3a- contraceptives and HRT

Question 1

what contraceptives increase the risk of breast cancer?

Answer 1

anything hormonal

Question 2

if a patient is concerned about breast cancer/ has a significant family history, what contraceptive choice is safest?

Answer 2

copper coil/ barrier methods

Question 3

which contraceptive choice increases the risk of cervical or endometrial cancer?

Answer 3

intrauterine system (IUS- Mirena coil)

Question 4

what contraceptive is contraindicated if the patient has Wilsons?

Answer 4

copper coil

Question 5

what risk factors, if present, can contraindicate the COCP?

Answer 5

• HTN
• migraine w/aura
• VTE
• age >35 AND smoking >15 a day (together, not as separate risks)
• major surgery
• vascular disease/stroke
• IHD, CM, AF
• liver cirrhosis
• SLE

Question 6

Up to what age can the COCP be used?

Answer 6

50

Question 7

what contraceptive must be stopped before the age of 50 and why?

Answer 7

progesterone injection (Depo-Provera)= risk of osteoporosis

Question 8

contraceptive options after giving birth

Answer 8

• fertility is low for 21 days after birth anyway
• lactational amenorrhoea (physiological)
• progesterone-only pill and implant (can be started anytime)
• copper coil/ IUS fine
• MUST NOT USE COCP IF BREASTFEEDING

Question 9

what is the action of the COCP?

Answer 9

• prevents ovulation
• progesterone thickens cervical mucus
• progesterone inhibits proliferation of endometrium (decreases chance of successful implantation)
• suppression of GnRH, FSH, LH

Question 10

side effects of COCP

Answer 10

• abnormal bleeding for 3 months
• breast pain/ tenderness
• mood changes
• headaches
• HTN
• VTE
• increased risk of breast and cervical cancer (returns to normal after 10 years of stopping pill)
• increased MI and stroke risk

Question 11

benefits of the COCP

Answer 11

• contraception
• fertility returns quickly once stopped
• improves premenstrual sx, menorrhagia and dysmennorhoea
• reduced risk of endometrial, ovarian and colon cancer

Question 12

what is the only UKMEC4 criteria for the progesterone only-pill?

Answer 12

active breast cancer

Question 13

after how many hours is the :

• COCP
• POP

considered late?

Answer 13

COCP= 24

POP=3

Question 14

how does the progesterone only pill work?

Answer 14

thickens cervical mucus

reduces ciliary action of fallopian tubes

makes endometrium less acceptable for implantation

Question 15

for the COCP and the POP, when is contraception provided if the pill is started:

• on day 1-5 of menstrual cycle
• after day 5

Answer 15

COCP

• days 1-5= immediately
• after day 5= 7 days

POP:

• days 1-5= immediately
• after day 5= 48 hours

(so inbetween, barrier contraception is required)

Question 16

possible SE’s of the POP

Answer 16

• abnormal bleeding (amenorrhoea etc)
• breast tenderness
• acne
• headaches

Question 17

how often is the Depo injection given and what type of contraceptive is it?

Answer 17

12-13 weeks, IM/SC

progesterone only

Question 18

give some contraindications for the progesterone-only injection

Answer 18

active breast cancer
IHD/stroke
unexplained vaginal bleed
severe liver cirrhosis/cancer

Question 19

what is the action of the progesterone injection

Answer 19

• inhibits ovulation (inhibits FSH)

- thickens cervical mucus

Question 20

side effects of the progesterone injection

Answer 20

• osteoporosis
• WG
• acne
• reduced libido
• headaches
• flushes
• alopecia

Question 21

where is the progesterone-only implant injected and how long does it last?

Answer 21

upper arm

3 years

Question 22

what is the only UKMEC4 criteria for the progesterone only-implant?

Answer 22

active breast cancer

Question 23

mechanism of action of the progesterone-only implant

Answer 23

Inhibiting ovulation
Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation

Question 24

what are the 2 types of coil used?

Answer 24

• copper coil (IUD)

- levonogestrel intrauterine system (IUS)

Question 25

Contraindications for IUD/IUS

Answer 25

- PID - immunosuppression - pregnancy - unexplained bleeding - pelvic cancer - fibroids

Question 26

what should be done before inserting the coil?

Answer 26

STI screen | bimanual examination

Question 27

how long does the copper coil (IUD) last for?

Answer 27

5-10 years

Question 28

mechanism of action of the copper coil

Answer 28

Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation

Question 29

benefits of using the copper coil

Answer 29

no hormones- so a lot safer in terms of cancer/ vascular risk can be inserted at anytime during menstrual cycle and is effective immediately

Question 30

most common levonorgestrel coil seen

Answer 30

Mirena IUS

Question 31

other than contraception, what else can the Mirena IUS be used for?

Answer 31

menorrhagia HRT

Question 32

Why can be Mirena coil be used for HRT?

Answer 32

contains levonorgestrel (progestogen)

Question 33

what are the 3 options for emergency contraception?

Answer 33

- levonorgestrel (within 72h) - ulipristal (also known as EllaOne)- (120 hours) - copper coil (within 5 days)

Question 34

suitable contraceptives for a trasngender male (assigned female at birth) who currently has a vagina (i.e. undergoing transition)

Answer 34

barrier copper coil (non-hormonal) progesterone only options (as oestrogen can interact w/ testosterone)

Question 35

Indications for HRT

Answer 35

- prematrue ovarian insufficiency - reducing vasomotor sx - imrpvoing sx- low mood, decreased libido - reduce osteoporosis risk in under 60's

Question 36

risks of HRT

Answer 36

- increased risk of breast cancer w/ combined HRT - increased risk of endometrial cancer - increased risk of venous thromboembolism - stroke and CAD

Question 37

when is there no risk of endometrial cancer in HRT?

Answer 37

if the woman has no uterus

Question 38

describe the 3 steps to deciding HRT

Answer 38

STEP 1: - local sx only= topical oestrogen cream - if systemic sx, go to step 2 STEP 2: does the woman have a uterus? - NO= use continuous oestrogen-only HRT - YES= combined HRT and go to step 3 STEP 3: have they had a period in the last 12 months? - YES (so perimenopausal)- give cyclical combined HRT - NO- so postmenopausal- give continuous combined HRT

Question 39

In HRT, what is the safest way to deliver oestrogen?

Answer 39

patches- reduced risk of venous thrombo-embolism

Question 40

in HRT, what is the best way of administering progesterone?

Answer 40

Mirena coil

Question 41

since HRT does not act as contraception, in perimenopausal woman what can be used as contraception?

Answer 41

mirena coil, progesterone-only pill (in addition to HRT)