Contraception

Question 1

List the Short and Long term contraceptive options for someone worried about becoming pregnant?

Answer 1

Short Term Barrier Methods:

• condom
• diaphragm (personally fitted 6 hours following sex)
• female condom - cervical cap

Long Term IUD:

• Copper
• Mirena (implanted during menstruation, every 5 year replaced, review annually and check 2-3months)
• Implanon - (estonogestrel implant) - unpredictable bleed, progesterone SE (breast tender, weight change), - insertion (adrenaline and local anaesthetic
• Depot-Provera (IM progestogen) - bone density, return to fertility in 1-2years (6month delay), injection every 12weeks

ST options:

• POP - (minipill - same time everyday) unpredictable bleeding patterns
• COCP - monophasic or triphasic - oestrogen and progesterone SEs

Question 2

What is the first line treatment for dysmenorrhoea in a non-currently sexually active women?

Answer 2

Pain relief Mefenamic acid (NSAID) aka Ponstan or paracetamol

Question 3

What are some important contraindications for the OCP?

Answer 3

1. CVD complications (DVT, HTN, smoking, diabetes, age, lipids, risk of stroke/IHD)
2. migraine with aura
3. hormone dependent cancers
4. thrombophilia (anyone in the family with bleeding disease)
5. liver disease
6. medications (antiepileptics, TB drugs, antibiotics for acne)
7. Others: post partum avoid for at least 21 days (no other VTE factors) Breastfeeding (not recommended until 6 weeks postpartum)

Question 4

What is the difference between monophasic and triphasic COCP?

Answer 4

• monophasic has a single dose of synthetic estrogen (ethinyl estradiol) and progestins throughout 21 days.
• Biphasic has two different progestins, while triphasic has three different doses of progestins.
• monophasic has decreased side effects triphasic has increased amenorrhea

Question 5

What are the side effects related to progesterone?

Answer 5

• Progesterone
• Amenorrhoea / breakthrough bleeding
• HA
• Breast tenderness
• ↑appetite
• ↓libido
• Mood Δ
• HTN
• OP
• Androgenic SE = levonorgestrel > norethisterone > > > more recent progestins that are
• antiandrogenic (cyproterone, drospirenone [less so] — or have low androgenic activity = desogestrel, gestodene)
  
  • Acne / oily skin
  • Hirsutism
  • Weight gain

Question 6

What are the side effects related to oestrogens?

Answer 6

• Nausea
• Breast Δ (tenderness, enlargement)
• Fluid retention / bloating / oedema
• Migraine / HA
• TE events (DVT)
• Breakthrough bleeding
• Rare - Weight gain (NO WEIGHT GAIN) and Liver adenoma

Question 7

Outline the Insertion of Implanon, what is involved and what are some risks?

Answer 7

• inserted subdermally on the inner side of the non-dominant arm around 8-10cm above the medial epicondyle. (marked with a marker)
• clean with antispetic
• anaethetise the insertion site
• angle less than 30 degrees
• applicator to hoizontal and slide
• verify the presence of the implant
• apply adhesive and pressure bandage to minimise bruising - keep dry for 24 hours and try not to heavy lift.
• itching, tenderness and bruising can occur. Can sometimes leave a scar.

Things to Note:

• lasts for 3 years
• 99% effective
• it increases the thickness of mucus of the cervix and stops egg release from ovary.
• it is a 4cm long plastic rod that contains progesterone.
• Its done on days 1-5 of your cycle. Can be done 21 days after birth and can be used while breastfeeding.

CI:

• breast or ovarian cancer
• DVT
• liver disease
• pregnancy possibility
• allergic reaction to local anaesthetic

SE:

• insertion - soreness, scarring, local anaesthetics. May scar
• changes in bleeding (20% none, 25% infrequent, 30% regular, 20% prolonged).
• progesterone related side effects. settle down.