Contraception

Question 1

How does contraception preventing ovulation work?

Answer 1

By suppressing FSH and LH

Question 2

How does conctraception preventing fertilisation work?

Answer 2

Creates a mechanical or surgical barrier or direct toxicity

Question 3

How does contraception preventing implantation work?

Answer 3

Creates a hostile endometrium or direct toxicity

Question 4

Which methods of contraception prevent ovulation?

Answer 4

Most hormonal methods

Question 5

Which methods of contraception prevent fertilisation?

Answer 5

Condoms, diaphragm + spermicide, female and male sterilisation, intrauterine devices, hormonal methods- cervical mucous

Question 6

Which methods of contraception prevent implantation?

Answer 6

intrauterine devices, hormonal methods

Question 7

What must a diaphragm be used with?

Answer 7

Spermicide

Question 8

List some benefits of hormonal contraception

Answer 8

Reduced;

• period pain
• menstrual bleeding
• irregular PV bleeding
• ovulation pain
• PMS
• Breast tenderness
• ovarian cysts
• endometriosis
• ovarian cancer
• acne
• hirsutism

Question 9

Which forms of contraception will reduce PV bleeding?

Answer 9

Combined hormonal contraception
Intrauterine system
DMPA

Question 10

Which women cannot use IUS or IUD?

Answer 10

Women with submucosal fibroids

Question 11

How long can the IUD last?

Answer 11

10 years

Question 12

What are the downsides of the IUD?

Answer 12

Makes periods heavier, longer and more painful. especially during the 3/12 post insertion

Question 13

Which women may benefit from the IUD?

Answer 13

Women after breast cancer

Question 14

Which form of contraception is more effective than the IUD?

Answer 14

The IUS

Question 15

What are the 4 main IUS devices ?

Answer 15

Mirena
Levosert
Kyleena
Jaydess

Question 16

What is the mirena licensed for?

Answer 16

Heavy periods, can be part of HRT

Often useful in endometriosis or hyperplasia

Question 17

What is common after insertion of the IUS?

Answer 17

Spotting in the first few months

Question 18

What percentage of women have amenorrhoea on mirena at 6 months?

Answer 18

50%

Question 19

What is nexplanon?

Answer 19

Subdermal contraceptive implant

Question 20

What is the most effective of all contraceptive methods?

Answer 20

Nexplanon

Question 21

How long does the nexplanon last?

Answer 21

3 years

Question 22

Which hormone/s is/are contained in the nexplanon?

Answer 22

Progestogen only

Question 23

What is the main side effect of nexplanon?

Answer 23

Prolonged PV bleeding

Question 24

What may be used to help bleeding on nexplanon?

Answer 24

Addition of the CHC

Question 25

What does UKMEC 1 mean?

Answer 25

Always useable, no increased risk(s) due to condition/characteristic

Question 26

What does UKMEC 2 mean?

Answer 26

Broadly useable, advantage(s) of method > risk(s) due to condition/characteristic- consider follow up

Question 27

What does UKMEC 3 mean?

Answer 27

Counsel/caution; risk(s) due to condition/characteristics > advantage(s) of method- expert opinion or specialist referral required

Question 28

What does UKMEC 4 mean?

Answer 28

Do not use, method contraindicated due to condition/characteristic; do not prescribe

Question 29

How should the COC be taken?

Answer 29

Start in the first 5 days of period OR At any time in cycle when reasonably sure not pregnant, plus condoms for 7 days

Question 30

What should be done if there is spotting during the COC?

Answer 30

Stop for 4 days and then restart

Question 31

What might impair the COC?

Answer 31

``` Impaired absorption; -GI conditions Increased metabolism; -liver enzyme induction, drug interaction Forgetting ```

Question 32

What are the risks of the COC?

Answer 32

``` Venous thrombosis Arterial thrombosis Adverse effects on some cancers Systemic hypertension Arterial disease ```

Question 33

How often should BP be checked on the COC?

Answer 33

Every 3 months

Question 34

What other risk factor may increase the risk of MI in COC users?

Answer 34

Smoking

Question 35

What BP indicates a higher risk of MI and stroke in COC users than hypertensive non-COC users?

Answer 35

Systolic >= 160mmHg | Diastolic <= 95mmHg

Question 36

What is migraine with aura?

Answer 36

A change occurring 5-20 minutes before the onset of headache

Question 37

What may an aura be?

Answer 37

Visual, scotoma, altered sensation, smell or taste, hemiparesis

Question 38

What is the risk of migraine with aura?

Answer 38

Increases the risk of ischaemic stroke- don't give COC

Question 39

Which age automatically puts you in the UKMEC 2 category

Answer 39

>35yrs

Question 40

What are the unwanted effects of the COC?

Answer 40

Breast cancer, 1.24 increased relative risk Cervical cancer- small increased risk

Question 41

How long does breast cancer risk take to reduce to background after stopping COC use?

Answer 41

10 years

Question 42

How long does cervical cancer risk take to reduce to background after stopping COC use?

Answer 42

10 years

Question 43

What are the positive effects of COC?

Answer 43

Protection against ovarian (20% reduction for every 5 years of use to a maximum 50% reduction after 15 years use) and endometrial cancer (20-50% reduction)

Question 44

What are the benefits of combined hormonal contraceptives?

Answer 44

- Beneficial effect on acne- antiandrogen/ progestogen/ antiglucocorticoid - less bleeding - fewer functional ovarian cysts - pre-menstrual syndrom - PCOS

Question 45

How should the POP be started?

Answer 45

Day 1-5 of period OR anytime if reasonably sure not pregnant plus condoms 2 days

Question 46

How does depo provera/sayana press work?

Answer 46

Lowers oestradiol | Supresses FSH

Question 47

How effective is the diaphragm?

Answer 47

71-88% effective with typical use

Question 48

How is vasectomy done?

Answer 48

Local or general anaesthetic | No-scalpel technique

Question 49

What are the complications of vasectomy?

Answer 49

- Anaesthetic - Pain - Infection - Bleeding/haematoma - failure - non-motile sperm at 7 months

Question 50

What is the failure rate of female sterilisation?

Answer 50

2-3/1000

Question 51

Which method of female sterilisation is used in tayside?

Answer 51

Clip

Question 52

How effective is natural family planning?

Answer 52

76% effective with typical use