency contraception cannot be given?

Answer 13

Do not give Ulipristal acetate if the person is breast feeding , is on liver enzyme inducers or is on drugs reducing gastric pH There are also other reasons not to give this drug - remember them

Question 14

Describe each of the 4 UKMEC categories? What does UKMEC stand for?

Answer 14

UK Medical Elgibiglity criteria for Contraceptive use

• * UKMEC category 1 - condition has no contraindications for the contraceptive use
• * UKMEC 2 - benefits of taking the contraception outweigh the risk due to the condition
• * UKMEC 3 - the risks due to the condition outweighs benefits of taking the contraception
• * UKMEC 4 - condition represents an unacceptable risk if contraceptive method used

Question 15

Name at least 3 UKMEC 4 contraindications to taking the combined hormonal contraception? (try and name all 5 that i have listed though)

Answer 15

• 1. Breast feeding 0-6 weeks post natally
• 2. Smoking 15 cigarettes per day at greater than 35 years of age
• 3. Personal history of breast cancer
• 4. Migraine with aura
• 5. Diabetic mircrovascular disease or macrovascular

Question 16

What are the 4 methods of contraception that work best? Which is permanent? What is the single best method?

Answer 16

• Progesterone only subdermal implant - best method
• Progesterone only intrauterine system (IUS) - 3 or 5 years
• Copper intrauteirne device (IUD) - 5 or 10 years
• Sterilisation - vasectomy or tubal ligation - permanent