Basics of contraception

Question 1

CHC

Answer 1

Combined hormonal contraceptive

Question 2

COC

Answer 2

Combined oral contraceptive (Pill)

Question 3

CTP

Answer 3

Combined transdermal patch (Evra)

Question 4

CVR

Answer 4

Combined vaginal ring (NuvaRing)

Question 5

Cu-IUD

Answer 5

Copper Intra-uterine device (Copper coil)

Question 6

DMPA

Answer 6

Depot Medroxyprogesterone Acetate

Question 7

LAM

Answer 7

Lactational Amenorrhoea Method

Question 8

LNG-IUD

Answer 8

Levonorgestrel Intra-Uterine Device

Question 9

NPF

Answer 9

Natural Family Planning

Question 10

POP

Answer 10

Progesterone Only Pill (MiniPill)

Question 11

SDI

Answer 11

Sub-Dermal Implant (Nexplanon)

Question 12

What are some reasons people have sex?

Answer 12

• Physical reasons - Pleasure, release of sexual tension, attraction, stress relief and mood boosting
• Emotional reasons - Love, commitment, curiosity, gratitude, need for affection
• Insecurity reasons - Self-esteem, sense of duty, internal and external pressures
• Goal-based reasons - Improve social status, seek revenge, power, make a baby

Question 13

What are some outcomes of unwanted pregnancy

Answer 13

• Have and keep the baby
• Termination of pregnancy
• Have the baby and put it up for adoption

Question 14

What is the pregnancy rate of unprotected sex?

Answer 14

85%

Question 15

What are the 3 mechanisms of contraception

Answer 15

1. Prevent ovulation
2. Prevent fertilisation
3. Prevent implantation

Question 16

How do most hormonal contraceptives work to prevent ovulation?

Answer 16

Suppressing FSH and LH via negative feedback in the HPO axis

Question 17

What are some methods of preventing fertilisation?

Answer 17

Barrier (E.g. condoms, sterilisation, mucus thickening)
Sperm toxicity
Ovum toxicity (IUDs)
Decreased tubal motility (POP, CHC)

Question 18

What are some methods of preventing implantation

Answer 18

Create a histile endometrium (Thin)
Inflammatory endometrium
Toxic environment

Question 19

What are some categories of contraceptives?

Answer 19

• Hormonal
• Barrier
• Intrauterine
• Permanent
• Fertility awareness
• Emergency

Question 20

What is LARC?

Answer 20

Long-Acting Reversible Contraception

Question 21

Def: Method failure rate

Answer 21

Failure rate with perfect use

Question 22

Def: User failure rare

Answer 22

Failure rate at typical use

Question 23

In LARC, User failure rate is equal to …

Answer 23

Method failure rate

Question 24

What is the most effective form of contraception?

Answer 24

Sub-dermal implant

Question 25

What are some reasons for failure in condoms?

Answer 25

Used too late, wrong lube (Oil-based), wrong technique, wrong size, inconsistent use, wrong storage, damage, expired

Question 26

What are some reason for failure in diaphragms?

Answer 26

Used too late, removed too early, wrong technique, inconsistent use

Question 27

What are some reasons for failure in CHC, POP and DMPA?

Answer 27

Inconsistent use, poor complience, wrong use, drug interactions (St John’s Wort)

Question 28

What are some causes of iatrogenic contraceptive failure

Answer 28

Poor counselling, poor or wrong instructions, no extra-precautions recommended when quick-starting, drug interactions, incorrect insertion

Question 29

What are some common concerns that play a role in choosing contraception

Answer 29

- Pleasure - Fertility - Weight - Bleeding and menstruation - Mood

Question 30

What are some factors to consider when prescribing contraception

Answer 30

- Personal preference - Age - Mental capacity - Child protection or wellbeing concerns - Partner(s) - Drug or alcohol use - Consent - Type of sex - Pregnancy risk - STI risk - Previous experiences with contraception - Future pregnancy plans - Practical issues (E.g. secrecy, storage, manual dexterity, time off school or work for LARC insertion) - Lifestyle and situation - Allergies and medications - Weight, BMI, blood pressure - PMH - Family history - Socio-cultural and religious aspects - Acceptability of: - Hormonal methods - Amenorrhoea and irregular bleeding - Side effects - Invasive procedures

Question 31

What are some benefits of hormonal contraception?

Answer 31

- Decreased period pain - Decreased heavy menstrual bleeding - Decreased ovulation pain (Mittelschmerz) (If ovulation is suppressed) - Decreased PMS (mainly CHC) - Decreased cyclical breast tenderness - Decreased risk of ovarian cysts (If ovulation is suppressed) - Decreased risk of ovarian cancer (If ovulation is suppressed) - Decreased acne or hirsutism (CHC only) - Decreased perimenopausal symptoms (CHC only)

Question 32

What is important when counselling about LARCs

Answer 32

- Establish rapport, listen and try to understand - Establish contraceptive needs - Do you have any plans to get preganncy - How important is it for you not to get pregnant - Understand previous experiences - Understand important factors - Give information

Question 33

What is UKMEC?

Answer 33

UK Medical Eligibility Criteria (UKMEC)

Question 34

What is UKMEC category 1

Answer 34

A - Always use - No restriction for use of contraceptive method

Question 35

What is UKMEC category 2

Answer 35

B - Broadly useable - Advantages outweigh risks

Question 36

What is UKMEC category 3

Answer 36

C - Counsel/Caution - Risks outweigh advantages - Expert opinion required

Question 37

What is UKMEC category 4

Answer 37

D - Do not use - Method strongly contraindicated due to condition or characteristics