combined hormonal contraception

Question 1

when choosing a COCP, what symptoms would make you pick a progesterone with lower androgenicity

Answer 1

premenstrual dysphoric disorder
weight gain concerns
acne
heavy menstrual bleeding

Question 2

COCP - absolute contraindications (16)

Answer 2

postpartum

• breastfeeding and <6 weeks postpartum
• 21 days postpartum with VTE risk factors

CVD risk factors

• > 35years, >15cigs / day in past year
• SBP >=160 or DBP>=95
• multiple CVD risk factors (diabetes, htn, obesity, metabolic syndrome)

CVD

• any vascular disease
• current or past ischaemic heart disease
• diabetes with complications, or diabetes and over 35
• complicated valvular heart disease

clotting

• current or past VTE
• known thrombogenic mutations - factor V leiden, prothrombin, protein s c antithrombin deficiencies
• SLE with phospholipid antibodies
• raynaud’s with lupus anticoagulant

gen med

• breast cancer
• migraine with aura
• liver disease

Question 3

combined hormonal contraception - at what altitude and duration of travel would you switch to a different contraceptive

Answer 3

travel >4500m for >1/52

Question 4

management options for breakthrough bleeding on COCP, if you wantt o stay on a CHC (3)

Answer 4

• change to a higher dose oestrogen
• change progestogen
• switch to nuvaring

Question 5

managing breakthrough bleeding on CHC, if you use it continuously

Answer 5

take a 4 day break to allow bleed to happen

go back to continuous dosing