Contraception - COCP and POP

Question 1

What are the 3 general principles that all contraception uses to be effective

Answer 1

• blocking sperm transport to oocyte
• disruption of HPG axis to stop ovulation
• Inhibits the implantation of conceptus into the endometrium

Question 2

Name the 6 types of contraception

Answer 2

Natural
Barrier
Hormonla
Intrauterine
Sterilisation
Emergency contraception

Question 3

What are the 5 types of hormonal control

Answer 3

COCP
POP
Progestogen injection
Progestogen implant
Combined hormonal contraceptive patch and transvaginal ring

Question 4

What is the COCP regime

Answer 4

Taken in 21 day cycles with a 7 day break

Question 5

What is COCP mechanism of action - 3

Answer 5

• prevents ovulation
• reduces implantation risk
• thickens cervical mucus

Question 6

What are ADRs of COCP - 3

Answer 6

VTE risk
Strokes
Breast and cervical cancer

Question 7

What are contraindications of COCP (UKMEC scale)
UKMEC 3 (5)
UKMEC 4 (7)

Answer 7

The UK Medical Eligibility Criteria scale aids in the decision of whether to start a woman on the COCP

UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method

UKMEC 2: advantages generally outweigh the disadvantages

UKMEC 3: disadvantages generally outweigh the advantages
Examples include:
- over 35 and smoking less than 15 cigs a day
- BMI over 35
- FH of VTE and over 45yrs
- Immobility
- Carrier of BRCA gene

UKMEC 4: represents an unacceptable health risk
Examples include:
- over 35 yrs smoking more than 15 cigs a day
- migraine with aura
- hx of VTE, stroke or IHD
- breast feeding
- HTN
- current breast cancer
- Immobility

Question 8

What age should COCPs be prescribed up to

Answer 8

Not advised to prescribe beyond 50 yrs old

Question 9

What are benefits of taking a COCP - 5

Answer 9

• reduced risk of ovarian, endometrial and colorectal cancer
• predictable bleeding patterns
• reduced dysmenorrhoea and menorrhagia
• manages PCOS, endo, premenstrual syndrome symptoms
• maintains bone mineral density in perimenopausal females

Question 10

What is the advice when taking COCP and having a surgery

Answer 10

Should be discontinued at least 4 weeks prior to major elective surgery - especially to pelvis or legs

Question 11

Name DDIs of COCP AND POPs(2)

Answer 11

CYP Inducers (rifampicin, alcohol, carbemazepine, phenytoin, sulphonylureas)

Iamotrigine (anti-epileptic) reduces efficacy

Question 12

What is the regime of POP

Answer 12

Taken daily with no breaks

Question 13

What is the mechanism of action of POP (2)

Answer 13

• thickens cervical mucus
• Reduces cillia activity in the fallopian tubes

DOES NOT PREVENT OVULATION!

Question 14

What advice around effectiveness of the POP should be given when starting

Answer 14

If commenced during menstruation, it provides immediate effect

Otherwise additional methods must be used for the first 2 days

Question 15

What advice should be given if a POP is missed

Answer 15

If its under 3 hours late - continue as normal

if its over 3 hours late - take as soon as possible but use extra contraceptive methods for 48 hours

Question 16

What advice around effectiveness of the COCP should be given when starting

Answer 16

if its started in the first 5 days of the cycle, then its effective immediately

If started at any other point, then alternative contraception must be used for first 7 days

Question 17

What advice should be given if a COCP is missed

Answer 17

If 1 pill is missed - take the last pill, even if youre taking 2 in one day. No additional contraception used

If 2 pills are missed, take the last pill and use additional contraception for 7 days after.