Contraception

Question 1

State some points that would make the ideal contraception.

Answer 1

• 100% effective and forgettable
• 100% safe with no unwanted side effects
• 100% convenient and unrelated to sex
• 100% reversible
• protection from STIs
• non contraceptive benefits
• cheap
• acceptable to all cultures and religions

Question 2

What are some risk factors for teenage pregnancy?

Answer 2

• Poverty (strongest risk factor)
• Looked after children
• Children with teenage mothers
• Low education achievement
• Poor transition from school to work (at age 16)
• Mental health problems
• Sexual abuse

Question 3

What are the two ways of unwanted pregnancy?

Answer 3

• Unprotected sex

- Failure of contraception i.e. Pill, IUD, Barrier

Question 4

What are the outcomes for unwanted pregnancy for:

• upto 72 hours
• upto 5 days
• upto 24 weeks

Answer 4

• Levonelle
• EllaOne or IUD
• Termination - use Mifepristone (antiprogestogenic - sensitises myometrium to Prostaglandins)

Question 5

For termination, what would you give?

Answer 5

Upto 24 weeks.
Giver single dose of Mifepristone (anti progestogenic - sensitises myometrium to prostaglandins), followed by a prostaglandin.

Question 6

What are some stages that people think life begins at?

Answer 6

• Fertilisation
• Implantation
• Quickening
• Brain activity
• Viability of the foetus
• Birth

Question 7

What are the current abortion laws?

Answer 7

• You can get a termination up until 24 weeks if there is a risk to the woman’s or her child’s physical or mental health
• There is no limit if the women’s health or life is massively threatened or if the child is likely to be born with severe physical or mental abnormalities
• no consent needed from doctor or partner or family
• no consent needed for under 16 in some circumstances

Question 8

Why does a foetus not have rights in the eyes of the law?

Answer 8

The foetus is not a person in the eyes of the
law, and so does not have the same legal
protection as persons. Only once outside
the womb, the baby acquires full legal
status.

Question 9

What is the Gradualist view?

Answer 9

• The fertilised egg has no intrinsic moral value
• It becomes valuable during its development
• It follows;
  a) early abortions is probably acceptable
  b) late abortions may be more difficult to justify
  c) at some point abortion may be immoral depending on where the line is drawn

Question 10

What is the Potential view?

Answer 10

An embryo is a potential person
Scientists that cures cancer… mass murderer?
Also, every sperm or egg is a potential person: do they merit the same production?

Question 11

How do EHCs work?

Answer 11

• Suppress ovulation
• Change the viscosity of cervical mucus
• Alter the state of endometrium to prevent implantation

Question 12

What is the efficacy of Levonelle between 49-72 hours after UPSI?

Answer 12

58%

Question 13

What is the efficacy of Levonelle between 25-48 hours after UPSI?

Answer 13

85%

Question 14

What is the efficacy of Levonelle between 0-24 hours after UPSI?

Answer 14

95%

Question 15

What would you give for above 72 hours after UPSI?

Answer 15

• EllaOne (upto 5 days)
• IUD (upto 5 days)
• They are POM drugs

Question 16

How does EllaOne or IUD work?

Answer 16

Acts as a synthetic progesterone receptor modulator.

It delays ovulation but can also cause disintegration of endometrium - loss of implanted eggs

Question 17

At what time is there an issue, regarding combined pill?

Answer 17

Missing two or more of 1st 7 pills

Question 18

At what time is there an issue, regarding Progesterone-only pill?

Answer 18

Missing one or more, more than 3 hours after usual taking (however, Cerazette - 12 hour window)

Question 19

What do you do if a patient is worried they are pregnant?

Answer 19

• Check the dates and nature of the last period - is it light?
• Refer
• Reassure
• Has the EHC been used since the last period? It’s safe but may cause menstrual disruption

Question 20

What medications contradict with the pill?

Answer 20

Antibiotics e.g. rifampicin, griseofulcin
Ritonavir
St Johns Wort
Anticonvulsants/ Benzos: Carbamazepine, Phenytoin, , Primidone

Question 21

When should EHC not be supplied?

Answer 21

• D & V
• Crohn’s disease
• Requesting for an advanced supply as it is POM
• Allergy
• Severe hepatic dysfunction

Question 22

What are some counselling points for EHC?

Answer 22

• If vomiting within 3 hours of taking, take a second dose
• It is not 100% effective
• There will be some menstrual changes
• Will need to consider the rest of the cycle also. The EHC only covers for a short while
• There is still risk from STI
• Consider contraception

Question 23

If a person is taking an antibiotic or medication that interacts with EHC, what do you do?

Answer 23

• Suggest alternative form of contraception that is not affected i.e. IUD
• Suggest additional form of contraception e.g. Condoms