Contraception

Question 1

What is the failure rate of the COCP

Answer 1

Perfect use 2-3 per 1000

Typical use 9% failure

Question 2

What is in the COCP

Answer 2

Oestrogens typically ethinyloestradiol, and progestogens e.g. levonorgestrel or dropirenone
Can be monophasic where the dose is constant throughout the pack, or phasic where the hormone doses vary thoughout ( theoretically more physiologic)

Question 3

How does the COCP work?

Answer 3

Inhibits ovulation, causes thickening of the cervical mucus to prevent sperm penetration and also causes endometrial atrophy to prevent implantation

Question 4

What are the side effects of the COCP

Answer 4

breakthrough bleeding, weight gain, mood chance, breast tenderness, headaches, bloating, N&V, acne
If the side effects persist, can consider a different dose or a different agent.

Question 5

List some contraindications to the COCP?

Answer 5

Pregnancy 
Hypertension and diabetes
undiagnosed PV bleeding
Thrombophilia
Smoker over age 35
BMI >35
Person hx of VTE
Migraine with aura
Active HPB disease or liver tumours

Question 6

What affect does the COCP typically have on menstruation?

Answer 6

Regular, lighter and less painful

Improvements in PMS, acne and endometriosis

Question 7

What are some advantages to using the COCP?

Answer 7

Menstruation + acne

- decreases the risk of colorectal , ovarian and endometrial cancer

Question 8

What are some disadvantages associated with the COCP?

Answer 8

User compliance is essential
increased risk of VTE
small increased risk of stroke and CVD
Increased risk of breast cancer

Question 9

What is the risk of VTE with the COCP?

Answer 9

General pop - 5 per 100,000 women /yr
2nd gen COCP risk 10-15
3rd gen 25
Pregnancy 60

Question 10

How is the COCP taken?

Answer 10

Should be started on the 1st day of bleeding ( but can started up to day 5)

• if started after day 5 - extra precaution for 7 days
• 1 pill per day for 21 days, followed by 7 pill-free days to allow for withdrawal bleed
• take at the same time every day
• there is some variation between different COCPs so always follow the instructions on the leaflet*

Question 11

What can affect the efficacy of the COCP?

Answer 11

Human error - missed pills
Diarrhoea & vomiting
After taking ulipristal acetate additional precautions should be taken for 14 days

Question 12

What forms of progesterone only contraceptives are available?

Answer 12

POP
IUDs - mirena, Eloisa, Kyleena, Jaydess
Injectable - Depo-provera
Subdermal implant - Implanon

Question 13

What is the typical failure rate of the POP

Answer 13

Typical 9-15%, vs less than 1% perfect use

Failure rate decreases with age

Question 14

What type of hormone is in cerazette?

Answer 14

POP - desogestrel

Question 15

How does the POP work?

Answer 15

Thickening of cervical mucous to prevent sperm penetration
Endometrial atrophy prevents implantation
inhibits ovulation - newer POP more effective

Question 16

When would you use the POP?

Answer 16

If the COCP is contraindicated

During breastfeeding

Question 17

CI to the POP

Answer 17

Pregnancy 
undiagnosed PV bleeding
Severe arterial disease
Active breast cancer (or within 5yrs)
Active hepatic disease 
Hx of ectopic pregnancy

Question 18

Adverse effects of the POP

Answer 18

Menstrual disturbance - 40% stay regular, 40% become irregular, 20% become amenorrhoeic
Mood swings, reduced libido, fluid retention, acne, bloating, breast tenderness ( all usually subside in a few months)
Increased risk of ovarian cysts

Question 19

Advice on taking the POP

Answer 19

One every day no pill-free period
start on day 1 ( up to day 5 ) of period for immediate effect
Must take at the same time everyday ( 3hr window) for effectiveness - newer pills have a 12hr window ( after hits need additional precautions)
In the case of postpartum contraception, the POP is effective immediately if started within 21 days of delivery

Question 20

What drugs interfere with the POP?

Answer 20

Anti-epileptics
Rifampicin
Antiretrovirals
St John's wort
Ulipristal acetate

Question 21

How does Depo-provera work?

Answer 21

Injection of progesterone - 150mg given IM every 12wks, effective immediately
Adverse affects - menstrual disturbance, irregular bleeding, weight gain, headache, acne, mood changes.
May take 6-12months for fertility to return after stopping

Question 22

How does implanon work?

Answer 22

Contains etonogestrel, it is inserted into the arm SC under a LA.
Effective immediately and for 3yrs .
Adverse effects include menstrual disturbance, irregular bleeding, weight gain, headache, acne, mood changes.
May take 6-12months for fertility to return after stopping

( Can cause heavier bleeding in women with already heavy periods )