Contraception

Question 1

What are the two main contraceptive mechanisms?

Answer 1

1) Inhibiting the development and release of the egg
- OCP, Depo progesterone, patch, ring

2) Imposing mechanical, chemical or temporal barrier between the sperm and egg
- Condom, diaphragm, IUD, natural family planning

Question 2

What is the difference between method failure rate and typical failure rate?

Answer 2

• Method Failure Rate: Failure rate of a contraceptive if used correctly 100% of the time
• Typical Failure Rate: Failure rate seen in typical use, accounting for occasional mistakes and non-compliance

Question 3

True or false, hormonal contraceptives can decrease a womans risk of developing ovarian or uterine cancer?

Answer 3

• True

Question 4

What is the mechanism of action of combined oral contraceptive preparations? (ie. what does the progesterone do, what does the estrogen do?)

Answer 4

1) Progesterone: supresses secretion of LH, and thus ovulation. Also causes thickening of cervical mucous to prevent sperm penetration, alters fallopian tube peristalsis, and inhibits sperm movement.
2) Estrogen: Suppresses secretion of FSH, which prevents the maturation of the follicle

Question 5

What are “phasic” oral contraceptives?

Answer 5

• These pills vary the ratio of Progesterone:Estrogen during the course of the cycle
• Leads to slightly less hormone uses, but has slightly higher rate of breakthrough bleeding (spotting)

Question 6

What is a “mini-pill”? How does it work?

Answer 6

A progestin only oral contraceptive pill
- Uses a lower dose, so the main mechanism is cervical mucous thickening as 40% of patients on this will continue to ovulate normally.

Question 7

How would you counsel a patient starting the mini-pill?

Answer 7

• Must be taken at the same time every day!
• Start taking it on the first day of your cycle
• If more than 3hrs late taking pill, use back-up contraception for 48 hours

Question 8

Break through bleeding occurs in 10-30% of patients taking low dose oral contraceptives during the first how many months? - councelling point

Answer 8

• 3 months. Typically will resolve spontaneously afterwards

Question 9

What are some of the minor side effects of estrogen?

Answer 9

• Bloating
• Weight gain
• Breast tenderness
• Nausea
• Fatigue
• Headache

Question 10

What are the absolute contraindications to the use of combined OCP?

Answer 10

• Thromboplebitis or Thromboembolic disease
• Undiagnosed abnormal vaginal bleeding
• Cerebral vascular disease
• Know or suspected pregnancy
• Coronary occlusion
• Smoker > 35 years old
• Impaired liver function
• Congenital hyperlipidemia
• Estrogen dependent tumour (Br or Uterus)
• Hepatic neoplasm
• Migraines with neurological symptoms (excluding aura)
• Uncontrolled hypertension

Question 11

Which drugs can reduce the efficacy of oral contraceptive pills?

Answer 11

• Barbituates
• Benzodiazapines
• phenytoin
• carbamazapine
• rifampin
• sulfonamides

Question 12

The contraceptive patch is less effective in women weighting over what amount?

Answer 12

• 90kg or 198lbs

Question 13

What is one of the primary concerns associated with Depo-Provera (DMPA) injections?

Answer 13

• Decreased bone density (due to changes in bone metabolism associated with decreased estrogen - like in menopause)
• Appears to be reversible following discontinuation

Question 14

How long after discontinuing Depo-provera does it take to resume normal menses?

Answer 14

• 50% will resume within 6 months

- 25% do not resume normal menses for over a year

Question 15

What are the barrier methods of contraception?

Answer 15

• Condom
• Diaphragm
• Cervical cap
• Sponge

Question 16

What is the active ingredient in spermacide?

Answer 16

• N-9 (Nonoxynol-9)

Question 17

How does a copper IUD work?

Answer 17

• Prevent eggs from being fertilized or from attaching to the wall of the uterus

Question 18

How does a progesterone containing IUD work?

Answer 18

• Prevents the egg from being fertilized

- Thickens the cervical mucous and creates an unfavourable uterine environment

Question 19

What does a progesterone containing IUD do to the severity of dysmenorrhea and the volume of menstrual blood loss?

Answer 19

• Decreases severity of dysmenorrhea
• 50% reduction in menstrual blood loss
• Make a key treatment option in endometriosis and adenomyosis

Question 20

How long can the copper IUD stay in place for while remaining effective?

Answer 20

• 10 years

Question 21

How long can the progesterone IUD stay in place for while remaining effective?

Answer 21

• 5 years

Question 22

What is the expulsion rate for IUD’s? When is this risk the highest?

Answer 22

• 1%-5%

- The risk is highest in the first few months of use

Question 23

Does having an IUD increase your change of having an ectopic pregnacy?

Answer 23

• NO!
• No increase in risk of ectopic pregnancy overall, however because very low chance of intrauterine pregnancy, the ratio of ectopic to normal pregnancies increases

Question 24

What are contraindications for the IUD?

Answer 24

• Pregnancy
• Pelvic inflammatory disease within the past 3 months
• STI (current)
• Purulent cervicitis
• Undiagnosed AUB
• Malignancy to genital tract
• Uterine anomalies blocking insertion
• Allergy, or copper IUD in wilson disease

Question 25

What is the calendar method?

Answer 25

- based on calculation of a womans fertile period. | - for a regular 28 day cycle the fertile period would be days 10 through 17

Question 26

What is the yuzpe method?

Answer 26

- A form of emergency post-coital contraception performed by: - Taking 2 tablets of combined OCP within 72 hours of unprotected intercourse, followed by another 2 tablets in 12 hours

Question 27

What is plan B?

Answer 27

A progestin only emergency contraception formulation - Take two tablets at once or 12 hours apart. - Greater effectiveness with less side effects than Yupze method

Question 28

How does plan B work?

Answer 28

- Temporarily stops the release of an egg from the ovary (by negative feedback to hypothalamus) - Prevents fertilization (thickening cervical mucous) - Prevents a fertilized egg from attaching to the uterus (alteration to the endometrium)