5. Contraception

Question 1

Describe the primary and secondary actions of the COCP

Answer 1

1. Primary: inhibits ovulation

2. Secondary: thickens cervical mucus and decreases endometrial receptivity

Question 2

Name 2 advantages of the COCP

Answer 2

1. can relieve menstrual disorders

2. reduces risk of ovarian and endometrial cancer

Question 3

Name 4 disadvantages of the COCP

Answer 3

1. user-dependent
2. no STI protection
3. increased risk of breast and cervical cancer
4. increased risk of venous thromboembolism, MI/stroke

Question 4

Suggest possible contra-indications for the COCP

Answer 4

1. smoking
2. hypertension or diabetes
3. current or past/family history of venous thromboembolism, MI or stroke
4. current or past history of breast cancer
5. migraines
6. 35 yrs +

Question 5

Describe the primary action of the POP

Answer 5

thickens cervical mucus (low dose progesterone)

Question 6

Name 2 advantages of POP

Answer 6

1. quickly reversible

2. can be used when COCP is contra-indicated

Question 7

Name 5 disadvantages of POP

Answer 7

1. user-dependent
2. no STI protection
3. common menstrual problems
4. interacts with other medications
5. risk of ectopic pregnancy

Question 8

name 2 types of long-acting reversible contraceptives

Answer 8

progesterone depot or implant (high dose progesterone)

Question 9

what are the principal and secondary actions of the progesterone implant/depot

Answer 9

• Principal: inhibits ovulation (high prog. inhibits +ve FB of oestrogen… prevents LH surge and ovulation)
• Secondary: thickens cervical mucus and prevents endometrial proliferation

Question 10

Name 3 advantages and disadvantages of the progesterone depot/implant

Answer 10

Advantages:

1. non-user dependent
2. long lasting (3 yrs)
3. quickly reversible

Disadvantages:

1. minor procedure to insert
2. no STI protection
3. side-effects

Question 11

Name the 2 types of coil - what are the differences in action

Answer 11

1. intrauterine system (IUS): progesterone releasing plastic device (3-5 yrs)
   - principal action: prevents implantation and decreases endometrial proliferation
   - secondary action: thickens cervical mucus
2. intrauterine device (IUD): plastic device with added copper (5-10 yrs)
   - principal action: copper toxicity to sperm and ovum
   - secondary actions: endometrial inflammatory reaction preventing implantation and changes in cervical mucus consistency