Contraception

Question 1

For the contraceptive implant what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects

Answer 1

1. Implant placed in the upper arm which releases progestogen. Inhibition of ovulation and thickening of cervical mucus.
2. Indications: Most women.
   Contraindications: Unexplained vaginal bleeding, current breast cancer, history of breast cancer, severe cirrhosis, hepatocellular adenoma, hepatocellular carcinoma.
3. The implant lasts 3 years. Over 99%
4. Temporary: headaches, nausea, breast tenderness and mood swings. Periods may become irregular or stop. Acne worsening. Bleeding.

Question 2

For the Intrauterine device and Intrauterine system what are:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects

Answer 2

1. Iud (copper) = releases copper into the uterine cavity which is toxic to sperm entering.
   Ius = release of levonorgestrel causing, endometrial atrophy (prevent implantation), thickening of cervical mucus.
2. Indications: Treatment of menorrhagia and women on HRT. Contraception.
   Contraindications:
   a. Both - 48 hours post-partum, post-partum sepsis, post-abortion sepsis, known long QT syndrome, unexplained vaginal bleeding, gestational trophoblastic disease, cervical cancer, endometrial cancer, uterine fibroids with distortion of the uterine cavity, PID, STIs, pelvic TB.
   b. IUS - liver disease and cancers.
3. Use ranges from 3-10 years. Over 99%
4. Insertion: failure, syncope, suspected perforation.
   After insertion: cramping, expulsion, infection, lost threads,

Question 3

For the contraceptive injection what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects

Answer 3

1. Inhibition of ovulation. Progestogen released into blood which prevents ovaries from releasing egg and thickens cervical mucus.
2. Indications: Most women. Women who would forget to take the pill, who cannot use contraception containing oestrogen.
   Contraindications: Multiple CVD risk factors, Vascular disease, history of IHD or stroke, unexplained vaginal bleeding, breast cancer, cirrhosis, liver cancers.
3. Injection lasting between 8, 12, 13 weeks. Over 99% if used correctly, 94% with typical use.
4. Weight gain, headaches, mood swings, breast tenderness and irregular bleeding. Periods can become longer, shorter or stop. Thinning of bones due to depletion in natural oestrogen levels.

Question 4

For male sterilisation what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects

Answer 4

1. Vas deferens are cut, blocked or sealed with heat.
2. N/A
3. N/A
4. Haematoma, sperm granulomas, Infection, long-term testicular pain, testicles feeling full, fertility (rarely).

Question 4

For female sterilisation what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects (risks)

Answer 4

1. Blockage of the fallopian tubes - eggs cannot meet the sperm and fertilisation is unable to occur. Tubal occlusion, blocking the tubes, or salpingectomy.
2. Indications: women that do not wish to have any(more) children.
   Contraindications: gynae malignancy, morbidly obese patients, incapacity.
3. Over 99% if successful.
4. Unsuccessful, perforation, injuries to close organs, regret, hernia, shoulder tip pain, death.

Question 5

For the contraceptive patch what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects
5. Rules for missed doses, diarrhoea/vomiting.

Answer 5

1. Oestrogen and progestogen. Prevents ovulation, thickens cervical mucus and thins lining of womb.
2. Indications: most women.
   Contraindications: 0-6 weeks post-partum, post-partum with risk factors of VTE, smokers (over 35), BMI over 35, complicated organ transplants, CVD risk factors, hypertension, IHD, stroke, VTE, family history of VTE, prolonged immobility, thrombotic mutations, complicated congenital heart disease, AF, migraine with aura, carriers of BRCA, breast cancer, nephropathy, vascular disease, cirrhosis, gallbladder disease, liver cancers, positive antiphospholipid antibodies.
3. Patch should be placed on skin that is clean, dry and non-hairy. New patch oncea a week for 3 weeks and then stop for 7 days. Over 99%, typical use 91%.
4. Headaches, nausea, breast tenderness, mood changes, bleeding between cycles and spotting. Increased risk of blood clots.
5. Patch fallen off for less than 48 hours = new patch or old patch (if still sticky) on as soon as possible, continue as normal. (still protected as long as it has been on properly for 7 days).
   Patch has fallen off for more than 48 hours = new patch as soon as possible and start a new patch cycle. Use of contraception for 7 days.

Question 6

For the contraceptive vaginal ring what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects
5. Rules for missed doses, diarrhoea/vomiting.

Answer 6

1. Ring releases oestrogen and progestogen preventing ovulation, causing cervical mucus thickening and thins the endometrium.
2. Indications: most women.
   Contraindications: 0-6 weeks post-partum, post-partum with risk factors of VTE, smokers (over 35), BMI over 35, complicated organ transplants, CVD risk factors, hypertension, IHD, stroke, VTE, family history of VTE, prolonged immobility, thrombotic mutations, complicated congenital heart disease, AF, migraine with aura, carriers of BRCA, breast cancer, nephropathy, vascular disease, cirrhosis, gallbladder disease, liver cancers, positive antiphospholipid antibodies.
3. Left in vagina for 21 days have a 7 day break and then insert a new ring. Over 99%, typical use 91%.
4. Increase in vaginal discharge, breast tenderness and headaches. Increased risk of blood clots.
5. Forgetting to remove the ring for up to 7 days after the end of week 3: take out as soon as, start 7 day interval, begin new ring as normal, no need for extra contraception.
   Forgetting to remove the ring for more than 7 days: take out as soon as and put a new ring in straight away. Use extra contraception for the next 7 days.

Question 7

For the COCP what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects
5. Rules for missed doses, diarrhoea/vomiting.

Answer 7

1. Contains oestrogen and progestogen which means it inhibits ovulation, thickens cervical mucus and thins the endometrium.
2. Indications: contraception, heavy periods, painful periods, PMS, and endometriosis.
   Contraindications: 0-6 weeks post-partum, post-partum with risk factors of VTE, smokers (over 35), BMI over 35, complicated organ transplants, CVD risk factors, hypertension, IHD, stroke, VTE, family history of VTE, prolonged immobility, thrombotic mutations, complicated congenital heart disease, AF, migraine with aura, carriers of BRCA, breast cancer, nephropathy, vascular disease, cirrhosis, gallbladder disease, liver cancers, positive antiphospholipid antibodies.
3. Every day for 21 days then stop for 7 days. The pill can also be taken back to back with no breaks. Pill needs to be taken at the same time every day. Over 99%, typical use 91%.
4. Mood swings, headaches, breast tenderness, blood clots and cervical cancer.
5. Missed 1 pill: take it asap (even if that means taking two), continue as usual.
   Missed 2 pills: take pill asap, leave any earlier missed pills, continue as usual but use extra contraception for next 7 days, may need emergency contraception.
   If you vomit within 2 hours of taking the pill take another one straight away. If vomiting is prolonged use contraception until this has stopped. Very severe diarrhoea can also affect the pill so use contraception while this persists.

Question 8

For the POP what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects
5. Rules for missed doses, diarrhoea/vomiting.

Answer 8

1. Progestogen-containing, thickens cervical mucus and inhibits ovulation.
2. Indications: women who are unable to take oestrogen.
   Contraindications: continuation after a stroke, breast cancer, cirrhosis, liver cancers.
3. 3-hour pill and 12-hour pill. Continues with no breaks. Over 99%, typical use 91%.
4. Acne, breast tenderness.
5. 3-hour pill less than 3 hours/12-hour less than 12 hours late: take asap and continue as normal but use contraception for 2 days.
   3-hour pill more than 3 hours/12-hour more than 12 hours late: take asap (more than one missed only take 1), take remaining pills as normal and use contraception for 2 days.

Vomiting within 2 hours take another pill straight away. If not taken within time limits - contraception for 2 days. Diarrhoea use contraception whilst ill and 2 days into recovery.

Question 9

For condoms what is:
1. MoA
2. Indications and contraindications
3. Correct use
4. Important side-effects