Lecture 13- Contraception

Question 1

Definition:

Answer 1

any method to prevent pregnancy

Question 2

Various methods of contraception (3)

Answer 2

• Blocking sperm transport to avoid fertilisation of oocyte
• Disruption of HPG axis- interfere with ovulation
• Inhibit implantation of conceptus into endometrium

Question 3

Categories of contraception

Answer 3

• Natural
• Barrier
• Hormone control
  
  • short or long acting reversible
• Prevention of implantation- IUD/IUS
• Sterilisation
• Emergency contraception

Question 4

Barrier method

Answer 4

• Provides physical +/- chemical barrier to stop sperm entering cervix
  
  • Male/female condoms
  • Diaphragms/cervical caps
  • Spermicides

Question 5

• Barrier method Advantages

Answer 5

• Reliable
• STI protection

Question 6

• Barrier method Disad
  *

Answer 6

• Disrupts intercourse
• Risk of dislodging
• Allergy/ sensitivity to latex

Question 7

Natural methods

Answer 7

• abstincence
• withdrawal
• fertility awaness methods
• lactational amenorrhoea method

Question 8

abstinence advantages vs disad

Answer 8

• Advantage- 100% effective
• Disad
  
  • Not option for most
  • Unprepared if sexually active

Question 9

coitus interruptus means

Answer 9

withdrawal method

Question 11

• Withdrawal- coitus interruptus advantages vs disadvantages

Answer 11

• Advantages
  
  • No device or hormones
• Disad
  
  • Unreliable
  • Pre-ejaculate
  • No STI protection

Question 12

how does​ Fertility awareness methods work

*

Answer 12

• Monitoring and recording fertility indicators throughout menstrual cycle:
  
  • Cervical secretions and changes in cervix
  • Body temp
  • Length of menstrual cycle- calendar method

Question 13

Fertility awareness methods advantages and disadvantages

Answer 13

• Advantages
  
  • No hormones/contraindications
• Disad
  
  • Time consuming
  • Unreliable
  • No STI protection
  • Not suitable for all

Question 14

• Lactational amenorrhoea method
  
  • Breastfeeding after childbirth to avoid pregnancy
  • Delays return of ovulation
  • Can be used effectively for 6 month postnatally
    
    • Exclusive breastfeeding
    • Complete amenorrhea

Question 15

Lactational amenorrhoea method​ advantages and disadvantages

Answer 15

• Advantages
  
  • No hormones/contraindications
• Disad
  
  • Unreliable after 6 months
  • No STI protection
  • Not suitable for all

Question 16

Hormonal control works by

*

Answer 16

• Interrupts HPG axis, prevents Ovulation, may effect endometrial lining
  
  • Short or long acting reversible contraception (LARC)

Question 17

types of hormonal control

Answer 17

• Combined oestrogen and progesterone- COCP, patch, ring
• Progesterone only pill (POP)
• LARC- progesterone depot and implant

Question 18

role of progesterone

Answer 18

at high levels

• enhances negative feedback of oestrogen hence
  
  • pre-ovulation- reduces FSH and LH
  • inhibtis positive feedback fo high oestrogen –> no LH surge –p> No ovulation

at low levels

• does not inhibit LH surge–> can still obvulate
• will thicken cervical mucus

Question 19

COCP

Answer 19

• Pill containing
  
  • Synthetic oestrogen and progesterone

Question 20

how is the COCP (combine oestrogen and progesterone) taken

Answer 20

• Usually taken 21 days with a 7 day break or 21 days + 7 placebo pills

Question 21

main action of COCP

Answer 21

• prevent ovulation – negative feedback of oestrogen and progesterone on LH surge
• Secondary action- reduce endometrial receptivity to implantation
  
  • Thickens cervical mucus

Question 22

advantages of COCP

Answer 22

• Advantages
  
  • Reliable if used correctly 99%
  • Relieve menstrual disorders
  • Decrease risk of ovarian and endometrial cancer
  • Decrease acne severity in some

Question 23

COCP disadvantages

Answer 23

• Disad
  
  • User dependent
  • No STI protection
  • Medication interaction
  • Contraindications
    
    • Raised BMI
    • Migraine and aura
    • Breast cancer
  • Side effects
    
    • Menstrual irregularities
    • Breast tenderness
    • Mood disturbances
  • Increased risk of CV disease, stroke, VTE, breast cancer and cervical cancer

Question 24

POP

Answer 24

progesterone only pill

Question 25

what is POP

Answer 25

low dose progesterone

Question 26

main action of POP

Answer 26

thickens cervical mucous--\> preventing entry of sperm other action: * Reduced cilia activity in fallopian tubes * Ovulation not prevented

Question 27

How is POP taken

Answer 27

daily no break

Question 28

advantages of POP

Answer 28

* Advantages * Reliable if used properly 99% * Can be used if COCP contraindicated

Question 29

* Disad of POP

Answer 29

* No STI protection * Strict timing- user dependent * Menstrual irregularities * Risk of ectopic pregnancy

Question 30

**Progesterone injection**

Answer 30

High dose progesterone- LARC e.g. depo-provera

Question 31

main action of progesterone injection

Answer 31

* Inhibit ovulation, thicken cervical mucus, thin endometrial lining

Question 32

how is the progesterone injection delivered

Answer 32

* Given intramuscularly every 12 weeks

Question 34

* Advantages of progesterone injection

Answer 34

* Reliable * No known medication interactions * Can be used if oestrogen contraindicated and raised BMI

Question 35

* Disadvantages of progesterone injection

Answer 35

* No STI protection * Not rapidly reversible * Menstrual irregularities * Hard to get appointment

Question 36

**Progesterone implant**

Answer 36

* Small subcutaneous tube inserted in the arm * High dose progesterone – LARC

Question 37

* Main action of progesterone implant

Answer 37

Inhibit ovulation, thicken cervical mucus, thins endometrial lining

Question 38

* Advantages of progesterone implant

Answer 38

* Reliable * 3 years lasting * Can be used if oestrogen contraindicated and raised BMI * Fertility returns faster than injection

Question 39

* Disad of progesterone implant

Answer 39

* No STI protection * Menstrual irregularities * Complications with insertion and removal

Question 40

coil works by

Answer 40

inhibiting implantation

Question 41

types of coil

Answer 41

Intrauterine system (IUS) Intrauterine device (IUD)

Question 42

Intrauterine system (IUS)

Answer 42

progesterone releasing coil- local e.g. mirena

Question 43

Intrauterine system (IUS) main action

Answer 43

prevent implantation and reduces endometrial proliferation, thickens cervical mucus ovulation usually continues

Question 44

intrauterine device- IUD

Answer 44

copper containing coil

Question 45

intrauterine device main and secondary actions

Answer 45

main action- copper is toxic to ovum and sperm preventing fertilisation secondary action- cervical mucus changes, endometrial inflammatory reactions inhibits implantation

Question 46

**Advantages of the coil**

Answer 46

* Convenient * 99% effective * LARC- 3-10 years * IUS for treatment of menorrhagia

Question 47

**Disadvantages of the coil**

Answer 47

* No STI protection * Complications with insertion-perforation * Menstrual irregularities * Displacement/expulsion may occur

Question 48

sterilisation men

Answer 48

vasectomy

Question 49

* **Vasectomy**

Answer 49

* Vas deferens snipped or tied to prevent sperm entering ejaculate * Under local anaesthetic * Must do post-vasectomy semen analysis -12 weeks post * Failure rate 1 in 2000 men

Question 50

sterilisation female

Answer 50

tubal ligation

Question 51

Tubal ligation

Answer 51

* Fallopian tube occluded to prevent ovum transport * Under local/ GA * Failure rate 1 in 200- 500 depending on method

Question 52

advantages and disadvantages of sterilisation methods (vasectomy and tubul ligation)

Answer 52

* Advantages- permanent * Disad * No STI protection * Regret * Not easily reversed * No available under NHS

Question 53

emergency contraception used when

Answer 53

following unprotected sexual intercourse (UPSI) or contraceptive failure

Question 54

types of emergency contraception

Answer 54

levonorgestrel ulipristal acetate copper iud

Question 55

Levonorgestrel

Answer 55

morning after pill- high dose progestogen (artificial progesterone) - inhibits ovulation

Question 56

ulipristal acetate

Answer 56

selective progesterone receptor modulator- inhibits/delays ovulation

Question 57

choice of emergency contraception depends on

Answer 57

several factors - time always think STI and safeguarding

Question 58

if UPSI within 72hours

Answer 58

levonorgestrel - maximum effect if taken within the first 12 hours - double dose in obese

Question 59

if UPSI +72h up to 120 hours

Answer 59

ulipristal (effectiveness may be reduced if patient has been taking progestogen) or copper IUD (most effective emergency contraception- can be left in situ for up to 10 years)

Question 60

contraceptive methods that dont depend on you remebering to take or use them

Answer 60

* contraceptive implant * intrauterine device (IUD) * Intrauterine system (IUS) * contraceptive injection * sterilisation

Question 61

contraceptive methods that you have to think about regulalry or use each time you have sex

Answer 61

* condom * diaphragm/ cap with spermicide * external condom * POP * COC Contraceptive patch * contraceptive vaginal ring * fertility awareness method

Question 62

summary of contraceptive methods- look in notes and read through pls and thanks :))))

Answer 62