Contraception

Question 1

You see 28 year old Abbe in clinic. She gave birth 8 weeks ago and is not breastfeeding. She is keen to consider contraceptive options.Which of the following is NOT a non-hormonal form of contraception?

1 - Post partum lactational amenorrhoea
2 - Copper IUD (<48 hours or > 4 weeks postpartum)
3 - Condoms
4 - Sterilisation (male/female)
5 - IUS

Answer 1

5 - IUS

This is the Mirena coil and is progesterone only

Question 2

You see 28 year old Abbe in clinic. She gave birth 8 weeks ago and is not breastfeeding. She is keen to consider contraceptive options.Which of the following is NOT a hormonal form of contraception?

1 - Mirena IUS (<48 hours or > 4 weeks postpartum)
2 - Copper IUD (<48 hours or > 4 weeks postpartum)
3 - COCP – only if not breastfeeding
4 - POP
5 - Progesterone only - implant/ injectable

Answer 2

2 - Copper IUD (<48 hours or > 4 weeks postpartum)

Question 3

The IUS (Mirena coil) and IUD (Ccopper coil) can only be prescribed within a specific window post-partum. Which of the following is correct for their insertion?

1 - between 48h and 2 weeks
2 - <48h
3 - after 2 weeks
4 - <48h or >4 weeks

Answer 3

4 - <48h or >4 weeks

Question 4

Rachel comes in to see you; she is a 38 year old woman with heavy menstrual bleeding (HMB). She has a regular cycle and a regular partner and is looking for contraception. Which of the following would be most appropriate for this patient?

1 - Copper intrauterine system (IUS)
2 - Mirena intrauterine device (IUD)
3 - Progesterone implant
4 - Combined oral contraception

Answer 4

2 - Mirena intrauterine device (IUD)

May initially cause light bleeding and spotting, but then can cause amenorrhea

IUD is the GOLD standard for patients who want contraception with heavy bleeding

Question 5

What is the primary mechanism of action of the Mirena intrauterine device (IUS)?

1 - thickens cervical mucus
2 - decreased sperm motility and survival
3 - inhibits ovulation
4 - prevents endometrial proliferation and causes cervical mucous thickening

Answer 5

4 - prevents endometrial proliferation and causes cervical mucous thickening

Question 6

Shazia tells you that she needs contraception as she has just started a new relationship, but she has always struggled with hormonal contraception in the past as it gives her headaches and makes her moody. Which of the following would be most effective for this patient?

1 - Copper intrauterine system (IUS)
2 - Mirena intrauterine device (IUD)
3 - Progesterone implant
4 - Combined oral contraception

Answer 6

1 - Copper intrauterine system (IUS)

Only form of non-hormonal contraception

Question 7

If a patient has the copper intrauterine system (IUS), but then decides she wants it out to start a family, how long will it be before she can get pregnant again?

1 - immediately
2 - 3 days
3 - 7 days
4 - 21 days

Answer 7

1 - immediately

Question 8

What is the primary mechanism of action of the copper intrauterine system (IUS)?

1 - thickens cervical mucus
2 - decreased sperm motility and survival
3 - inhibits ovulation
4 - prevents endometrial proliferation and causes cervical mucous thickening

Answer 8

2 - decreased sperm motility and survival

Question 9

What is the primary mechanism of action of the combined oral contraception?

1 - thickens cervical mucus
2 - decreased sperm motility and survival
3 - inhibits ovulation
4 - prevents endometrial proliferation and causes cervical mucous thickening

Answer 9

3 - inhibits ovulation

Question 10

What is the primary mechanism of action of the Injectable contraceptive (medroxyprogesterone acetate)?

1 - thickens cervical mucus
2 - decreased sperm motility and survival
3 - inhibits ovulation
4 - prevents endometrial proliferation and causes cervical mucous thickening

Answer 10

1 - thickens cervical mucus

Question 11

Which of the following forms of emergency medication is only effective if used within 72 hours?

1 - Ulipristal
2 - Copper intrauterine system (IUS)?
3 - Levonorgestrel

Answer 11

3 - Levonorgestrel

Stops ovulation and inhibit implantation

Question 12

Levonorgestrel is a progesterone only form of emergency contraception that can be used if unprotected sex within 72 hours. Can this be used more than once in a patients menstrual cycle?

Answer 12

• Yes

If patient vomits <3h from taking, they need to take it again

Question 13

Levonorgestrel is a progesterone only form of emergency contraception that can be used if unprotected sex within 72 hours. Following taking Levonorgestrel, how soon can a patient begin taking contraception again?

1 - 21 days
2 - 14 days
3 - 3 days
4 - immediately

Answer 13

4 - immediately

Question 14

Which of the following forms of emergency medication is only effective if used within 5 days?

1 - Ulipristal
2 - Copper intrauterine system (IUS)?
3 - Levonorgestrel

Answer 14

1 - Ulipristal

Progesterone receptor modulator that inhibits ovulation

Question 15

Ulipristal is a progesterone receptor modulator that inhibits ovulation and is a form of emergency contraception that can be used if unprotected sex within 5 days. Following taking Ulipristal, how soon can a patient begin taking contraception again?

1 - 21 days
2 - 14 days
3 - 5 days
4 - immediately

Answer 15

3 - 5 days

Cannot start other contraception for 5 days, so need barrier protection in the meantime

Question 16

Which of the following must occur following the taking of Ulipristal?

1 - delay hormonal contraception for 14 days
2 - do not use more than once in any 1 monthly cycle
3 - delay breastfeeding for 5 days
4 - all of the above

Answer 16

3 - delay breastfeeding for 5 days

Question 17

Can Ulipristal and Levonorgestrel be used more than once during a monthly cycle?

Answer 17

• yes

Question 18

How long from the time of unprotected sex is the copper intrauterine device effective?

1 - 21 days
2 - 14 days
3 - 5 days
4 - immediately

Answer 18

3 - 5 days

Suggested to impact fertilisation and/or implantation

Question 19

CYP450 enzymes inducers increase the clearance of contraceptive hormones making them less effective. All of the following are affected EXCEPT which two?

1 - Combined hormonal contraceptives
2 - Progestogen-only pills (POP)
3 - Mirena intrauterine system
4 - Etonogestrel implant
5 - Ulipristal and Levonorgestrel
6 - Progestogen-only injection

Answer 19

3 - Mirena intrauterine system
6 - Progestogen-only injection

Question 20

Post-partum patients are advised that following delivery, they do NOT need contraception for what time period?

1 - 24h
2 - 7 days
3 - 21 days
4 - 28 days

Answer 20

3 - 21 days