Contraception

Question 1

How does the combined oral contraception pill work?

Answer 1

• Oestrogen - FSH suppression
• Progestogen - LH suppression
  
  • Cyproterone - helps with skin problems
• Cervical mucus thickening

Question 2

When can a woman commence the oral contraceptive pill?

Answer 2

Day one of her period (or earlier if pregnancy is excluded)

Question 3

How long should a woman use back-up contraception for when starting the pill?

Answer 3

7 days

Question 4

How can a woman manage a missed COC pill?

Answer 4

• < 48 hours since last pill - take missed pill and others as normal
• > 48 hours since last pill - take missed pill and use condomsfor 7 days
  
  • If < 7 pills taken since last placebo, consider EC if unprotected sex in last 5 days
  • If < 7 pills left since last placebo break, skip placebos

Question 5

What are the contraindications for using the COC pill?

Answer 5

• Undiagnosed vaginal bleeding
• Multiple major cardio risk factors
• Stroke
• Thrombophilia
• Focal migraine (with aura)
• Active liver disease
• Hormone dependent cancer
• Breastfeeding <6/12
• Drug interactions

Question 6

List some advantages and disadvantages of the COC pill

Answer 6

Easy administration, reversible, independent of sex, reduction in period pain and flow, reduction in PID, cysts, ovary and endometrial cancer, benign breast disease

Must be taken daily, slightly increased risk of DVT, breast cancer, breast tenderness, nausea, mood and libido changes

Question 7

When is diabetes a contraindication to taking the COC pill?

Answer 7

When there is evidence of end-organ damage?

Question 8

What is the mode of action of progesterone-only contraception?

What is the main contraindication?

Answer 8

Thickens cervical mucus, inhibiting sperm action. Causes atrophic endometrium and some people stop ovulating. Some suppress pituitary action

Hormone-dependent cancer

Question 9

How do women need to take the progesterone-only pill?

Answer 9

• Daily at the same time
  
  • If > 3 hours late, take 3 pills and use other contraception for 48 hours
• When starting, unless days 1-5, use back-up contraception

Question 10

How often do IUDs require changing?

Answer 10

5-yearly (5-10 for copper)

If inserted at 45+ can be retained until menopause to a maximum of 7 years

Question 11

In terms of emergency contraception, when can the pill form be taken? The copper form? What are the possible substitutes for the pill form?

Answer 11

• Pill - up to 3 days post
• Copper IUD - up to 5 days post
• Pill substitutes - 4 COC pills or 25 progesterone-only pills