Contraception - Combined Hormonal

Question 1

What does hormonal contraction use?

Answer 1

The female steroid hormones oestrogen and progesterone

Question 2

Is hormonal contraception effective?

Answer 2

Yes, is very effective way of preventing pregnancy

Question 3

What can hormonal contraception be split into?

Answer 3

• Combined methods

- Progesterone-only

Question 4

What do combined methods of hormonal contraception contain?

Answer 4

Oestrogen and progesterone

Question 5

What is the primary action of combined hormonal contraception?

Answer 5

Inhibits ovulation due to the negative feedback effect of the oestrogen and progesterone on the hypothalamic-pituitary axis. This prevents the surge in LH, thus preventing ovulation

Question 6

What are the additional actions of progesterone in combined hormonal contraception?

Answer 6

• Inhibits proliferation of endometrium, creating unfavourable conditions for implantation
• Increases thickness of cervical mucus, preventing passage of sperm

Question 7

How is a period free of hormones achieved in combined hormonal contraceptives?

Answer 7

The patient takes a pill-free break or takes placebos

Question 8

What does the period free of hormones cause when using combined hormonal contraceptives?

Answer 8

A fall in hormone levels, which leads to degeneration of the endometrium and menstrual bleeding

Question 9

What is the failure rate of combined hormonal contraceptives with perfect use?

Answer 9

0.3%

Question 10

What is the typical failure rate of combined hormonal contraceptives?

Answer 10

9%

Question 11

What is the combined oral contraceptive pill (COCP) commonly called?

Answer 11

The pill

Question 12

What does the COCP contain?

Answer 12

Oestrogen and progesterone

Question 13

How many tablets are there in a packet of the COCP?

Answer 13

Either 21 or 28

Question 14

What is the regime of COCP with a packet containing 21 tablets?

Answer 14

Taken consecutively for 21 days, and then a 7-day break when no pills are taken

Question 15

What is the regime of COCP with a packet containing 28 tablets?

Answer 15

The pills are taken non-stop, and there is no break before starting the next packet

Question 16

What are the types of COCP?

Answer 16

• Monophasic

- Phasic

Question 17

What is meant by monophonic COCP?

Answer 17

Every pill contains the same levels of oestrogen and progesterone

Question 18

What is meant by phasic COCP?

Answer 18

Levels of oestrogen and progesterone in the pills changes throughout the cycle

Question 19

Other than monophonic and phasic, how can the hormone levels vary between different pills?

Answer 19

Can have varying levels of oestrogen

Question 20

What is classified as a ‘low oestrogen’ COCP?

Answer 20

Contains 20µg of ethinylestradiol

Question 21

What is more common, monophasic or phasic?

Answer 21

Monophasic

Question 22

Give 2 examples of monophasic COCPs?

Answer 22

• Microgynon 30

- Brevinor

Question 23

Is microgynon 30 and brevinor given in 21 or 28 tablet packs?

Answer 23

21

Question 24

What are the types of phasic COCPs?

Answer 24

• Biphasic
• Triphasic
• Quadriphasic

Question 25

What is very important when the patient is taking phasic COCP?

Answer 25

They take them in the correct order

Question 26

Give 2 examples of phasic COCPs

Answer 26

- Qlaria | - Binovum

Question 27

What kind of COCP is Qlaria?

Answer 27

Quadriphasic

Question 28

Is Qlaria given in 21 or 28 tablet packs?

Answer 28

28

Question 29

How many active pills are there in a pack of Qlaria?

Answer 29

26 (2 inactive)

Question 30

What kind of COCP is Binovum?

Answer 30

Biphasic

Question 31

Is Binovum given in 21 or 28 tablet packs?

Answer 31

21

Question 32

What is the contraceptive patch?

Answer 32

A small 5x5cm patch that can be stuck onto the body to prevent pregnancy

Question 33

Where can the contraceptive patch be stuck?

Answer 33

- Upper arm - Abdomen - Buttock - Back

Question 34

What is the brand of contraceptive patch used in the UK called?

Answer 34

Ortho Evra

Question 35

How often should the contraceptive patch be changed?

Answer 35

Every 7 days over a period of 3 weeks (21 days)

Question 36

What should happen after the patient has worn the contraceptive patch for 21 days?

Answer 36

It should be removed for 7 patch-free days

Question 37

What will happen when the contraceptive patch is withdrawn?

Answer 37

The patient will usually experience a withdrawal bleed

Question 38

How sticky is the contraceptive patch?

Answer 38

Extremely lol

Question 39

Can the contraceptive patch be worn whilst bathing or swimming?

Answer 39

Yes

Question 40

What is the brand name for the contraceptive vaginal ring?

Answer 40

NuvaRing

Question 41

What is the contraceptive vaginal ring?

Answer 41

A plastic ring that is inserted into the vagina and provides hormones

Question 42

How long is does the contraceptive vaginal ring sit in the vagina once inserted?

Answer 42

21 days

Question 43

When might women feel discomfort with the contraceptive vaginal ring?

Answer 43

Some women feel uncomfortable inserting or removing the ring

Question 44

What are the advantages of combined hormonal contraception?

Answer 44

- Non-invasive - More effective than barrier methods if taken correctly - Sex doesn't need to be interrupted to use contraception - Menses tend to become regular, lighter, and less painful - Reduced risk of certain medical conditions - Normal fertility returns immediately after stopping use

Question 45

What medical conditions does combined hormonal contraception reduce the risk of?

Answer 45

- Cancer of the ovary, uterus, and colon | - Functional ovarian cysts

Question 46

What is an additional clinical use of combined hormonal contraception?

Answer 46

Can allow for timing over menses

Question 47

What are the disadvantages of combined hormonal contraception?

Answer 47

- User dependant - Some temporary adverse effects may be experienced by some women - Women may experience breakthrough bleeding and spotting for first few months - Increased risk of VTE - Small increase in risk of MI and strokes - Small increase in risk of breast cancer

Question 48

What temporary adverse effects may be experienced with combined hormonal contraception?

Answer 48

- Headaches - Breast tenderness - Mood changes

Question 49

What are the contraindications to combined hormonal contraception?

Answer 49

- BMI over 35 - Breastfeeding - Smoking over the age of 35 - Hypertension - History or family history of VTE - Prolonged immobility due to surgery or disability - Diabetes mellitus with complications, e.g. retinopathy - History of migraines with aura - Breast cancer or primary liver tumours