Contraception

Question 1

What is the most commonly used form of female contraception?

Answer 1

Combined hormonal contraception (CHC)

Question 2

What are the different options for male contraception?

Answer 2

Condom

Vasectomy

Question 3

What are some characteristics of an ideal contraceptive? (there is none that is completely ideal - but if)

Answer 3

• 100% reversible
• 100% effective
• Free of adverse side effects
• Protection against STI’s
• Low maintenance

Question 4

What is one benefit of LARC (long acting reversible contraceptives)?

Answer 4

Minimize user input due to long acting nature, more convenient and minimizes chance of user error leading to pregnancy

Question 5

When is a woman most likely to become pregnant with regards to her ovulation cycle?

Answer 5

Likely to ovulate around day 12-18
Egg survives 24 hours
Sperm survive less than 4 days (5% may survive a week)

So sex within days 8-19 of a woman’s cycle is most likely to cause pregnancy

Question 6

What are the different forms of combined hormonal contraception? How often do each need to be administered?

Answer 6

Pill - needs to be taken daily

Skin Patch - changed weekly

Vaginal ring - changed every 3 weeks (can take out for 3 hours in every 24)

Question 7

Which hormones are administered by combined hormonal contraception devices?

Answer 7

Ethinyl Estradiol - synthetic oestrogen
Progestogen - synthetic progesterone

Work by inhibiting ovulation, also cause changes in cervical mucus and endometrium

Question 8

What are the benefits of combined hormonal contraceptives?

Answer 8

Regulate / reduce bleeding (help heavy periods)

Stop Ovulation

Reduction in functional ovarian cysts

50% reduction in ovarian and endometrial cancer

Improve acne and hirsutism

Reduce benign breast disease, RA, colon cancer and osteoporosis

Question 9

What are some possible complications associated with combined hormonal contraception?

Answer 9

• Breast tenderness / weight gain
• Nausea / headache
• Irregular bleeding for first 3 months
• Increased risk of arterial & venous thrombosis
• Avoid if active gall bladder disease / prev liver tumour
• Increased risk of cervical and breast cancer

Question 10

What hormones are used in the progestogen only pill (POP)? How do they work? How often do they need to be taken?

Answer 10

Desogestrel or Levonorgestrel (both progesterone analogues)

Work by making cycles anovulant (no ovulation), also affect mucus.
Desogesterel - most cycles bleed free, LNG - 1/3 bleed free

Need to be taken daily

Question 11

What are some complications associated with the progestogen only pill?

Answer 11

Appetite increase
Hair loss / gain
Mood change 
Bloating or fluid retention
Headaches 
Acne 

Need to avoid POP if current breast cancer or previous / present liver tumour

Question 12

What hormone is in “the jag” (injectable progestogen)? How often does the injection need to be taken & where is it injected?

Answer 12

progestogen depomedroxyprogesterone acetate

150mg 1 mL deep intramuscular injection into the upper outer quadrant of the buttocks every 13 weeks

Question 13

How does the injectable progestogen shot work?

Answer 13

1. Prevents ovulation
2. Alters cervical mucus making it hostile to sperm
3. Makes endometrium unsuitable for implantation

Question 14

What are some of the complications associated with injectable progestogen?

Answer 14

Delay in return to fertility - avg. 9 months

Reversible reduction in bone density (osteoporosis risk)

Problematic bleeding especially over first 3 doses

Weight gain (2/3 of women gain 2-3kg)

Question 15

What is the subdermal progestogen implant made out of?

Answer 15

4cm long, 2mm wide rod containing:

• 68mg progestogen etonogestrel core
• Rate controlling membrane made from ethinyl vinyl acetate

Implanted subdermally

Question 16

How long does the progestogen implant last? How does it work?

Answer 16

Can last 3 years or be removed at any time during this

Inhibits ovulation and has an effect on cervical mucus

Question 17

What are some complications associated with the progestogen implant?

Answer 17

30% of women have prolonged / frequent bleeding

More significant mood alteration than other progestogen only methods

Question 18

How long does intrauterine contraception (the coil) last for? What are some benefits?

Answer 18

Long acting reversible contraception - lasts 5-10 years

Requires little upkeep, effects immediately reversible when removed

Question 19

How do copper IUD’s (intrauterine devices) work? What are some possible complications?

Answer 19

Toxic to sperm - stop sperm reaching the egg. May also prevent implantation of fertilized egg. Non-hormonal

May make periods heavier / crampier

Not a contraindication to MRI

Question 20

How does the Levonorgestrel IUS (intrauterine system) work? How long is it effective for?

Answer 20

Affect cervical mucus and endometrium, prevent fertilization and possibly implantation. Most women still ovulate. Also reduces menstrual bleeding after 4 months

Works via slow release of low dose progestogen

Lasts for 3-5 years depending on model

Question 21

What are the most effective options for emergency contraception?

Answer 21

Copper IUD is most effective, fit before implantation, less than 1 pregnancy per 100 women. Can keep method long term if patient likes it

Levonorgestrel pill (plan B) - take within 72 hours. 2-3 pregnancies per 100 women

Ulipristal pill - take within 120 hours, 1-2 pregnancies per 100 women. More contraindications (drugs / breast feeding)

Question 22

When should a woman start contraceptives with regards to her cycle?

Answer 22

Start within first 5 days of cycle

Women can also get pregnant 21 days after delivery, or 5 days after miscarriage / abortion

Question 23

What drugs can reduce the effectiveness of the pill, patch, ring, POP and implant?

Answer 23

Enzyme inducing drugs

Eg. carbamezapine, topiramate, rifampicin

Question 24

What are some examples of barrier methods of contraception?

Answer 24

• Male condom
• Female condom
• Diaphragm (covers the cervix so sperm can’t get into the uterus)
• Sponge with spermacide (similar to diaphragm)
• Cervical cap (similar to diaphragm)

Question 25

What are some surgical options for female sterilization?

Answer 25

Laparoscopic sterilization - clips placed across fallopian tubes to block lumen Salpingectomy - removal of fallopian tubes

Question 26

What are some benefits to female sterilization? Some possible complications?

Answer 26

Risk of pregnancy reduced to 1/200 lifetime No effect on periods / hormones Reduces ovarian cancer risk Irreversible - risk regret Risk of general anaesthetic and laparoscopy

Question 27

How is a vasectomy done? Is it completely effective? Possible complications?

Answer 27

Vas deferens is divided and ends cauterized, under local anaesthetic usually in primary care. Takes 4-5 months to be effective 2% do not get clear sperm samples - ineffective, if clear samples 1/2000 risk of pregnancy 1/100 risk lifelong testicular pain No effect on testosterone or sexual function