Contraception

Question 1

What does COCP contain and how does it work?

Answer 1

Contains both oestrogen + progesterone.

-ve feedback = suppressing the lncrease of GnRH.

Question 2

Why can’t COCP be taken on the 1st 21 days postpartum ?

Answer 2

increased risk of VTE esp. while breastfeeding.

Question 3

What is COCP protective against?

Answer 3

Ovarian and endometrial cancer

Question 4

What is MoA of COCP?

Answer 4

Preventing ovulation (primary mechanism of action).

Progesterone thickens the cervical mucus.

Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation.

Question 5

What are the RF of COCP?

Answer 5

Unscheduled bleeding in 1st 3 months.
Breast pain + tenderness
Mood changes + Depression
Headaches
Migraines w/ aura = risk of Stroke / VTE
Hypertension
Increase Risk of Breast + cervical cancer

Question 6

When to take COCP?

Answer 6

1st day of mensural cycle = should after 7 days of use.

Question 7

Why is POP useful?

Answer 7

Has fewer contraindications + risk compared w/ combined pill

Question 8

Is POP useful for breastfeeding ?

Answer 8

For breastfeeding women + non-breastfeeding women = POP can be started immediately.

Does not contain oestrogen = less likely to supress milk production.

Question 9

What is counted as a missed pill when taking POP (Traditional) ?

Answer 9

Cannot be delayed by > 3 hrs.

Taking the pill more than 3 hrs later = missing pills.

Question 10

MoA of POP?

Answer 10

Traditional: Thickening the cervical mucus.
Destogestrel: inhibits ovulation.

Question 11

How long does POP take to work?

Answer 11

2 days.

Question 12

How long does it take for fertility to return after Progesterone Injection ?

Answer 12

12 months. (Not suitable for younger kids).

Question 13

When is Progesterone Injection started?

Answer 13

Started on 1 - 5 days of menstrual cycle offers immediate protection = injection required every 12 weeks (3 months).

Question 14

What are the contraindications for Proges Injection?

Answer 14

Active breast cancer. 
Ischaemic heart disease + stroke.
Unexplained vaginal bleeding.
Severe liver cirrhosis.
Liver cancer.

Question 15

What is the MoA of progest Injection ?

Answer 15

Inhibits ovulation = inhibiting FSH secretion = stopping development of follicles.

Thickening cervical mucus.

Altering the endometrium and making it less accepting of implantation.

Question 16

What are the RF for Progest injections?

Answer 16

Bleeding may become heavier + longer = can become irregular. 
Weight gain - :(
Acne
Reduced libido
Mood changes
Headaches
Flushes
Hair loss (alopecia)
Skin reactions at injection sites

Question 17

Negative cause in using Progest injection?

Answer 17

Can cause osteoporosis = consider in older women, steroids users / inflammatory conditions.

Question 18

What are the benefits of Progest Injection?

Answer 18

Improvesdysmenorrhoea(painful periods).
Improvesendometriosis-related symptoms.
Reduces the risk ofovarian+endometrial cancer
Reduces the severity ofsickle cell crisisin patients with sickle cell anaemia.

Question 19

What is Progest Implant ?

Answer 19

Plastic rod placed in the upper arm = above subcutaneous fat (subdermal) non-dominant arm.

Question 20

How long does the implant Last ?

Answer 20

3 years

Question 21

Implant cannot be use in pts w/…

Answer 21

Active breast cancer

Question 22

When does the implant work?

Answer 22

Insertion on day 1 - 3 of menstrual cycle = immediate protection = if after 5 days = require extra protection e.g. condoms.

Question 23

MoA of Implant?

Answer 23

Inhibiting ovulation.
Thickening cervical mucus.
Altering the endometrium and making it less accepting of implantation.

Question 24

RF of the Implant?

Answer 24

Worsens Acne
Causes problematic bleeding
Implant can be lost

Question 25

Coils are contraindicated?

Answer 25

``` Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion (e.g. by fibroids) Wilson disease (excessive copper) ```

Question 26

How long can copper coil be used ?

Answer 26

5 - 10 yrs

Question 27

How long does copper coil take to work?

Answer 27

immediatly

Question 28

MoA of Copper coil ?

Answer 28

Toxic to the ovum + sperm. | Alters the endometrium + makes it less accepting of implantation.

Question 29

What negatives do some women experience w/ copper coil?

Answer 29

Heavy bleeding + pain | increases risk of Ectopic Preg

Question 30

LNG-IUS contains what?

Answer 30

progesterone = slowly released into the uterus

Question 31

How long can IUS be used?

Answer 31

5 years

Question 32

MoA of IUS?

Answer 32

Thickening cervical mucus Altering the endometrium and making it less accepting of implantation Inhibiting ovulation in a small number of women

Question 33

Benefits of IUS?

Answer 33

It can make periods lighter or stop altogether Irregular bleeding LATER light / amenorrhea It may improve dysmenorrhoea or pelvic pain related to endometriosis

Question 34

What are the 3 types of Emergency Contraception?

Answer 34

Levonorgestrel should be taken within 72 hours of UPSI Ulipristal should be taken within 120 hours of UPSI Copper coil can be inserted within 5 days of UPSI

Question 35

SE of Levonorgestrel?

Answer 35

N + V = MOST COMMON. If vomiting still occurs within 3 hrs = repeat the pill. Spotting and changes to the next menstrual period Diarrhoea Breast tenderness Dizziness Depressed mood

Question 36

What is the SE of Ulipristal ?

Answer 36

``` Spotting and changes to the next menstrual period Abdominal or pelvic pain Back pain Mood changes Headache Dizziness ```

Question 37

Contraindication for Ulipristal

Answer 37

Breastfeeding = avoided for 1 week after taking ulipristal (milk should be expressed and discarded) Ulipristal should be avoided in patients with severe asthma.