Contraception

Question 1

Which methods of contraception require ongoing action by the individual?

Answer 1

• oral contraception
• barrier methods
• fertility awareness
• coitius interruptus
• oral emergency contraception

Question 2

What are methods of contraception which prevent conception by default?

Answer 2

• IUCD/IUI/IUs
• progestogen implants
• progestogen injections
• sterilisation

Question 3

What features would “the perfect contraceptive” acquire?

Answer 3

• 100% reliable
• 100% safe
• non-user dependent
• unrelated to coitus
• visible to the woman
• no going medical input
• completely reversible within 24 hours
• no discomfort

Question 4

What are risks of contraception?

Answer 4

• cardiovascular
• neoplastic
• emotional
• infection related
• allergic
• Iatrogenic

Question 5

What are risks of no contraception?

Answer 5

• childbirth related
• abortion related
• social costs
• economic costs

Question 6

What are benefits of treatment?

Answer 6

• the non-contraceptive benefits
• psychosocial
• choice
• sexual health
• cost savings
• female equality

Question 7

What are the benefits of not having contraception?

Answer 7

• non interference
• population growth
• control of women

Question 8

Combined oral contraception

• What is it?
• What does it include & where do they act?
• Examples?

Answer 8

• oestrogen + progestogens
• oestrogen -> act on ant pit, ovary, endometrium
• progestogens -> act on ant pit, ovary, endometrium, fallopian tubes + cervical mucus
• older (2nd gen) - norethisterone, levnorgestrel
• newer (3rd gen) - noregestromin
• latest - drospirenone

Question 9

What are the contraceptive benefits of the combined oral pill?

Answer 9

• reliable
• safe
• unrelated to coitus
• woman in control
• rapidly reversible

Question 10

What are the non-contraceptive benefits of oral contraception?

Answer 10

• halve ovarian cancer
• halve endometrium cancer
• decrease colon cancer
• helps endometriosis, fiborids, RA, premenstrual syndrome, dysmenorrhoea, menorrhagia

Question 11

What are the risks of combined oral contraception?

Answer 11

• cardiovascular - HBP, DVT, pulm embolism, migraine
• neoplastic - breast, cervix, liver
• gastrointestinal - COH/insulin metabolism, weight gain, crohns
• hepatic - hormone metabolisms, jaundices, gallstones
• dermatological - chloasma, acne
• psychological - mood swings, depression, libido

Question 12

What are the rules of taking the combined oral contraceptive pill?

Answer 12

• start 1^st packet 1^st day of menstrual period
• take 21 pills + stop for 7 day break (PFI)
• restart each new packet on 8^th day (same)
• do not start new packets late
• if late or missed pills in 1st 7 days, condoms
• if missed pills in last 7d ays no PFI

Question 13

What are interacting meds to look out for with combined oral contraception?

Answer 13

• liver enzyme inducing drugs - affect metab of both oestrogen + progestogen
• beware rifampicin + anti-epileptics
• broad spectrum antibiotics - affect enterhepatic circulation of oestrogen only (40%)

Question 14

What is the combined vaginal contraceptive?

Answer 14

• similar as COCP except vaginal delivery (ring) for 21 days
• remove for 7 days
• adv - don’t have to take every day
• disadv - don’t have to take every day!!

Question 15

What are some progestogen only methods?

Answer 15

• default methods
  
  • implants (implanon, norplant)
  • hormone releasing IUCD (mirena IUS)
• user dependent methods
  
  • POPs (prog only pills) - eg cerazette
  • injectables - depo provera, noristerat

Question 16

Why is Cerazette taking over the world?

Answer 16

• as effective as COCP (slightly less though)
• no oestrogen - contraindications eg. breastfeeding
• favourable side effect profile vs older POPs
• bleeding as predictable as COCP
• 12 hour window

although it has less efficiency than COCP

Question 17

What are IUCDs?

Answer 17

• copper bearing intrauterine contraceptive devices are inserted into uterus
• by suitably trained practitioners + may be left in situ long term

Question 18

How do IUCDs act?

Answer 18

• destroying spermatozoa
• preventing implantation - inflammatory rxn + pg secretion as well as a mechanical effect

Question 19

What are the two types of IUCDs?

Answer 19

• copper bearing eg. ortho T, multiload
• hormone bearing - Mirena

Question 20

What are benefits of IUCDs?

Answer 20

• non user dependent
• immediately + retrospectively effective
• immediately reversible
• can be used long term
• extremely reliable
• unrelated to coitus
• free from serious medical dangers

Question 21

What are disadvantages of IUCDs?

Answer 21

• has to be fitted by trained medical personnel
• fitting may cause pain/discomfort
• periods may become heavier and painful
• it does not offer protection against infection
• threads may be felt by the male

Question 22

What are the risks of IUCDs?

Answer 22

• miscarriage if elft in situ if a pregnancy
• ectopics?
• may be expelled
• the uterus may be perforated

Question 23

What are absolute contraindications of IUCDs?

Answer 23

• current pelvic inflammatory disease
• suspected or known pregnancy
• unexplained vaginal bleeding
• abnormalities of uterine cavity

Question 24

What are relative contraindications of IUCDs?

Answer 24

• nulliparity (never completing pregnancy beyond 20 weeks)
• past history of PID
• not in mutually monogamous relationship
• menorrhagia / dysmenorrhoea
• small uterine fibroids

Question 25

What are advantages of condoms to the male?

Answer 25

* man in control * protects against STIs * no serious health risks * easily available (free at family planning clinics)

Question 26

What are advantages of (female) condoms to females?

Answer 26

* woman in control * protects against STIs * can be put in advance + left inside after erection lost * not dependent on male erection to work

Question 27

What are disadvantages of male condoms?

Answer 27

* last minute use * needs to be taught * may cause allergies * may cause psycho sexual difficulties * higher failure rate among some couples * oily preparations rot rubber

Question 28

What are disadvantages of female condoms?

Answer 28

* obtrusive * expensive * messy * rustles during sex * uncertain failure rate

Question 29

What are diaphgragm caps?

Answer 29

* made of latex * fit across vagina * sizes 55-95mm in 5cm jumps * must be used with spermicide and left in at least 6 hours after sexual intercourse

Question 30

What are advantages + disadvantages of diaphgram caps?

Answer 30

* **advantages**: woman in control, can be put in in advance, offers protection against cervical dysplasias, perceived as 'natural' * **disadvantages**: needs to be taught, messy, higher failure rate than most methods, higher UTI, higher candiasis

Question 31

What are suction (cervical) caps?

Answer 31

* made of plastic * suction to cervix or vaginal vault * diff sizes * must be used with spermicide and left in 6 hours or more

Question 32

What are advantages and disadvantages of suction caps?

Answer 32

* **advantages**: suitable for women with poor pelvic muscles, no probs with rubber allergies, very unobtrusive, woman in control * **disadvantages**: needs an accessible + suitable cervix, higher failure rate than diaphgram, not easy to find experienced teacher

Question 33

How long can sperm survive in the female tract?

Answer 33

* 5 days * Ova can survive 24 hours * ova are fertilised in fallopian tube + take 4 days to reach uterus + implant * cervical mucus is receptive to sperm around time of ovulation * use periodic abstinence/alternative contraception to avoid pregnancy * time intercourse to pre-ovulatory phase to conceive

Question 34

What factors are important with natural family planning?

Answer 34

* temperature * rhythm * cervix position * cervical mucus * persona * lactational amenorrhoea

Question 35

What are advantages of fertility awareness?

Answer 35

* non-medical * can be used in 3rd world * allowed by catholic church * can result in closeness of understanding between partners

Question 36

What are disadvantages of fertility awareness?

Answer 36

* failure rate heavily user dependent * requires skilled teaching * may require cooperation between partners * may involve limiting sexual activity * can cause strain

Question 37

Postcoital pills are used as emergency contraception. What is the time window for them to be given following unprotected sexual intercourse? Examples?

Answer 37

* up to 72 hours after unprotected sexual intercourse (UPSI) * Schering Pc4 - prevents 3/4 pregnancies which would have occurred * Levonelle - prevents 7/8 pregnancies * ellaOne (ulipristal) - similar * act by postponing ovulation in 1st part of cycle - so beware, act by preventing implantation in 2nd part of cycle

Question 38

Copper bearing IUCDs can also be given as emergency contraception. What is the time window for this?

Answer 38

* up to 5 days after presumed ovulatin * or 5 days after one single episode of UPSI at any time of the cycle * failure extremely rare * copper kills sperm in 1st part of cycle, device prevents implantation in 2nd part of cycle

Question 39

Describe similarities and differences between PC4 and Levonelle 2

Answer 39

* **PC4**: lower failure rate in 1^st 24 hours, causes nausea + vomiting in many women, contraindicated during focal migraine attack * **Levonelle 2**: lower failure rate in 1^st 24hrs, very little nausea, only contraindicated in women taking very potent liver enzyme meds (anti TB)

Question 40

Describe ellaOne

Answer 40

* postcoital pill * ulipristal acetate * new selective progestagen receptor * up to 120 hours * RR 0.58 pregnancy vs Levonelle * possible slightly higher side effect profile - GI symptoms mainly