12 - Contraception

Question 1

What part of the gonad differentiates to become the ovary and the testes?

Answer 1

Cortex - female ovary

Medulla - male testes

One that doesn’t differentiate regresses

Question 2

Where do primordial germ cells migrate from?

Answer 2

Yolk sac along retroperitoneum to the gonad at the urogenital ridge

Question 3

Answer 3

Weight loss due to excess cortisol

Question 4

What effects does oestrogen have on the female reproductive tract in the proliferative phase?

Answer 4

Question 5

What effects does progesterone have on the female reproductive tract in the secretory phase?

Answer 5

Question 6

Which cells release b-hCG?

Answer 6

Syncytiotrophoblasts

Question 7

What are some causes of primary and secondary amenorrhoea?

Answer 7

Question 8

How can you tell where the issue is in primary amennorhoea?

Answer 8

Measure blood FSH

• Low: hypothalamus/pituitary
• High: ovary

Question 9

How can you have female secondary sexual characteristics in androgen insensitivity?

Answer 9

Testosterone converted to oestrogen

Question 10

What is contraception?

Answer 10

Always important to balance patient safety and patient preference

Question 11

What are the different groups of contraception?

Answer 11

Can be short acting or long acting

Question 12

What are the different types of natural contraception, and the advantages/disadvantages of both?

Answer 12

Question 13

How does the fertility awareness method work?

Answer 13

• Measure basal body temperature, cervical secretions and menstrual cycle length
• Avoid sex or use further protection dyring ovulation

Question 14

How does lactational amenorrhoea work as a contraceptive method?

Answer 14

• Breastfeeding delays return of ovulation
• Suckling stimulus stops GnRH release
• Need to exclusively breast feed with no top up, amenorrheic and only effective for 6 months

Question 15

What is barrier contraception and the advantages and disadvantages?

Answer 15

- Prevent sperm entering the cervix

• Male condoms, female condoms, diaphragms/caps with spermicide

Question 16

What are the different hormonal contraceptives?

Answer 16

Question 17

What are the advantages and disadvantages of short acting hormonal contraception and how do they work?

Answer 17

Question 18

What are the rules with missing a hormonal contraceptive pill?

Answer 18

• If one pill missed take the pill when you release and take the rest of the pack normally
• Take last pull missed and leave any earlier pills. Continue taking the rest of the pack but use condoms for the next 7 days. If less than 7 pills left don’t take a break and start next pack

Question 19

What are some cases where you should not prescribe the COCP?

Answer 19

• High BMI
• Migraines aura as risk of stroke
• Previous breast cancer
• Smoking
• Over 35
• Diabetes
• High altitude

Thromboembolic so use progesterone contraception

Question 20

What are the advantages and disadvantages of long acting reversible contraception and how do they work?

Answer 20

Question 21

What happens to stop fertility at different doses of progesterone?

Answer 21

Question 22

What contraceptive methods work by inhibiting implantation and what are the advantages and disadvantages?

Answer 22

IUD has no effect on endometrial lining so not effective in menorrhagia so heavy painful periods

Question 23

What are irreversible forms of contraception?

Answer 23

• Have to be 100% sure

- Vasectomy: clip vas def under local anaesthetic to stop sperm entering ejaculate. High success rate but need samples after to ensure effective

- Tubal Ligation: clip fallopian tube to stop ovum entering uterus, general or local anaesthetic but higher failure rate

Question 24

What is some types of emergency contraception?

Answer 24

• IUD up to five days after event
• Hormonal pill within 3-5 dayd

Question 25

What guidelines should a GP use when deciding what type of contraception a woman should use?

Answer 25

- UKMEC - Safe to prescribe if 1 or 2 - Compromise between safety and preference

Question 26

What are some causes of erectile dyfunction in a young man?

Answer 26

- Antihypertensives - Smoking - Tear in TA - Psychological - Diabetes

Question 27

How can we measure if ovulation has taken place?

Answer 27

Progesterone blood test on day 21, will be high if ovulation

Question 28

How do you test tubal patency?

Answer 28

Hysterosalpingogram

Question 29

How does **clomiphene** work to increase fertility levels?

Answer 29

- Given for first 5 days of menstrual cycle - Binds to oestrogen receptors so no negative feedback on the GnRH so LH and FSH can continue to rise - When receptors come back, oestrogen concentration is high enough to cause a positive feedback and an LH surge

Question 30

What would happen to the fertility of a woman if you gave her metoclopramide?

Answer 30

- Would decrease as this is a dopamine antagonist so more prolactin made. Prolactin inhibits GnRH

Question 31

Will a woman with an IUS continue to ovulate?

Answer 31

**Yes -** release of progesterone is just local and thins lining of endometrium

Question 32

How does the COCP work?

Answer 32

Stops ovulation primarily and then inhibits endometrial lining from thickening and thickens mucus lining