Contraception

Question 1

If no contraception is used what is the chance of getting pregnant?

Answer 1

85%

Question 2

What percentage of pregnancies are unplanned?

Answer 2

40%

Question 3

Name three mechanisms of action of contraception

Answer 3

Prevention of ovulation
Prevention of fertilisation
Prevention of implantation

Question 4

How does contraception prevent ovulation?

Answer 4

Suppresses FSH and LH by negative feedback

Question 5

How can fertilisation be prevented?

Answer 5

Mechanical Barrier - condoms/diaphragm
Surgical Barrier - sterilisation
Direct toxicity - spermacide/IUD

Question 6

How is implantation prevented?

Answer 6

Thinning of womb lining to create a hostile environment

Question 7

What does LARC stand for?

Answer 7

Long Acting Reversible Contraception

Question 8

What methods of contraception are not advised?

Answer 8

Withdrawal and abstinence

Question 9

State some of the factors to consider when choosing contraception

Answer 9

• Personal preference
• Age
• Mental Capacity
• Wellbeing/child protection
• Relationship
• Pregnancy risk/future planning
• STI
• Practical issues (storage of pill etc)
• Compliance
• Allergy/medications
• BMI/BP
• PMH
• Family history
• Invasive procedure
• Side effects
• Non-contraceptive benefits

Question 10

Describe the two types of effectiveness

Answer 10

Typical use/user failure rate

Perfect use/method

Question 11

Why are condoms often not effective?

Answer 11

Put on too late, wrong lube (oil based), wrong technique, wrong size, damaged, expired

Question 12

Why are diaphragms often not effective?

Answer 12

Put in too late, removed too early, wrong technique

Question 13

Why is the pill often not effective?

Answer 13

Compliance problems, too late starting, drug interaction, quick starting

Question 14

What are the three main types of LARC?

Answer 14

Copper Coil
Hormonal Coil
Rod

Question 15

State the complications of the procedure to insert the coil

Answer 15

Perforation
PID
Malposition/expulsion

Question 16

When are coils contraindicated?

Answer 16

Submucosal fibroids

Uterine malformation

Question 17

How long does the copper coil last?

Answer 17

10 years, if >40years old it can stay until menopause

Question 18

What is a down side of the copper coil?

Answer 18

Often periods become heavier and longer and more painful - NSAIDs can help

Question 19

In what circumstances may the copper coil be the only option?

Answer 19

After breast cancer

Emergency - up to 5 days after sex

Question 20

Name four types of hormonal coil

Answer 20

Mirena
Levosert
Kyleena
Jaydess

Question 21

What is the non-contraception use of mirena coil?

Answer 21

HRT
Endometriosis
Hyperplasia

Question 22

What happens to bleeding on the mirena coil?

Answer 22

Irregular spotting/PV bleeding common in first months then high chance of no/irregular periods after 6 months

Question 23

How long can the implant be kept in for?

Answer 23

3 years

Question 24

What is the main side effect of the subdural implant?

Answer 24

PV bleeding - very unpredictable but important to exclude other causes if it does occur

Question 25

How can bleeding with the implant be controlled?

Answer 25

COCP

Question 26

How do LARC methods work?

Answer 26

Prevent fertilisation and implantation

Question 27

How do combined hormonal methods work?

Answer 27

Prevention of ovulation

Question 28

What is the efficacy of combined hormonal methods?

Answer 28

Perfect use 0.3% | Typical 8%

Question 29

How do you start the combined hormonal methods?

Answer 29

Start in first 5 days of period | At any time in the cycle when not pregnant but use condoms for 7 days

Question 30

What are the three regimes?

Answer 30

Take daily for 21 days followed by 7 days break (withdrawal bleed) Continuously for 3 packs, then stop for 7 days (tricycling) Continuously until bleed, stop for 4 days and then start again

Question 31

What are the risks of combined oral contraceptive pill?

Answer 31

``` Venous thromboembolism (5-12%) Systemic hypertension (140/90) Arterial disease (MI/Stroke) Migraine with aura Age >35 years Breast cancer Cervical cancer - HPV/condom use and smear ```

Question 32

What can alter the effectiveness of COCP?

Answer 32

Impaired absorption Increased metabolism Forgetting

Question 33

State the benefits of combined oral contraception

Answer 33

Reduction in ovarian cancer and endometrial cancer Improvement of acne Less PMS, PCOS, bleeding, fewer functional cysts

Question 34

What are the common side effects of combined hormonal contraception?

Answer 34

Nausea Bleeding Acne Breast tenderness

Question 35

What is the efficacy of the progestogen only pill?

Answer 35

Perfect <1% | Typical 9%

Question 36

How does the progestogen only pill work?

Answer 36

Inhibits ovulation | - older forms not as reliable as act on cervical mucous

Question 37

Describe starting progesterone only pill

Answer 37

Start in day 1-5 of period | Anytime if not pregnant but must use condoms for 7 days (injection/implant), 2 days for pill

Question 38

What is the only contraindication for the progesterone only pill?

Answer 38

Breast cancer

Question 39

What are the common side effects of the progesterone only pill?

Answer 39

Nausea, spots, irregular bleeding, headaches

Question 40

What is the regime for taking the pill?

Answer 40

Take the pill at the same time everyday, >12 hours late it won't work for 2 days

Question 41

How do the injections work?

Answer 41

Lower estradiol and suppress FSH

Question 42

What is the efficacy of injections?

Answer 42

Perfect 0.3% | Typical 3%

Question 43

When are the injections very useful?

Answer 43

Epilepsy - unaffected by enzyme inducing drugs

Question 44

What are the side effects of injections?

Answer 44

Nausea, weight gain, spots, headache, bleeding

Question 45

Why must the injection be used with caution?

Answer 45

Bone health - it can reduce peak bone mass

Question 46

Describe the diaphragm

Answer 46

71-88% effective Not often used but involves no hormones. Used with spermicide and must be kept in for at least 6 hours post sex. Wash in warm water and put in a box.

Question 47

What are the three types of emergency contraception?

Answer 47

Levonorgestrel Ella one - ulipristal Copper coil

Question 48

How does emergency contraception work?

Answer 48

Delays/inhibits ovulation

Question 49

How long after sex can emergency contraception be used?

Answer 49

Levonorgestrel - within 72 hours ella one - within 120 hours copper coil - within 5 days

Question 50

Which type of emergency contraception makes the pill less effective?

Answer 50

ella one

Question 51

Which form of emergency contraception can be used more than once in a cycle?

Answer 51

Lenonorgestrel

Question 52

Name the side effects of emergency contraception

Answer 52

Menstrual irregularities Nausea, vomiting Headache, dizziness, breast tenderness, diarrhoea

Question 53

What forms of contraception are safe to use in patients on epilepsy medication?

Answer 53

Depo provera/Sayana press Hormonal IUD Copper IUD