Which methods of contraception are classed as combined hormonal contraception?
- COCP
- Transdermal patch
- Vaginal ring
Describe the primary mechanism of action of the combined oral contraceptive pill
Inhibits ovulation
Describe the primary mechanism of action of…
a) Progesterone-only pill (excluding desogestrel)
b) Desogestrel
a) Thickens cervical mucus
b) Inhibits ovulation
Which methods of contraception are classed as progesterone-only hormonal contraception?
- POP
- Implant
- Injection
How long does the contraceptive implant (Nexplanon) last?
3 years
Give a potential side effect of the contraceptive injection
Weight gain
What is the IUD (intrauterine device)?
Copper coil
What is the IUS (intrauterine system)?
Hormonal coil, e.g. Mirena
Describe the mechanism of action of the IUD
Releases copper, which decreases sperm motility and survival
Describe the primary mechanism of action of the IUS
Inhibits endometrial proliferation
When can the IUD be fitted during the menstrual cycle?
- Can be fitted anytime during the menstrual cycle
- Provides contraception IMMEDIATELY
When can the IUS be fitted during the menstrual cycle?
- Can be fitted anytime during the menstrual cycle
- Only effective immediately if fitted within the first 7 days of the menstrual cycle (otherwise, additional contraception is required for 7 days)
Other than use as a regular contraceptive, does the IUD have any other uses?
- Emergency contraception (effective if fitted within 5 days of UPSI)
How long does the IUD last?
5-10 years (depending on the type)
Which contraceptives can be taken while breastfeeding?
- Progesterone-only contraceptive pill
- Implant
- Injection
- IUD/IUS
*COCP is contraindicated up to 6 weeks postpartum, but can be prescribed after 6 weeks postpartum, even while breastfeeding
What are the different types of emergency contraception available?
- ‘Morning after pill’ (Levonorgestrel or Ulipristal acetate, also known as EllaOne)
- IUD
Describe the mechanism of action of the ‘morning after pill’ (both types)
Delays ovulation by 5-7 days, after which sperm will have become non-viable
Levonorgestrel is licensed for use within … hours of UPSI
72 hours of UPSI
EllaOne is licensed for use within … hours of UPSI
120 hours of UPSI
Give an example of a situation when the morning after pill may not work
Vomiting shortly after taking emergency contraception
Is contraception required immediately after giving birth - if not, how long is contraception NOT required for?
- No
- In non-breastfeeding women, ovulation can occur as early as day 28, therefore contraceptive protection is required from day 21 onwards
What are the risks of the combined oral contraceptive pill with regards to women’s cancers?
Combined oral contraceptive pill:
- Protective against ovarian and endometrial cancer
- Increased risk of breast and cervical cancer
If not started on day 1 of cycle, when do the following forms of contraception become effective?
- IUD
- POP
- COCP
- Implant
- Injection
- IUS
- IUD = immediately
- POP = 2 days
- COCP, implant, injection, IUS = 7 days
A woman who is taking the COCP presents to her GP having missed 1 pill. What do you advise her?
If 1 pill is missed (at any time in the cycle):
- Take the last pill even if it means taking two pills in one day
- Continue with the rest of the pack
- No additional contraceptive protection needed
