Combined hormonal

Question 1

MoA of combined hormonal contraceptives (3)

Answer 1

• inhibit ovulation due to negative feedback

oestrogen and progesterone act on hypothalamo-pituitary axis (negative feedback) → surge of LH is inhibited → no ovulation

• progesterone → proliferation of the endometrium is inhibited (unfavourable condition for implantation)
• progesterone → thickens cervical mucus (sperm cannot pass)

Question 2

What happens in a pill-free interval?

Answer 2

Fall in hormonal concentration → degeneration of endometrium → bleeding

Question 3

What are two types of COCPs?

Answer 3

• monophasic pills → every pill contains the same level of oestrogen and progesterone
• phasic pills → the level of oestrogen and progesterone changes throughout the cycle

Question 4

(2) names of monophasic pills

Answer 4

• Microgynon30
• Brevinor

Question 5

Example of names of phasic pills (2)

Answer 5

• Qlaira
• BiNovum

Question 6

What do we need to remember with phasic pills? (in terms of intake instruction)

Answer 6

need to be taken in a specific order (as hormonal level varies across the cycle)

Question 7

Where can we stick a combined patch?

Answer 7

• arm
• abdomen
• buttock
• back

Question 8

What’s the name of the only combined patch licensed in the UK?

Answer 8

Ortho Evra

Question 9

MoA of Contraceptive Transdermal Patch

Answer 9

Work in the same way as the COCP by preventing ovulation, thinning the endometrial lining and thickening cervical mucus

Question 10

How long does the patch can be applied for?

Answer 10

• the patch is applied and changed every 7 days over period of 3 weeks (21 days)
• then (after 3 weeks) the patch is removed for 7 patch-free days → withdrawal bleed

Question 11

Can the patch be used while swimming/batching?

Answer 11

Yes, it’s extremely sticky

Question 12

What’s the name (1) of Combined Contraceptive Vaginal Ring?

Answer 12

NuvaRing

Question 13

MoA of Combined Contraceptive Vginal Ring

Answer 13

• plastic ring is inserted into the vagina and delivers the hormones
• work in the same way as the COCP by preventing ovulation, thinning the endometrial lining and thickening cervical mucus

Question 14

How long does Contraceptive Vaginal Ring stay in the vagina for?

Answer 14

• once inserted the ring sits in the vagina for 21 days
• it is then removed for 7 days before inserting the new ring

Question 15

Advantages of combined contraceptives

Answer 15

• Non invasive
• More effective than barrier methods if taken correctly
• Sex doesn’t need to be interrupted to use contraception
• Menses tends to become regular, lighter and less painful, also allowing for control over timing of menses
• Reduced risk of cancer of the ovary, uterus and colon
• Reduced risk of functional ovarian cysts
• Normal fertility returns immediately after stopping usage

Question 16

Disadvantages of combined contraceptives

Answer 16

• user dependent
• temporary adverse effects such as headaches, breast tenderness and mood changes can be experienced
• Blood pressure may increase
• Women may experience breakthrough bleeding and spotting for the first few months
• Increased risk of venous thromboembolism
• Small increase in risk of myocardial infarctions and strokes
• Small increase risk of breast and cervical cancer

Question 17

Contraindications for use of combined contraceptives

Answer 17

• BMI greater than 35
• Breast feeding
• Smoking over the age of 35
• Hypertension
• History of or family history of venous thromboembolisms
• Prolonged immobility due to surgery or disability
• Diabetes mellitus with complications e.g. retinopathy
• History of migraines with aura
• Breast cancer or primary liver tumours