Contraception

Question 1

What would the ideal contraceptive be?

Answer 1

Reversible, effective, convenient and unrelated to intercourse, free of SEs, protective against STIs, have non-contraceptive benefits, be low maintenance

Question 2

What are the two ways of measuring the effectiveness of a contraceptive method?

Answer 2

Pearl index: no of pregnancies per 100 woman years

Life table analysis: contraceptive failure for each month of use (this is the one we tend to use)

Question 3

What is the difference between typical and perfect use?

Answer 3

Perfect use is using it as you are supposed to perfectly, typical use is how most people use it and is associated with a higher failure rate in most contraceptives

Question 4

What is the % of woman experiencing an unintended pregnancy using male condoms perfect use vs typical use?

Answer 4

Perfect - 2

Typical - 15

Question 5

What is the % of woman experiencing an unintended pregnancy using hormonal IUD perfect use vs typical use?

Answer 5

0.1 for both

Question 6

How effective is the COCP?

Answer 6

> 99%

Question 7

What is the COCP made up from?

Answer 7

Ethinyl estradiol (EE) and synthetic progesterone (progestogen)

Question 8

What is the usual dose of COCP?

Answer 8

20-35microgram

Question 9

What are the second and third generated COCPs made from?

Answer 9

Second - levonogestrel (LNG) and norethisterone (NET)

Third - gestodene (GSD) and desogestrel (DSG)

Question 10

How is the COCP taken?

Answer 10

21 days on, 7 days off

Takes 7 days to work unless taken in first 5 days of period starting

Question 11

Is it okay to run packets of COCP together?

Answer 11

Can tricycle

Even evidence that continuous use may be okay

Question 12

How does the COCP work?

Answer 12

Synthetic hormones supress GnRH through negative feedback so reduced FSH –> reduced follicular development
Inhibition of LH surge –> no ovulation
Inadequate endometrium is not suitable for implantation
Cervical mucus thickening acts as physical barrier to sperm

Question 13

What are the non-contraceptive benefits of the COCP?

Answer 13

Regular bleeds
Reduction in heavy/painful menstruation and anaemia
Reduction in ovarian and endometrial cancer, acne and benign breast disease, RA, colon cancer and osteoporosis

Question 14

What is the main risk of the COCP?

Answer 14

VTE

Question 15

What other factors increase risk of VTE?

Answer 15

Major surgery, immobility
Thrombophilia
FH of VTA in under 45s
BMI >30
Underlying vascular dx 
Post-natally within 21 days

Question 16

In which group of people would we not prescribe COCP and why?

Answer 16

Focal migraine

Increases risk of stroke

Question 17

What cancer does COCP increase the risk of?

Answer 17

Cervical cancer

Breast (risk disappears after 10y)

Question 18

What are the two main brands of POP?

Answer 18

Cerelle/cerazette

Question 19

How do you take the POP?

Answer 19

Every day within 3h (some now have 12h period) of the same time

Question 20

How does the POP work?

Answer 20

Thickens cervical mucus so sperm cannot penetrate

Question 21

How many days does it take the POP to work?

Answer 21

2 days

Question 22

What substance is in the DeproProvera?

Answer 22

Depot medroxyprogesterone acetate

Question 23

How is DeproProvera administered?

Answer 23

150mg deep IM into upper quadrant of buttocks

Question 24

How does DeproProvera work?

Answer 24

Prevents ovulation
Thickens cervical mucus
Makes endometrium inhabitable for implantation

Question 25

What are the pros of DeproProvera?

Answer 25

Don't have to remember to take pills Most amenorrhoeic Oestrogen free

Question 26

What are the cons of DeproProvera?

Answer 26

Delay in return to fertility Reversible reduction in bone density Problematic bleeding Wt gain

Question 27

What substance is in the subdermal implant?

Answer 27

68mg of progesterone etonogesrel in matrix of EVA

Question 28

How long does the subdermal implant last for?

Answer 28

3y

Question 29

How does the subdermal implant work?

Answer 29

Inhibits ovulation | Thickens cervical mucus

Question 30

What is the non-hormonal IUD and how does it work?

Answer 30

Copper coil | Copper toxic to sperm so prevents penetration and implantation

Question 31

What is the issue with the copper coil?

Answer 31

Can lead to heavy more painful periods

Question 32

What are the three hormonal coils and how long do they last for?

Answer 32

5y - mirena 5y - kyleena 3y - Jaydess

Question 33

How do the hormonal IUDs work?

Answer 33

Progesterone thins endometrium so it is not habitable for implantation

Question 34

What is first line treatment for heavy menstrual bleeding?

Answer 34

Hormonal IUDs

Question 35

What is the most effective emergency contraception?

Answer 35

CU-IUD

Question 36

What are the other options of emergency contraception?

Answer 36

Levonorgestrel in 72h Ella one in 120h NB longer you wait --> less effective it is

Question 37

What are the barrier methods?

Answer 37

Male and female condoms Cervical cap Diaphragm and spermicide

Question 38

How is female sterilisation done?

Answer 38

Laparoscopically | Traditionally done with tube ligation by Filshie clips

Question 39

What is vasectomy?

Answer 39

Permanent division of the vas deferens under LA

Question 40

What are the SEs of vasectomy?

Answer 40

Pain due to sperm granuloma (mass of degenerating spermatoxoa surrounded by macrophages)

Question 41

When should termination be aimed to be carried out by?

Answer 41

9wks

Question 42

If it is passed how many weeks of pregnancy, you must be referred to England?

Answer 42

20wks

Question 43

What is involved in clinical consultation of termination?

Answer 43

Methods of termination Contraception FBC/group and screen/rubella/scan/self obtained swab for chlamydia and gonorrhoea, STI blood testing offered

Question 44

What is the medical method of termination?

Answer 44

Mifepristone (anti-progesterone) switches of progesterone which keeps uterus from contracting allow pregnancy to grow 48h later get misoprostol which initiates uterine contraction and opens cervix

Question 45

What are the risks with medical termination?

Answer 45

Failure Haemorrhage Infection Prolonged bleeding

Question 46

What are the risks with surgical termination?

Answer 46

Haemorrhage Infection Failure Cervical trauma

Question 47

What is conscientious objection?

Answer 47

Right of medical staff to refuse participation in a termination as they have a conscientious objection Obligation to ensure woman has access to appropriate care, and that their refusal doesn't affect the physical/mental health of the mother

Question 48

What are the rules for having a termination?

Answer 48

<24wks and would be less harmful to mother/baby's health (mental or physical) to have termination