Chapter 19: Contraception Flashcards
ou are a trainee intern in a general practice with Nicky, a 22 year old nulliparous Māori cis female who is requesting to start on contraception. Nicky has considered the options and prefers an oral method rather than long acting reversible contraception (LARC). Nicky has no contraindications to the combined oral contraceptive pill (COC). From the following options, what type of oral contraceptive will most likely be prescribed?
Levlen ED (contains 30mcg oestrogen and a progestogen)
Ginet-84 (contains 35mcg oestrogen and cyproterone acetate)
Mercilon 28 (contains 20mcg oestrogen and a third generation progestogen)
Cerazette (contains the progestogen Desogestrel)
Microgynon 50 (contains 50mcg oestrogen and a progestogen)
Feedback
Levlen
You are a trainee intern in a general practice with Sam, a 26-year-old European person who would like to have a copper IUC (intrauterine contraception) inserted. Sam’s periods are light with a cycle of 4/28, and last menstrual period was just 5 days ago. Cervical and STI screening are up to date. Which one of the following would be an absolute contraindication to having a copper IUD inserted today?
Previous ectopic pregnancy
Nulliparity
Past history of high grade squamous Intraepithelial lesion (HSIL)
Carbamazepine to control epilepsy
Past history of treatment for uncomplicated genital chlamydia
Breastfeeding
Previous treatment for pelvic inflammatory disease (PID)
Multiple sexual partners
Recent untreated known genital chlamydia
Recent untreated known genital chlamydia
You are a trainee intern in general practice with Marama, a 20 year old G0P0 Pākehā cis female. Marama has been using the combined oral contraceptive (COC) pill Norimin 28 for the past six months and takes hormone pills continuously to avoid having a bleed. However, Marama went away for the weekend and forgot her pill packet, missing the 5th and 6th hormone pills in the packet. From the following options, what is the most important appropriate advice in regards to Marama’s contraception?
Use condoms or avoid sex until after the next withdrawal bleed (period)
Use condoms or avoid sex until you have taken the next 7 hormone pills.
Stop the pill for a further 5 days and then start a new pack
You are contraceptively safe and there is no need for extra precautions
Use condoms or avoid sex until you have taken the next 5 hormone pills
Take the active pills every day for at least the next 10 days
You need to start a new pack today, and take for three weeks
You are contraceptively safe and there is no need for extra precautions
You are a trainee intern in general practice with Sarah, a 20 year old Filipino cis female. Sarah has been taking the combined oral contraceptive pill (COC) Norimin 28 for the last 6 months and prefers to take the 7 days of inactive (sugar) pills each month to have a withdrawal bleed. Sarah is in the 3rd week of active (hormone) pills and realised that she has forgotten to take the 17th, 18th and 19th hormone pills in the packet. From the following options, what is the most important advice to Sarah in order for her to be contraceptively safe?
Complete the active pills, have a withdrawal bleed and then start a new pack. No extra precautions required
Take an active pill every day for the next 7 days - use condoms or avoid sex until then
Stop the hormone pills now and go straight to the inactive pills
Use barrier contraception until after the next withdrawal bleed (period)
You need to start a new pack today, and take for three weeks/21 days
You need to finish the hormone pills of this pack, and then go straight to the hormone pills of the next packet without having a withdrawal bleed. No extra precautions required
Take an active pill every day for the next 10 days - use condoms or abstain until then
You need to finish the hormone pills of this pack, and then go straight to the hormone pills of the next packet without having a withdrawal bleed. No extra precautions required
You are a trainee intern at a GP practice with Alex, a 22 year old European who had a progestogen implant (Jadelle) inserted 6 months ago but is wanting it removed because of problems with frequent almost continuous light bleeding. Alex had a normal STI check, and negative pregnancy test 2 weeks ago. Examination of the cervix was unremarkable. From the following options, what is the most likely step in managing her contraception and bleeding?
Discuss using the combined oral contraceptive pill (COC) to control the bleeding if Alex has no contraindications to the COC
Remind Alex that such bleeding is a common side-effect and may or may not settle in the next few months
Send Alex for an ultrasound scan and refer to gynaecology outpatients
Do another STI check
Arrange to remove the implant today and provide condoms for ongoing contraception
Discuss using the combined oral contraceptive pill (COC) to control the bleeding if Alex has no contraindications to the COC
You are a trainee intern in general practice with Kora, a 28 year old para 3 Māori woman who is starting on Depo Provera today for contraception. Kora asks you when the next injection should be given. From the following options, what do you advise?
4 weeks
1 year
12 weeks
13 weeks
6 months
24 weeks
Feedback
13 weeks
You are a trainee intern in general practice with Aarushi, a 28 year old Asian cis female who had a TT380 Standard copper IUC inserted at a 6 week postnatal check. The procedure was uncomplicated. Aarushi asks, “If all goes well, how long is the IUD effective for before it needs to be changed or taken out?” From the following options what is your recommended advice?
1 year
10 years
At least 5 years
3 years
2 years
4 years
10 years
You are a trainee intern in a general practice with Chun, an 18 year old Asian cis female student who presents wishing to start the combined oral contraceptive pill (COC). She has some discomfort with her periods sometimes requiring analgesia – and she usually has a regular 28-30 day cycle. Her LMP was 5 weeks ago. She has no personal or family medical history of note. Of the following options, which assessment/investigation is the most important before you consider starting a second generation combined oral contraceptive pill?
Ultrasound scan pelvis
Urine HCG
Thrombophilia profile
Blood pressure measurement
Cervical smear
Urine HCG
You are a trainee intern at a Family Planning clinic with Alyssa, a 19 year old G1P0 Pākehā cis female who is booked for a contraceptive options appointment. Alyssa had an uncomplicated early medical abortion (EMA) 2 weeks ago and is wanting reliable contraception. She has previously had regular painless periods. She smokes 20 cigarettes per day and describes migraines preceded by visual aura for which she occasionally requires injections. Alyssa’s father had a MI aged 42yrs. Her BP is 140/90. From the following options, which method of contraception is absolutely contraindicated?
Copper IUD
Condoms
Progestogen implant
Levonorgestrel releasing IUD (Mirena)
Combined oral contraceptive pill
Combined oral contraceptive pill
You are a trainee intern at a general practice with Jem, a 16 year old NZ European cis female who would like contraception that “I can forget about for ages and that will help with my periods.” Jem has always had heavy periods and has been referred to a gynaecologist in the past. The combined oral contraceptive pill worked well but Jem does forget to take it. From the following options, what would be the method of contraception that best meets Jem’s needs?
Combined oral contraceptive pill (COC)
Copper IUD
Progestogen implant (Jadelle)
Progestogen only pill (POP)
Levonorgestrel releasing intrauterine device (Mirena)
Injectable progesterone (Depo Provera)
Levonorgestrel releasing intrauterine device (Mirena)
You are a trainee intern in a general practice seeing Amara, a 36 year old cis female of Asian descent. Amara has started a new relationship and would like to go back on the combined oral contraceptive pill that she used before having her children, the younger of whom is now aged 8 years. Which one of the following findings would be the biggest contraindication to prescribing Amara a combined oral contraceptive pill?
Smokes 10 cigarettes per day
Her mother had breast cancer diagnosed when 55 years old
Mild elevation blood lipids
BMI 32 kg/m2
Well-controlled non-insulin dependent diabetes without vascular disease
Smokes 10 cigarettes per day
You are a trainee intern in a general practice with Mio, 20 year old NZ European person who presents reporting two episodes of bilateral frontal headaches. The problem has only occurred since they started the COC, Levlen ED, three months ago. The headaches come on just after Mio starts the inactive pills and before the withdrawal bleed starts. The headaches are not associated with nausea and no focal symptoms. The headaches did not interfere with activities of daily living life or require analgesia. Apart from the headaches Mio is happy to take the COC. From the following options, what is the appropriate advice
Increase the oestrogen content in the COC pill
The COC is contraindicated and advise changing to the POP
Take the COC continuously, skipping the sugar pills in the pack
Avoid hormonal contraception and suggest an IUC is inserted
Use NSAIDs on days 1-3 of the sugar pills to manage the headaches
Avoid hormonal contraception and use condoms
Take the COC continuously, skipping the sugar pills in the pack
You are a trainee intern in a general practice. You have been asked to see Jamie, a 16 year old Māori cis female who had a progestogen implant (Jadelle) inserted one year ago. Jamie getting few side-effects the implant and finds it a good form of contraception. She recently started on sodium valproate and fluoxetine and is wondering if these new medications will affect her contraception? From the following options, what is the best advice?
Both fluoxetine and sodium valproate interfere with the contraceptive efficacy of the implant
Sodium valproate interferes with the efficacy of the implant and it should be removed and Depo Provera commenced
Advise her as long as she is not getting break through bleeding she is contraceptively covered
Fluoxetine interferes with the efficacy of the implant so it should be removed and the COCP commenced
Neither drug will interfere with the contraceptive efficacy of the implant so she can continue as normal
Feedback
Neither drug will interfere with the contraceptive efficacy of the implant so she can continue as normal
You are a trainee intern in a general practice. Neve is a 32 year old person who identifies as non-binary. Neve presents requesting emergency contraception as they had unprotected sex the previous evening. Their last period started 8 days ago, and they have a regular 28 day cycle. Neve is not taking any medications and their BMI is 25 (weight 65kg). From the following options, what do you advise?
Conception is unlikely but recommend they have an STI screen today
Provide 1.5mg (one tablet) levonorgestrel (Postinor - 1)
Conception is unlikely but return for a STI screen in 2 weeks’ time
Provide 3mg (two tablets) levonorgestrel (Postinor-1) and a pregnancy test to do in 3 weeks’ time
Offer to insert a post-coital IUC (copper IUC))
Provide 1.5mg (one tablet) levonorgestrel (Postinor - 1) now and 1 tablet in 12 hrs time.
Offer to insert a post-coital IUC (copper IUC))
You are a trainee intern in a general practice. You have been asked to see Lisa, an 18 year old cis female originally from Australia. She is requesting long acting reversible contraception (LARC). Lisa takes carbamazepine 600mg bd for epilepsy having developed this at age 13 years - her last seizure was 6 months ago. She also has a history of heavy and painful periods with iron deficiency anaemia. From the following options, what do you advise as the most effective and appropriate contraceptive for her?
The levonorgestrel IUS (Mirena)
The 30mcg combined oral contraceptive pill
The copper IUC
The progestogen only implant (Jadelle)
The 50mcg combined oral contraceptive pill
Depo Provera
Condoms and lube with good education around how to use
The levonorgestrel IUS (Mirena)
