Contraception

Question 1

What is meant by the follicular and luteal phases?

Answer 1

Follicular - days 1 - 14 when there is growth and development of the follicle within the ovary (leading follicle becomes prominent) Luteal phase - days 14-28 when the ovum is released from the mature follicle (ovulation) and there is development of the corpus luteum from the empty follicle.

Question 2

When will menses occur?

Answer 2

after day 28 if there has been no fertilisation of the ovum. The corpus luteum will degrade (no more progesterone) and endometrial lining will be shed

Question 3

Describe the pattern of LH and FSH through the follicular and luteal phases?

Answer 3

FSH levels are higher during the follicular phase There is a peak in both but LH will surpass FSH at ovulation (day 14) Levels will both decrease but FSH slightly higher during the luteal phase.

Question 4

What happens to oestradiol during ovulation?

Answer 4

During the follicular phase there is a steady increase in levels, a sharp fall at ovulation then occurs followed by a gradual increase and decrease back to baseline during the luteal phase. Gradually increases through menses.

Question 5

What happens to Progesterone during ovulation

Answer 5

Will remain at baseline throughout the follicular phase and ovulation. Will then increase significantly during the luteal phase (due to corpus luteum) and decrease again if no pregnancy and menses begins.

Question 6

Why is there a peak in oestradiol prior to ovulation?

Answer 6

This will stimulate the release of LH and FSH and thus cause ovum release from follicle.

Question 7

Give some examples of natural contraceptive methods?

Answer 7

Basal body temperature (if taken in morning there will be an increase in temp 0.2 degrees 3 days before and 6 days after ovulation) Cervical mucous will become sticky and thick post ovulation Breast feeding Lower and closed cervix when less fertile

Question 8

How long can sperm and ovum live in the genital tract for?

Answer 8

Sperm = 5 days Ovum = 17-24hrs

Question 9

What are the conditions for breast feeding to be 98% effective as a contraceptive?

Answer 9

Must be exclusively breast feeding Must be <6 months post-partum Must be amenorrhagic

Question 10

How does the combined oral contraceptive pill work?

Answer 10

Releases oestrogen and progesterone to inhibit ovulation and trick the body into thinking you’re pregnant when you’re not (rigevidon or co-cyprodiol)

Question 11

What is the failure rate of the COCP?

Answer 11

0.2% but in practice probably more like 9% as poor compliance and not taken as should

Question 12

When should the COCP NOT be prescribed?

Answer 12

FHx or risk of VTE, stroke, clotting disorders etc > 35 yrs old with risk factors Migraine with aura (as will increase risk of stroke) Breast cancer hx or cervical cancer hx Within 6 weeks post-partum as increased VTE risk

Question 13

What is the effect of oestrogen on clotting?

Answer 13

Will block anti-thrombin 3 and protein s (inhibit anti-coagulation)

Question 14

What can the COCP help with?

Answer 14

Functional ovarian cysts, PCOS, premenstual syndrome, acne

Question 15

Which cancers does COCP reduce risk of?

Answer 15

Endometrial and ovarian

Question 16

What is the progesterone only pill?

Answer 16

Contraceptive pill without oestrogen - newer versions have desogestrol

Question 17

How does the POP work?

Answer 17

Mainly by inhibiting ovulation (tricky body into think pregnant) but also makes cervical mucous sticky, endometrium less favourable and effects fallopian tube transport.

Question 18

What are side effects of the COCP?

Answer 18

Bloating, mood changes, bleeding, systemic hypertension (need to check at 3 months from starting)

Question 19

How should COCP be taken?

Answer 19

If taken within 5 days of starting period then effects are immediate, if not then 7 days to kick in. Can run packs together as bleed is actually just a withdrawal from the hormone (not real period).

Question 20

What hormone(s) are released in the sub-dermal implant?

Answer 20

Progesterone - inhibitis ovulation, effects on cervical mucous, endometrium and fallopian tube mobility

Question 21

Give example of the implant

Answer 21

Nexplanon

Question 22

What are the effects of the IUS?

Answer 22

Miruna and Jaydess are the two types available Release of progestrogen so will cause cervical mucous thickening, endometrial thinning, can prevent ovulation

Question 23

How long can the IUS be left for?

Answer 23

5 years

Question 24

What is the failure rate of the IUS

Answer 24

0.2% (incorrect positioning)

Question 25

What is the failure rate of the sub-dermal implant?

Answer 25

0.05%

Question 26

How does the Cu-IUD work?

Answer 26

Copper will cause an inflammatory response in the endometrium (unfavourable for implantation) and will also be toxic to sperm.

Question 27

How long can the Cu-IUD be left in for and what are its failure rates?

Answer 27

5-10 years 0.6-0.8% failure rate

Question 28

Discuss female and male sterilisation

Answer 28

Male is more effective than female Females require an abdominal surgery whereas males is a non-invasive surgery Need to be absolutely sure not pregnant or ovum in fallopian tube as can cause an ectopic pregnancy

Question 29

What should you ALWAYS do before prescribing contraceptives?

Answer 29

Sexual history - need to know if currently pregnant BMI and BP

Question 30

What can make you reasonably certain that a patient is not pregnant?

Answer 30

No sex since last period Taking contraception reliably \<7 days since last period \<4 weeks post-partum (not breast feeding) \<6 months post partum (breast feeding and amenohorragic) Negative pregnancy test and \>3weeks since UPSI

Question 31

What can be given as emergency contraception?

Answer 31

Copper IUD (10x more effective than oral) LNG-EC UPA-EC

Question 32

How does LNG-EC work

Answer 32

High dose of progesterone given to prevent ovulation - does not work after ovulation or during LH surge effective for up to 72hrs after UPSI (will decrease in efficacy after 24hrs)

Question 33

How does UPA-EC work?

Answer 33

Works as an antiprogestrogen Will be active for up to 120hrs after UPSI and is effective during LH surge (not ovulation though) Will be 85% effective over all 5 days Contraception (oral) will interfere with it's action so avoid if on already

Question 34

What must you do if giving oral contraceptive after administering UPA-EC?

Answer 34

delay oral contraceptive by 5 days

Question 35

Give example of an LNG-EC and UPA-EC

Answer 35

levonelle and ullipristal acetate