contraception

Question 1

assessment

1-Exclude pregnancy.
2-Assess her suitability for the different contraceptive methods
3-Assess her risk of sexually transmitted infections (STIs)
4-Carry out a risk assessment for sexual abuse, rape, and non-consensual sex,
5-Consider other relevant legal and ethical issues

Answer 1

exclude pregnancy

1-first 7 days on her cycle or after miscarriage
2- postpartum
a- first 4 week if not breastfeeding
b-first 6 month if fully breast feeding and a menorrhea
3-sexual intercourse
a- no intercourse since last period
b-A pregnancy test is performed no sooner than 3 weeks since the last episode of unprotected sexual intercourse
(UPSI) and is negative.
4-on a reliable method of contraception correctly and consistently

Unable to exclude pregnancy
1- assess the need for emergency contraception
2- woman is likely to continue to be at risk of pregnancy or has expressed a preference to begin contraception as soon as possible:
start quick starting contraception and advise on effect of early pregnancy

Question 2

assesment for STI

high risk group

1- Young people under 25 years of age.
2- People who frequently change sexual partners.
3- People involved in prostitution.
4- Men who have sex with men.
5- People who have come from, or who have visited, areas of high HIV prevalence and have been sexually active there.

Answer 2

1- Do not initiate the copper intrauterine device (Cu-IUD) or levonorgestrel intrauterine system (LNG-IUS) due to unacceptable health risks (UKMEC 4). However, the device can be left in place if the woman already has one fitted, as the advantages generally outweigh the theoretical or proven risks (UKMEC 2).
A-CURRENT PID
b- current symptomatic chlamydia infection
c-purulent cervicitis or gonorrhoea
d- UKMC3 instead of 4 if a symptomatic chlamydia infection

2-All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).
a- history of PID
b-vaginitis

Question 3

In women with idiopathic menorrhagia
1-line levonorgestrel intrauterine system (LNG-IUS)
2-line COC
3- POP injectable only

In women with unexplained vaginal bleeding:
need to be investigated of course
1- (Cu-IUD) or the LNG-IUS initiate =(UKMEC 4) leave in place (UKMEC 2).
2-The progestogen-only implant and progestogen-only injectable
3-All other hormonal methods of contraception can be used as the benefits generally outweigh the risks (UKMEC 2).

Answer 3

In women with uterine fibroids:

1-If there is no distortion of the uterine cavity:
All hormonal and intrauterine methods (UKMEC 1).
2-If there is a distortion of the uterine cavity:
A-The Cu-IUD and LNG-IUS (UKMEC 3).
B-All other hormonal methods (UKMEC 1).

In women with a history of ectopic pregnancy:
All hormonal and intrauterine methods of contraception can be used without restriction (UKMEC 1).

Question 4

diabetes mellitus?

1-diabetes mellitus and no vascular disease, gestational diabetes
All hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
2- nephropathy, retinopathy, neuropathy, or other vascular disease:
A-Combined hormonal contraception (pill, transdermal patch, or vaginal ring) (UKMEC 3).
B-All other hormonal and intrauterine methods (UKMEC 1 or 2).

headache or migraine?

A-In women with non-migraineurs headaches all acceptable

B- migraine without aura
1-COC (UKMEC 2).
2- if developed while on COC (UKMEC 3).
3- all other acceptable

C-migraine with aura:
1- CHC due to unacceptable health risks (UKMEC 4).
2-All other hormonal and intrauterine methods of contraception can be used (UKMEC 1 or 2).
3-CHC is (UKMEC 3). if headache free for 5 years