Contraception - tutorial

Question 1

What contraception is recommended to make periods lighter?

Answer 1

NICE CKS:
1. LNG-IUS (Mirena 5yrs, can have smaller 3yr option if difficult to fit)
2. COCP
3. POP/depot

Question 2

Contraception that can make periods heavier

Answer 2

• Copper IUD
• POP/depot - unpredictable reaction so can make heavier or lighter
• Emergency contraception

Question 3

Contraceptions to caution in migraine

Answer 3

• Any combined hormonal contraception
  Cannot have if:
• > 35 with any migraines
• Any age with migraines with aura
• Migraine attacks start while on pill

Question 4

Long acting contraception options and -ves

Answer 4

• Implant - can cause irregular bleeding, works for 3 years, can get hormonal side effects (eg acne, weight gain)
• IUS - fitting pain, irregular bleeding, can come out - up to 6yrs
• IUD - fitting pain, heavier periods, can come out but 10 yrs lasting usually
• Depot - injection, need every 12 weeks, takes months for fertility to return, direct cause of weight gain (only one found to be direct cause) but do usually stop periods after 6/12, risk of osteoporosis?

Question 5

What to refer to for contraindications for contraception?

Answer 5

• UK MEC criteria
• Grade 1-4
• Grade 1 and 2 can use
• Grade 3 and 4 risk outweight benefits = avoid

Question 6

What should patients know about vasectomy?

Answer 6

• Need to use contraception for up tp 12 weeks after procedure - residual motile sperm in vas
• Local anaesthetic, awake, no pain
• Small risk infection
• Permanent - reversal is non NHS and does not always work
• No effect on sex drive/enjoyment of sex, can still get erections and ejaculate
• 2x semen samples taken after procedure to check success and for residual sperm
• No STI protection - may need barrier

Question 7

Reversal rate vasectomy vs hysterectomy

Answer 7

• All NON NHS
• 75% males if within 3 yrs though, decreases after this (55% within 10, 25% after this)
• Between 50-80% for women, largely depends on age

Question 8

Failure rate female vs male sterilisation

Answer 8

• Male - 1 in 2000
• Female - 1 in 200

Question 9

Emergency contraception options

Answer 9

• Levonelle (levonorgestrel) - if within 3 days of UPSI
• EllaOne (ulipristal acetate) - if within 5 days of UPSI

BUT need to have not ovulated
If ovulated:
* Copper IUD within 5 days of UPSI

Question 10

EllaOne vs Levonelle

Answer 10

• If used within 24hrs, EllaOne is found to be 2.5x more effective than Levonelle
• BUT is much more expensive so Levonelle recommended if within timeframe and not ovulated

Question 11

Starting COCP post emergency contraception

Answer 11

If used levonelle:
* Can start straight away at same time, wait 7 days until reliable
If used EllaOne:
* wait 5 days to commence - has been shown to reduce effectiveness of EllaOne

Question 12

Migraine with aura symptoms

Answer 12

• Blind spots - simple geometric shapes outline
• Zig-zag lines in vision
• Shimmering spots/stars
• Numbness or tingling in part of body
• Muscle weakness
• Dizzy/off balance
• Changes to speech