contraception

Question 1

potential harms + benefits of oral contraceptive pill

Answer 1

1. The COC is > 99% effective if taken correctly
2. small risk of blood clots
3. very small risk of heart attacks and strokes
4. increased risk of breast cancer and cervical cancer

Question 2

advise on taking COC pill

Answer 2

1. if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
2. should be taken at the same time everyday
3. taken for 21 days then stopped for 7 days - similar uterine bleeding to menstruation
4. advice that intercourse during the pill-free period is only safe if the next pack is started on time

Question 3

situations where efficacy of pill is reduced

Answer 3

1. if vomiting within 2 hours of taking COC pill

2. if taking liver enzyme inducing drugs

Question 4

antibiotic use with COC pill

Answer 4

1. for many years doctors in the UK have advised that the concurrent use of antibiotics may interfere with the enterohepatic circulation of oestrogen and thus make the combined oral contraceptive pill ineffective - ‘extra-precautions’ were advised for the duration of antibiotic treatment and for 7 days afterwards
2. no such precautions are taken in the US or the majority of mainland Europe
   in 2011 the Faculty of Sexual & Reproductive Healthcare produced new guidelines abandoning this approach. The latest edition of the BNF has been updated in line with this guidance
3. precautions should still be taken with enzyme inducing antibiotics such as rifampicin

Question 5

contraception methods + delay in fertility

Answer 5

1. Condoms work as a barrier contraceptive and do not affect ovulation and hence do not delay fertility.
2. The intrauterine system (IUS) works by thickening cervical mucous and in some women may prevent ovulation, however the majority of women still ovulate. After removal of the IUS the majority of women regain fertility immediately.
3. The combined oral contraceptive pill can delay return to normal menstrual cycle in some women but the majority will be able to conceive within a month of stopping. The progesterone only pill is less likely to delay return to normal cycle as it does not contain oestrogen.
4. Depo-Provera lasts up to 12 weeks, it can take several months for the body to return to the normal menstrual cycle and hence delay fertility. For this reason, it is the least appropriate method for this woman who wants to return to ovulatory cycles immediately.

Question 6

Depo Provera

Answer 6

1. main injectable contraceptive used in the UK*.
2. It contains medroxyprogesterone acetate 150mg. It is given via in intramuscular injection every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions**
3. The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.
4. Disadvantages include the fact that the injection cannot be reversed once given. There is also a potential delayed return to fertility (maybe up to 12 months)

Question 7

adverse effects of Depo Provera

Answer 7

1. Irregular bleeding
2. weight gain
3. may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
4. not quickly reversible and fertility may return after a varying time