COCP

Question 1

COCP UKMEC 3 (disadvantages outweigh advantages)

Answer 1

> 35 years, smoking <15 cig daily
BMI >35
FHx Thromboembolism <45 years
Controlled HTN
Immobility i.e. wheelchair
BRCA1/2 breast ca carrier gene
CURRENT GALLBLADDER DISEASE (oestrogen alters bile acid composition increasing chances gallstone formation)

Question 2

UKMEC 4 COCP (unacceptable)

Answer 2

> 35 years, smoking >15 cigs daily
MIGRAINE WITH AURA
Hx thromboem/VTE
Hx stroke/ IHD
BREASTFEEDING <6 WEEKS POST PARTUM
Uncontrolled HTN
Current breast Ca
Major surgery with prolonged immobilisation
Antiphospholipid antibody- SLE

***DM diagnosed greater than 20 years UKMEC 3 or 4 DEPENDING ON SEVERITY

Question 3

COCP increases which cancers

Answer 3

Increases risk of breast and cervical cancers (BC)

Question 4

COCP reduces risk of which cancers

Answer 4

Protective against endometrial and ovarian cancers, reduces risk of colorectal cancer

Question 5

Which contraception is also used for menorrhagia

Answer 5

IUS- Levonorgesterel uterine system- IUS, Mirena

Question 6

IUD

Answer 6

1. Decreases mobility of sperm CAN BE RELIED UPON IMMEDIATELY AS CONTRACEPTION
   Flaws- makes periods heavier, longer and more painful, uterine perforation (higher in breast feeding women), expulsion

Question 7

Post partum contraception

Answer 7

• required after 21 days
  -POP can be started any time PP- after 21 days additional contraception required during first 2 days

Question 8

COCP Post partum

Answer 8

ABSOLUTELY CI if breastfeeding <6 weeks PP - increases VTE risk
After 21 days additional contractraception should be used for 7 days

*IUD can be inserted 48hrs after birth or 4 weeks
Lactation amenorrhoea method is 98% effective if woman fully breastfeeding (no supplements)

Question 9

When does a cyclical regimen have to be used for HRT?

Answer 9

When the patients period is less than 12 months
*TRANSDERMAL is recommended by NICE over ORAL if they have CVS & VTE RF (i.e. obese)

Question 10

If uterus is intact, which kind of HRT is required?

Answer 10

Combined regimen (oestrogen and progesterone)
(Oestrogen only given to women without a uterus as can increase risk of endometrial cancer)

Question 11

How will you Rx cyclical regimen for HRT?

Answer 11

If periods regular- monthly HRT- take oestrogen everyday and then progesterone alongside it in last 14 days of menstrual cycle.
If periods irregular- oestrogen everyday then progesterone alongside it for 14 days every 3 months

Question 12

When do you use continuous combined HRT

Answer 12

When woman is postmenopausal- hasn’t had period for 1 year. Continuous combined involves taking oestrogen and progesterone without a break every day. Oestrogen only HRT (for hysterectomy women) usually taken every single day without a break too

Question 13

Lifestyle modification for menopause

Answer 13

1. Hot flushes- weight loss, regular exercise, reduce stress
2. Sleep disturbance- avoid late evening exercise, maintain good sleep hygiene
3. Mood- Sleep, regular exercise and relaxation

Question 14

HRT Contraindications?

Answer 14

Current/past breast cancer
Any oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

Question 15

Management with non HRT

Answer 15

Vasomotor Sx- Fluoxetine, Citalopram or venlafaxine
Vaginal dryness- Lubricant/ moisturiser
Psychological- CBT, self help groups, antidepressants

Question 16

Counselling on HRT

Answer 16

Advise menopausal Sx can last between 2-5 years
Slight increase risk: VTE- with all oral forms (no increased risk with transdermal)
Stroke- slight increase risk with oral oestrogen
Coronary heart disease- with combined HRT slight increase risk
Breast & ovarian cancer- slight increased risk with combined HRT

Question 17

Depo Provera injectable

Answer 17

May decrease bone mineral density in women (given IM every 3 months)
May be potential delay of returning fertility by 12 months (MOA: inhibits ovulation)
SE: weight gain, irregular bleeding

Question 18

‘Progesterone effects’

Answer 18

Headaches, nausea, breast pain

Question 19

Vaginal dryness menopausal women

Answer 19

Can use oestrogen vaginal lubricant in addition to HRT
REVIEW AFTER 3 months

Question 20

Missed COCP

Answer 20

if 1 pill is missed, take the last pill ASAP but no further action is needed

If 2+ missed:
1) take asap even if its means taking 2 pills in one day- then continue as normal one a day

❗️should use condoms or abstain from sex until she has taken pills for SEVEN DAYS IN A ROW❗️

DEPENDS WHEN ON CYCLE MISSED 2 PILLS

❗️Week 1 (Day 1-7)- emergency contraception if had UPSI or in pill free period

❗️Week 2- after 7 consecutive days of taking COCP NO need for emergency contraception

❗️Week 3- finish the pills in the current pack and then start the next pack straight away thus missing the pill free period out

Question 21

Missed COCP summarised

Answer 21

Missed 2+

Week1/ pill free interval- take straight away even of its 2 in a day and emergency contraception

Week2- after 7 consecutive days of taking pill no emergency contraception needed

Week3- finish current pack and start next one straight away

Question 22

Twin pregnancy

Answer 22

G1 (Numb of times pregnant) P2 (2 people)

Question 23

Dose of first time users of COCP

Answer 23

Oestrogen of 30mcg

(a pill containing 30 mcg ethinyloestradiol with levonorgestrel/norethisterone (e.g. Microgynon 30 - ethinylestradiol 30 mcg with levonorgestrel 150 mcg)