Contraception

Question 1

COC in women 35+?

Answer 1

Low dose monophonic (unless smoker)
Controls hot flushes of perimenopause if continued until ~30y
Cease pill around 51y, wait several weeks and check FSH/oestradiol
if FSH high and oestradiol low, presume menopause

Question 2

Absolute contraindications to COC?

Answer 2

Pregnancy
First 2 weeks post partum
Hx of thromboembolic disease / thrombophilia
Cerebrovascular disease
Focal migraine
Coronary artery disease
Oestrogen dependent tumours
Active liver disease
Polycythemia

Question 3

Relative contraindications to COC?

Answer 3

Heavy smoking
> 35 + smoking / other CV RFx
Undiagnosed abnormal vaginal bleeding
Breastfeeding
4 weeks before surgery, 2 weeks post
GB/liver disease
HTN / DM / hyperlipidemia
Chloasma
Severe depression

Question 4

Circulatory disorders linked with COC use?

Answer 4

Venous: DVT, PE (+rare = mesenteric, hepatic, renal thrombosis)
Arterial: MI, thromboembolic/haemorrhagic stroke (+rare = retinal and mesenteric thrombosis)

Question 5

What causes increased circulatory d/o risk in COCs?

Answer 5

Oestrogen content. Now reduced as doses have been reduced to 20mcg etc

Question 6

Which cancers may be influenced by COC use?

Answer 6

Very low risk: cervix, breast

Protective: endometrial, epithelial ovarian

Question 7

Mx breakthrough bleeding on low dose COC?

Answer 7

Usual to have breakthrough bleeding in first 2 months. If minor, continue. If major, cease and start new pill, usually with 50mcg ethinyloestradiol

Question 8

Advice when starting pill?

Answer 8

Periods often become shorter and lighter
No break is necessary
Drugs that may affect pill: antacids, purgatives, vitamin C, antibiotics, anticonvulsants
D/V may reduce effectiveness: if vomits within 2h taking pill, take another active pill
Return yearly for review

Question 9

Advice re missed pills?

Answer 9

Just keep going: take a pill as soon as possible then resume usual schedule
IF >2x20 or >3x30 EO pills are missed, use condoms / abstinence for 7 days

Question 10

7 day rule for missed or late pill?

Answer 10

take forgotten pill asap, even if you take 2 the next day
if >12h late, increased risk of pregnancy so use another contraceptive method for 7 days
if these 7d run beyond last hormone pill in pack, miss the inactive pills and start next pack
you may miss a period (at least 7 hormone tablets should be taken)

Question 11

What is the mini pill?

Answer 11

Progestogen only pill e.g. levonorgestrel 30mcg/day

Question 12

Side effects mini pill?

Answer 12

No serious AEx. Compliance a problem due to cycle irregularity, irregular bleeding.
Often decreases cycle length

Question 13

Indications for POP (progestin-only pill)?

Answer 13

> 45y
smokers 45y+
CIx to or intolerance of oestrogen (migraines, DM, chloasma, lactation, HTN)

Question 14

What is the injectable contraceptive?

Answer 14

Depo-provera. Only IM contraceptive in Aus.

150mg injection every 12 weeks

Question 15

What is the implanon?

Answer 15

Subdermal contraceptive implant containing etonogestrel (progestogen). Inhibits ovulation and has anti mucous effect.
3y system

Question 16

Absolute IUD contraindications?

Answer 16

Known or suspected pregnancy
Active PID
Undiagnosed genital tract bleeding
Previous ectopic
Severe uterine cavity distortion

Question 16

Problems with IUD?

Answer 16

Pregnancy / ectopic pregnancy
PID
Extrusion, perfortaion or uterus, translocation
Bleeding
Pain

Question 17

A patient presents today for a follow-up visit to receive her third Depo-Provera injection. The APN notes that she is 16 days late in receiving her scheduled Depo-Provera injection. Which statement by the APN is most appropriate?
A. “You can receive your injection today without any problem.”
B. “You do not need to use alternative contraception protection right now.”
C. “You will need a repeat pregnancy test before restarting injections.”
D. “You will need to return for your injection in 4 weeks.”

Answer 17

C. The injectable form requires administration every 12 weeks. If a woman is outside the 2-week window to receive the Depo-Provera injection, she must repeat a pregnancy test with a negative result.