Contraception

Question 1

IM Depo Provera important features

Answer 1

Every 3 months
12 months for fertility to return
Irregular bleed, weight gain, transient osteoporosis
Can improve seizures, sickle cell anemia, dysmenorrhea, good for those with malabsorption

Question 2

Implanon important features

Answer 2

Etonorgestrel
Lasts 3 years
Fertility comes back immediately
Causes irregular bleeding and weight gain

Question 3

Mirena important features

Answer 3

Expensive
Lasts 5 years
Amenorrhea - can improve menorrhagia, can improve dysmenorrhea
CI: active PID, undiagnosed vaginal bleed, fibroids, STI
SE: Pain, irregular bleed, ectopic, infection, perf

Question 4

Progesterone only pill important features

Answer 4

Must take everyday at same time within 3 hour window

Lactating postpartum women

Question 5

Postpartum contraception

Answer 5

Breastfeeding 6 months 
Progestogen only methods 
- pill, injectable, implant 
- can start immediately 
- safe for breastfeeding
Barrier method 
IUD 
- insert 48 hours after delivery otherwise delay till 28 days postpartum 
Levonorgestrel safe 
NO COCP

Question 6

What does NuvaRing contain and what’s the risk

Answer 6

Estrogen and progestin

DVT

Question 7

How soon after medical abortion can Copper IUD be inserted

Answer 7

After complete expulsion of POC. If >5 days after, exclude repeat pregnancy

Question 8

When can Mirena be inserted after an abortion in the 2nd trimester

Answer 8

Similar to postpartum. But if inserted within 48 hours it works immediately, otherwise within 7 days

Question 9

What does COCP increase the risk of

Answer 9

Gall bladder dx, VTE, arterial vascular disease, ischemic stroke, MI, cervical cancer

Question 10

Medications that decrease efficacy of COCP

Answer 10

Rifampicin, AED, St. john’s Wart

Question 11

When can you start COCP postpartum

Answer 11

If no menses, anytime after 3-6 weeks

If menses, anytime after 6 weeks

Question 12

Rule for missed pills COCP

Answer 12

If <24 hours late: take missed pill ASAP and continue as usual

If >24 but <96, take most recent pill and continue pills but use additional contraception till 7 active hormone pills taken

Miss more than 4: stopped using COCP

If pill missed in first 7 active days after placebo: consider emergency contraception if unprotected sex in past 5bdays

If missed pills in the last 7 days of active pills before placebo, omit pill-free interval

If sig vomiting/diarrhoea within 2 hours of taking, missed pill

Question 13

Dose of Ella (ulipristal acetate)

Answer 13

30mg, can use till 120 hours after UPSI

Question 14

Dose of Escapelle

Answer 14

1.5mg stat