7. What are the common side effects of progestogen?
PMT symptoms, depression. Breast discomfort, weight gain, reduced libido, acne. Spotting.
8. What are the common side effects of oestrogen?
nausea, headaches, weight gain. Breast tenderness, spotting. Rarely hypertension.
9. If you are giving the pill, in which 2 situations might it have reduced efficacy?
reduced absorption (antibiotics, diarrhoea and vomiting, other drugs), missed pill.
10. What are the rules for a missed pill?
If missed by < 12 hours, take it and carry on as usual. If over 12 hours, take the missed pill and then take pills for at least 7 days (even if you were meant to have a break). Use a barrier method for this time.
11. What are the rules for a pill and surgery?
Stop pill 4 weeks before surgery and use alternative contraception.
12. How long does the pill take to work?
13. What 4 main pieces of information do you need to give to someone starting the pill?
Major complications (advise to stop smoking), see doctor if major complications, situations of reduced efficacy, follow up
14. What are the major complications of the pill?
Venous thrombosis (6 x increase to 30 / 100,000) and myocardial infarction. This is increased with smoking and increased age. Slightly increased risk of focal migrain, hypertension, stroke.
15. What are the commonest side effects of the pill?
weight gain, nausea, headaches, breast tenderness. Breakthrough bleeding for 3 months.
16. What are the absolute contraindications for the pill?
previous DVT, CVA or IHD. Migraine (severe or focal), ovarian or endometrial cancer. Clotting defects, pregnancy, smoking (if over 35), liver disease.
17. What are the main drawbacks of hte progesterone only pill (the mini-pill)?
Needs to be taken meticulously at the same time, and higher failure rate (PEARL = 1) as only stops ovulation in 40%.
18. What are the benefits of the mini-pill?
Can be used where the pill is contraindicated e.g. Lactating mothers. No increased risk of thrombosis. Best for older women.
19. What do you need to counsel with the mini-pill?
Bleeding (breakthrough bleeding, with PMS symptoms), emphasise meticulous timekeeping.
20. What is the main contraceptive action of the mini-pill?
Makes cervical mucus hostile to sperm.
21. What is contained in the depot injection?
22. What are the advantages of a depot injection?
Only taken every 3 months. PEARL < 0.1.
23. What are the drawbacks of a depot injection?
Prolonged amenorrhoea after cessation. Osteoporosis. Spotting. PMS symptoms.
24. What is contained in the implant?
25. What are the benefits of the implant?
PEARL < 0.1. Last 3 - 5 years. Can be removed at any point, with rapid resumption of fertility.
26. What are the drawbacks of an implant?
Spotting in the first year.
27. What methods of emergency contraception exist?
morning after pill (72 hours after) has a reduction in pregnancy of 75%. 100 mg of combined contraceptive pill. Mifepristone. IUD (up to 5 days after). Vomiting and menstrual disturbance in the following cycle can occur.
28. What are the advantages of a IUD?
Fewer side effects than progesterone. PEARL is < 0.5. Lasts 5 - 10 years.
29. What are the complications of the coil?
pain, cervical shock, expulsion (in first months), perforation (at insertion), infection, spotting for first 3-6 months
30. What are the absolute contraindications to the coil?
endometrial or cervical cancer / undiagnosed vaginal bleeding, pelvic infection, pregnancy.
31. What counselling points should you discuss with the coil?
major risks, talk to doctor if intermenstrual bleeding, pelvic pain, pregnancy, check for lost strings periodically.