7. Contraception

Question 1

Long-Acting Reversible Contraception

Answer 1

• Intrauterine System (IUS or Mirena – or new SKYLA)
• Intrauterine Device (IUCD or copper coil)
• Contraceptive Injection (“depot” or medroxyprogesterone acetate)
• Subdermal Contraceptive Implant (etonogestrel)

Question 2

COCP Risks

Answer 2

VTE, breast cancer, cervical cancer

Question 3

COCP role

Answer 3

Inhibits ovulation, inhibits implantation, thickens mucus

Question 4

COCP ingredients

Answer 4

Ethinylestradiol and semi-synthetic progesterone

Question 5

COCP Pros

Answer 5

• Does not interrupt sex
• Periods lighter, less painful
• Helps PMS, reduced acne
• Reduces risk of bowel and ovarian cancer
• Protects from fibroids, ovarian cysts, fibrocystic breast disease

Question 6

COCP Cons

Answer 6

• Efficacy is user dependent

- Does not prevent STI

Question 7

Emergency contraception

Answer 7

Levonelle, IUD, Ella One

Question 8

Levonelle as emergency contraception

Answer 8

Single dose 1500 mcg, up to 72h post sex

Can be used >1x in a cycle, re-start contraception within 12h

Question 9

IUD as emergency contraception

Answer 9

Banded IUD 380mm copper

Inserted up to 5 days post sex or 5 days post ovulation

Question 10

EllaOne as emergency contraception

Answer 10

30 mg Ulipristal acetate; up to 120h

Can be used >1x in a cycle, re-start contraception after 5 days

Question 11

EllaOne Emergency vs Progesterone contraception

Answer 11

EllaOne blocks action of progesterone (use extra precautions 7-21days)

Question 12

Emergency contraception considerations

Answer 12

Abx prophylaxis, STI screen,

Question 13

Intrauterine System

Answer 13

52 mg levonorgestrel, average 20 mcg/day.

Can be used for 5 years;

Question 14

IUS risks

Answer 14

ectopic pregnancy, ovarian cysts, glucose tolerance affected,

Question 15

IUS side effects

Answer 15

depression, reduced libido, headache, acne, irregular vaginal bleeding, vaginal discharge.

Question 16

IUS role

Answer 16

inhibits implantation, thickens mucus

Question 17

IUS Pros

Answer 17

• No user dependent
• Periods lighter, less painful, no periods
• long lasting and reversible
• does not interfere with sex

Question 18

IUS Cons

Answer 18

• Discomfort and risk of insertion

- Irregular vaginal bleeding

Question 19

IUD

Answer 19

Licensed for 5-10 years

Question 20

IUD role

Answer 20

Inhibits fertilisation and implantation

Question 21

IUD risks

Answer 21

Ectopic pregnancy

Question 22

IUD side effects

Answer 22

irregular vaginal bleeding, heavier periods, iron deficiency, cramping abdo pain

Question 23

IUD Pros

Answer 23

• No user dependent
• Lasts 5-10years
• Does not interfere with sex
• Does not contain hormoes
• Can be used as emergency contraception
• Immediate return to fertility

Question 24

IUD Cons

Answer 24

• Insertion - discomfort and risk

- Periods heavier/painful/longer

Question 25

Subdermal contraceptive implant

Answer 25

68 mg etonorgestrel (30-60 mcg/day), | Licensed for 3 years; Contains barium

Question 26

Subdermal contraceptive implant role

Answer 26

Prevention of ovulation and implantation, thickens mucus

Question 27

Subdermal implant risks

Answer 27

bleeding, bruising, haematoma, infection, allergic reaction, scar, lost implant

Question 28

Subdermal implant side effects:

Answer 28

depression, reduced libido, headache, acne, irregular vaginal bleeding, breast tenderness

Question 29

Subdermal implant Pros

Answer 29

- No user dependent - Lighter period - Does not interfere with sex - No hormoes - Fertility returns soon after removal - Safe in breast feeding

Question 30

Subdermal implant Cons

Answer 30

- Insertion/Excision surgery - irregular vaginal bleeding - does not prevent STI - can interact with other medications

Question 31

Contraceptive injection

Answer 31

Depo provera, | 150 mg medroxyprogesterone acetate

Question 32

Contraceptive injection risks

Answer 32

reduce mineral bone density, local infection, allergic reaction

Question 33

Contraceptive injection side effects

Answer 33

Anorgasmia, depression, anxiety, reduced libido, acne, rash, headache, loss of bone density, osteoporosis, bloating, nausea, breakthrough bleeding

Question 34

Contraceptive injection Pros

Answer 34

- Less prone to user failure - Does not interfere with sex - Can be used in breast feeding - periods less heavy/none

Question 35

Contraceptive injections Cons

Answer 35

- Unacceptable bleeding pattern - Delays fertility return - Weight gain - Does not protect from STI

Question 36

POP role

Answer 36

(synthetic progesterone) • Thickens mucus, may inhibit ovulation

Question 37

POP Pros

Answer 37

- helps with pain,PMS - does not interfere with sex - Safe in breast feeding

Question 38

POP cons

Answer 38

- Tight interval window - Does not protect from STI - can interact with other meds - Irregular vaginal bleeding

Question 39

Lactational amenorrhoea (as a contraception)

Answer 39

- No periods since birth - bebo <6 months - exclusively breastfeeding

Question 40

Contraception and enzyme inducing drugs (epilepsy)

Answer 40

Progesterone only injectable; IUD; IUS