Contraception

Question 1

Who decided eligibility criteria for contraceptives in UK?

Answer 1

Determines whether particular method of contraception is suitable to prescribe

Question 2

What is CHC?

Answer 2

Combined hormonal contraception

Question 3

Examples of CHC?

Answer 3

• COCP
• Evra patch
• Novaring

Question 4

What is primary mechanism of CHC?

Answer 4

Ovulation suppression

So it causes endometrial changes and thinning

Question 5

When do you start CHC?

Answer 5

First 5 days of period or anytime in cycle when reasonably sure not pregnant plus condom for 7 days

Question 6

How to take COC?

Answer 6

Daily for 21 days followed by 7 day break

Question 7

Risks of COC?

Answer 7

Venous thrombosis
Arterial thrombosis
Adverse effects on some cancers (breast, cervical)
Systemic HT

Question 8

Arterial thrombosis RFs in COC?

Answer 8

Small increased risk of MI, particularly in smokers, potential increased risk of ischaemic stroke

Question 9

What is someone has migraine with aura and is on the COC?

Answer 9

-Increases risk of ischaemic stroke

THIS IS CONTRAINDICATED

Question 10

Side effects of COCP?

Answer 10

Nausea
Spots
Bleeding
Breast tenderness

Question 11

WHat is IUD?

Answer 11

Intrauterine Device (copper coil)

Question 12

Effect of IUD?

Answer 12

Direct toxic effect (same as spermicides)

Non hormonal

Question 13

Can be used as emergency post-coital contraception?

Answer 13

Copper coil IUD

Question 14

IUD effect on periods?

Answer 14

Longer, heavier, more painful, especially during first 3 months post insertion

Question 15

Most suitable and reliable method for women after breast cancer?

Answer 15

IUD

Question 16

How long does IUD last?

Answer 16

between 3-10 years depending on device

Question 17

Effectiveness of IUD?

Answer 17

VERY effective

Question 18

Insertion pain?

Answer 18

3/10 for mothers

5/10 for not mothers

Question 19

Risk of IUD?

Answer 19

Perforation (small)

Question 20

Who is IUD unsuitable for?

Answer 20

Women with submucosal fibroids

Uterine malformation

Question 21

What is an IUS?

Answer 21

Plastic device placed in uterus which produces progesterone

Question 22

What physiological effect does IUD have?

Answer 22

Endometrial changes/thinning

Question 23

Physiological changes of IUS?

Answer 23

Thickened cervical mucous
Endometrial changes/thinning
Ovulation suppression

Question 24

IUS lasts for?

Answer 24

3-10 years

Question 25

Which is more effective IUD or IUS?

Answer 25

IUS

Question 26

Four main IUS devices in market?

Answer 26

Mirena Levosart Kyleena Jaydess

Question 27

Mirena is licensed to treat?

Answer 27

Heavy periods HRT Other therapeutic uses (endometriosis)

Question 28

Kyleena has a how long license?

Answer 28

5 year

Question 29

Jaydees has how long a license?

Answer 29

3 years

Question 30

Average insertion of IUS pain?

Answer 30

3/10 for mums | 5/10 for not mums

Question 31

IUS is unsuitable for?

Answer 31

Women with submucosal fibroids | Uterine malformation

Question 32

What is DMPA?

Answer 32

Depot medroxyprogesterone acetate

Question 33

Types of DMPA?

Answer 33

Depoprovera | SayanPress

Question 34

Physiology of DMPA?

Answer 34

``` Ovulation suppression Thickened cervical mucous Endometrial changes/thinning Lower oestradiol Suppresses FSH ```

Question 35

Side effects of DMPA?

Answer 35

``` Spots Weight gain Nausea Headaches Bleeding Can decrease peak bone mass so not given to <21s ```

Question 36

What is LAM?

Answer 36

Lactational amenorrhoea method

Question 37

Phsysiology of LAM?

Answer 37

Ovulation suppression Thicken cervical mucous Endometrial changes/thinning

Question 38

Examples of POP?

Answer 38

Desogestrel

Question 39

POP is?

Answer 39

Progesterone only pill

Question 40

Physiology of POP?

Answer 40

Ovulation suppression Endometrial changes/thinning Thickened cervical mucous

Question 41

When to start POP?

Answer 41

Day 1-5 of period

Question 42

Contraindication of POP?

Answer 42

Current breast cancer

Question 43

Side effects of POP?

Answer 43

Nausea Spots Bleeding Headaches

Question 44

What is an SDI?

Answer 44

Sub dermal implant

Question 45

Example of SDI?

Answer 45

Nexaplanon

Question 46

Physiology of nexplanon?

Answer 46

Ovulation suppression Thickened cervical mucous Endometrial thinning/changes

Question 47

What is most effective of all contraceptive methods?

Answer 47

SDI

Question 48

How long does SDI last for?

Answer 48

3 years

Question 49

SDI has a lot of hormonal side effects. True or False?

Answer 49

FALSE | -low and stable level of hormones

Question 50

Is the nexplanon safe for most women?

Answer 50

Yes- it is progesterone only

Question 51

Main side effects of nexplanon?

Answer 51

Prolonged PV bleeding

Question 52

If bleeding with SDI what is DDx?

Answer 52

Cervicitis/endometriosis due to STI Pregnancy complication Cervical polyp Cervical cancer

Question 53

How is bleeding often controllled on SDI?

Answer 53

CHC (if not contraindicated)

Question 54

Contraindication for SDI?

Answer 54

Current breast cancer

Question 55

Mechanical barriers are?

Answer 55

Female and male condoms Cervical caps Diaphragms

Question 56

Complications of a vasectomy?

Answer 56

Failure Pain Infection Bleeding/haematoma

Question 57

Emergency contraception?

Answer 57

Emergency IUD | Emergency hormonal contraception (Ulipristal acetate or levonorgestrel)

Question 58

Examples of hormonal contraception in emergency?

Answer 58

Levonorgestrel | Ulipristal acetate

Question 59

Main mechanism of most hormonal methods?

Answer 59

Prevention of ovulation

Question 60

What is prevention of ovulation not the mechanism in?

Answer 60

Hormone coil | Traditional POP

Question 61

How does prevention of ovulation work?

Answer 61

Suppressing FSH and LH (-ve feedback hypothalamus/pituitary)

Question 62

What contraception methods have the mechanism 'prevention of fertilisation'?

Answer 62

``` Condoms Diaphragms + spermicide Female and male sterilisation Intrauterine devices Hormonal methods ```

Question 63

What is mechanism of hormonal contraceptive methods?

Answer 63

Prevention of implantation

Question 64

Secondary mechanism of action for intrauterine devices?

Answer 64

Prevention of mechanism

Question 65

How does prevention of implantation work?

Answer 65

Created hostile endometrium or direct toxicity

Question 66

Non-contraceptive benefits of hormonal contraception?

Answer 66

- Period pain - Heavy bleeding - Irregular PV bleeding - PMS - Cyclical breast tenderness - Ovarian cysts - Endometriosis - Ovarian cancer - Acne or hirsutism (CHC only) - Perimenopausal symptoms (CHC only)