Contraception

Question 1

UKMEC 4 to IUD?

Answer 1

PID or signs and symptoms of chlamydia or gonorrhoea

Question 2

UKMEC 3 to IUD?

Answer 2

Distorted uterine cavity, unexplained vaginal bleeding, post partum 48 hrs to 4 weeks, current or past breast cancer, cirrhosis of the liver, liver tumours, HIV

Question 3

UKMEC 4 to COCP?

Answer 3

Migraine with aura, current breast cancer, history of VTE/known thrombophilia, complicated valvular heart disease, cardiac arrhythmia, IHD, cerebrovascular disease, > 35 yrs of age, smoker of > 15 cigs per day, HTN > 160/100,liver cirrhosis, liver tumours, post partum up to 3 weeks, with additional VTE risks, breastfeeding and up to six weeks post partum

Question 4

UKMEC 3 to COCP?

Answer 4

First degree relative aged < 45 yrs who has had VTE, strong CV risks (e.g. diabetes with renal complications), BMI > 35, past breast cancer, acute viral hepatitis, postpartum, not breastfeeding: 0-3 weeks without additional VTE risks or 0-6 weeks with additional VTE risks

Question 5

When is the implanon effective using the Quickstart method?

Answer 5

7 days (use condoms or abstain until it is effective)

Question 6

When will a pregnancy test need to be conducted using Quickstart with implant

Answer 6

4 weeks

Question 7

Most common cause of irregular vaginal bleeding in young women?

Answer 7

Chlamydia

Question 8

Treatment options for irregular bleeding with implanon?

Answer 8

Wait and see, COCP for 3 months, 5 day course of NSAID, 5 day course of TXA, commence another method and remove the implant once the new method is effective, norethisterone 5mg TDS for 21 days, POP 30mcg BD for 20 days, early replacement of the insert

Question 9

What forms of contraception are suitable immediately post partum?

Answer 9

IUD’s (inserted within 48 hrs of childbirth, or else no before 4 weeks because of the higher risk of expulsion, malposition or perforation, implanon, depot, POP

Question 10

When can COCP be used post partum

Answer 10

From 6 weeks

Question 11

What emergency contraception options are available in Australia?

Answer 11

Levonorgestrel (LNG) containing pill and ulipristal acetate (UPA) and the copper IUD

Question 12

How long can UPA be taken after sexual intercourse?

Answer 12

Up to 5 days

Question 13

How does LNG and UPA work?

Answer 13

Preventing of delaying ovulation (before the LH surge)

Question 14

LNG directions?

Answer 14

1.5mg tab taken ASAP after sex within 72 hrs

Question 15

What dose of LNG should be taken if the woman is taking liver enzyme inducing drugs?

Answer 15

3mg

Question 16

What is the dose of UPA?

Answer 16

30mg PO within 5 days (120hrs) of sex

Question 17

When should contraception start after UPA administration?

Answer 17

5 days. The effectiveness can be reduce by progesterone containing contraceptives

Question 18

Which method of emergency contraception is not safe while breast feeding?

Answer 18

UPA

Question 19

How long can a copper IUD be inserted after sex?

Answer 19

5 days

Question 20

MOA of the copper IUD?

Answer 20

inhibition of fertilisation - the copper ions released from the device have a toxic affection the sperm

Question 21

When should emergency contraception be used when taking the COCP?

Answer 21

When 2 or more pills are missed in the week before and the week after the hormone free interval and unprotected sex occurs during the hormone free interval or week one

Question 22

When should emergency contraception be used when taking the POP?

Answer 22

Late or missed pill (> 3 hrs late) and unprotected sex, or barrier failure has occurred before effectiveness has been re-established (ie 48 hrs after restarting)