Contraception

Question 1

Key facts of women aged 16-49 taking contraception

Answer 1

• Combined oral contraceptive pill → 25%
• Progestogen-only pill → 5%
• Progestogen-only implant/ injectable → 3%
• Intrauterine methods (coil) → 6%
• Sterilisation → 28%
• Not using contraception despite sexual activity and not wishing to be pregnancy → 12%

Question 2

Effectiveness and efficacy of contraceptives

Answer 2

• Pearl index (no. contraceptive failures/ 100 women/ year)
• Life table index (cumulative contraceptive failure/ specified time)

Question 3

Key facts of combined contraceptive pill

Answer 3

• Orally administered pill combining ethinyl oestrodiol and synthetic progesterone
• Take for 21 days, 7 days off the pill, 3 months continuously, 7 days off the pill, repeat

Question 4

Mechanism of action of the combined contraceptive method

Answer 4

• Alters LH and FSH (lack of LH surge)
• Inadequete endometrium (prevents implantation)
• Increased viscosity of cervical mucous (prevent sperm penetration)

Question 5

Other benefits of taking CCP

Answer 5

• Regular and less painful heavy periods
• Reduced functional ovary
• 50% reduction in endometrial and ovarian cancer risk
• Improved acne
• Reduced risk of benign breast disease, rheumatoid arthritis, colon cancer, osteoporosis

Question 6

Risk of venous thromboembolus in CCP

Answer 6

• After major surgery
• Thrombophilia
• FH of VTE and under 40 years old
• BMI more than 40
• Underlying vascular disease
• Post-natal (under 21 days)

Question 7

Other risk of taking the CCP

Answer 7

• Small increased risk of ischaemic stroke
• Small increased risk of breast cancer
• Doubled risk of cervical cancer with 10 years of use

Question 8

Contraindication of CCP

Answer 8

• Migraines + aura
• Thrombophilia
• Breast cancer
• Major surgery
• Stroke
• Ischaemic heart disease

Question 9

Key facts of the contraceptive patch

Answer 9

• Small transdermal patch that release hormones into bloodstream preventing pregnancy -> EVRA
• Lasts 7 days, change weekly for 3 weeks, 1 week off patch
• Wearable in water
• Helps with heavy and painful menstruations
• Increased BP -> headaches
• Protects against ovarian, womb and bowel cancer
• Contraindication
  
  • Smnokers
  • Over 35
  • Over 90kg

Question 10

Key facts of the vaginal ring

Answer 10

• Plastic ring inserted into the vagina that released continuous dose of oestrogen and progesterone
• Provides 1 month of continous uninterrupted protection
• Works depsite vomitting and diarrhoea
• Doestn work against STIs
• Use anytime in menstrual cycle
• 21 days of use, 7 days off, repeat

Question 11

Key facts of the progesterone only pill (POP)

Answer 11

• Lower failure rates in older women (lower fertility, less sexually active)
• 2 types
  
  • 3 hour (must be taken within 3 hour window each day)
  • 12 hour (must be taken in 12 hour window each day)
• Take once everyday continously
• Causes impenetrable cervical mucous

Question 12

Keys factors of the contraceptive injection

Answer 12

• Lasts 8 or 13 weeks (depends on type)
• Useful to those unable to take medication everyday
• Must be consistent with injection times
• Useful for those who cannot take oestrogen containing contraceptives
• Side effects
  
  • Weigth gain
  • Headaches
  • Mood swins
  • Breast tenderness
  • Irregular bleeding
• Disadvantages
  
  • Long wait for returning fertility
  • Reduction in bone density (reversible)

Question 13

Key facts of intrauterine contraceptive

Answer 13

• Long-acting reversible contraceptive (LARC)
• Can be inserted anytime during menstrual cycle
• Must be removed by an specialist sexual health professional
• Heavy, long and painful periods in first 3-6 months
• Risk of pelvic infection
• No protection against STI’s

Question 14

Difference between IUS and IUD

Answer 14

• IUD releases copper into cervix (also thickens cervical mucous)
• IUD releases progesterone

Question 15

Female sterilisation

Answer 15

• Laparascopic tubal ligation
• 1/500 risk of failure
• Risk of tubal occlusion

Question 16

Male sterilisation

Answer 16

• Vasectomy
• Permenant division of the vas deferens
• Failure of 1/2000
• No change in androgen hormone and risk of testicular/ prostate cancer

Question 17

Key facts of induced abortion

Answer 17

• Medically induced termination of pregnancy (MTOPS)
• Available below 24 weeks
• Indicated when continuation of pregancy would cause greater harm pscyhosocial harm, foetal anomaly and materal health

Question 18

Home abortion

Answer 18

• Legal in Scotland, Wales and England
• Indicated by WHO
• Increases access to safe abortion

Question 19

Clinical consultation for MTOPS

Answer 19

• Explaination of termination
• Complication during MTOPS
• Contraceptive advice
• STI testing
• Certificate A signature (must be signed by 2 doctors)

Question 20

How is MTOPS carried out

Answer 20

• Administration of mifepristone
• Inhibits pregnancy hormones (progesterone)
• Stops uterus from growing and disinhibits contractions
• 48 hours later, uterus contracts and expels foetus

Question 21

Complications of MTOPS

Answer 21

• Failure to terminate foetus
• Haemorrhage
• Infection
• Prolonged bleeding
• Retained products of conception (RPOC)
• Risk of pscyhological problems
• Future fertility unaffected
• Unaffected risk of breast cancer

Question 22

Conscientous objection

Answer 22

• Right to refuse in participation of abortion
• Duty of care to ensure alternative further access to safe abortion