Contraception

Question 1

Managing HRT side effects

Answer 1

Change dose
Change route
Change to different oestrogen/progesterone

For sequential: Drop progesterone period from 14 to 10 days

Question 2

HRT preparations

Answer 2

Sequential combined HRT (for perimenopause)
- Progesterone taken for second 10-14 days of each month

Continuous combined HRT (menopause)

Oestrogen only (if no uterus)

Vaginal oestrogen (for isolated vaginal Sx)

Question 3

Missed pill COCP rules

Answer 3

If 1 pill missed and <48 hours since last pill: Take missed pill and continue with no extra precautions

If 2 or more pills are missed: take missed pill and use condoms for 7 days

If pills missed in week 1 and UPSI in pill-free interval or week 1: Consider emergency contraception

If pills missed in week 2: No need for emergency contraception if pills taken correctly for previous 7 days (still use condoms for 7 days)

If pills missed in week 3: Take missed pills (up to 2 in one day), finish pack as normal, omit pill-free interval and start another

Question 4

Contraindications to COCP

Answer 4

Migraine with aura
>35 + smoking >15 per day
HTN >160/110
VTE Hx
IHD/Stroke Hx
Current Breast cancer

Question 5

Missed pill definition

Answer 5

Not taken pill and >24h after the time that you should have taken it

Question 6

Indications to stop HRT

Answer 6

• Suspicion of DVT/PE
  ○ Sudden severe chest pain
  ○ Sudden breathlessness or haemoptysis
  ○ Unexplained swelling or severe pain in calf
  
  • Severe stomach pain
  • Serious neuro effects including prolonged headache, loss of vision, hearing disturbance, motor disturbances, marked numbness affected one side/part of body
  • Hepatitis, jaundice, hepatomegaly
  • BP >160/95
  • Prolonged immobility after surgery or leg injury
  • Detection of contraindicating RF