7. Contraception 2 (lecture)

Question 1

how do you inhibit sperm transport?

Answer 1

by thickening cervical mucus

Question 2

which pill inhibits sperm transport by thickening cervical mucus?

Answer 2

progesterone only pill (POP)

Question 3

what is the POP?

Answer 3

lower dose progesterone

Question 4

what is POP a secondary action of?

Answer 4

COCP
progesterone depot
progesterone implant
intrauterine system

Question 5

at lower doses, what does progesterone act to do?

Answer 5

progesterone doesn’t inhibit LH surge - ovulation still likely
but lower dose of progesterone will THICKEN cervical mucus - inhibiting sperm transport
(oestrogen still positive effect on hypothalamus and ant pit)

Question 6

what is the principal action of progesterone only pill?

Answer 6

thickens cervical mucus, making it impenetrable to sperm

ovulation usually NOT prevented

Question 7

what are the advantages of POP?

Answer 7

can be used where the COCP is contraindicated (cannot be used)

Question 8

what are disadvantages of POP?

Answer 8

menstrual problems are common

must be taken at the same time each day (error for forgotten pills is only 3 hours late)

Question 9

how should POP be taken?

Answer 9

pill containing progesterone only (lower dose)

taken everyday

Question 10

explain how lower progesterone dose works? (POP)

Answer 10

lower dose, progesterone does NOT inhibit LH surge, ovulation still likely
lower dose only THICKENS cervical mucus, preventing sperm from penetrating

Question 11

what are the 2 different coils used in inhibition of implantation?

Answer 11

intrauterine system (IUS)
intrauterine device (IUD)

Question 12

what does intrauterine system (IUS) contain?

Answer 12

progesterone

Question 13

what does intrauterine device (IUD) contain?

Answer 13

copper

Question 14

how do coils sit?

Answer 14

placed into the uterus

Question 15

what is the principal action of IUS (system)?

Answer 15

progesterone reduces endometrial proliferation and prevents implantation
(high conc of progesterone, inhibits positive feedback of oestrogen)

Question 16

what are secondary actions of IUS?

Answer 16

thickens cervical mucus

ovulation usually NOT prevented

Question 17

what are advantages of IUS?

Answer 17

convenient
long duration of action
can also relieve menstrual disorders

Question 18

what are disadvantages of IUS?

Answer 18

insertion may be unpleasant
IUS displacement / expulsion may occur
menstrual irregularity common in first 6 months
risk of uterine perforation (2/1000)

Question 19

what is an IUS?

Answer 19

small device made of plastic with added slow-release progestogen, that is placed into uterus

Question 20

how long does an IUS last?

Answer 20

can last between 3-5 years

Question 21

what is the principal action of intrauterine device (IUD)?

Answer 21

contains copper

copper is toxic to sperm and ovum - prevents fertilisation

Question 22

what are the secondary actions of IUD?

Answer 22

copper cause endometrial inflammatory reaction - prevents implantation
reduces penetration by sperm due to effect of copper on cervical mucus

Question 23

what are the advantages of IUD?

Answer 23

convenient
long duration of action
can also be used as emergency contraception (up to 5 days after unprotected intercourse)

Question 24

what are disadvantages of IUD?

Answer 24

insertion may be unpleasant
IUD displacement / expulsion may occur
periods may be heavier, longer, more painful
risk of uterine perforation (2/1000)

Question 25

what is uterine perforation?

Answer 25

injury to surrounding blood vessels or viscera such as the bladder or intestine

Question 26

what is an IUD?

Answer 26

small device made of plastic with added copper that is placed into the uterus

Question 27

how long can IUD be effective for?

Answer 27

5-10 years

Question 28

what is male sterilisation?

Answer 28

vasectomy

Question 29

what is the mechanism of action of male vasectomy?

Answer 29

vas deferens interrupted to prevent sperm entering ejaculate | sperm produce in seminiferous tubules --> rete testes --> vas deferens

Question 30

how is vasectomy performed?

Answer 30

under local anaesthetic

Question 31

how do you confirm whether a vasectomy was successful?

Answer 31

post-operative semen analysis to confirm no sperm in ejaculate (approx. 12-16 weeks after surgery)

Question 32

what are the advantages of sterilisation?

Answer 32

permanent | no hormonal side effects

Question 33

what is sterilisation in females?

Answer 33

tubal ligation / clipping

Question 34

what is the mechanism of action of tubal ligation / clipping?

Answer 34

fallopian tubes cut / blocked to stop the ovum travelling from the ovary to the uterus

Question 35

how is tubal ligation / clipping carried out?

Answer 35

under local / general anaesthetic

Question 36

what are the disadvantages of sterilisation?

Answer 36

should not be chosen if any doubt about having children in future

Question 37

what is the failure rate of vasectomy in males?

Answer 37

1/2000

Question 38

what is the failure rate of tubal ligation / clipping in females?

Answer 38

2-5/1000