Contraception

Question 1

Fraser guidelines

Answer 1

under 16s
May provide contraception without parental consent if:
- Understand doctor’s advice
- Cannot be persuaded to inform parents
- Very likely to continue having sex
- Mental + physical health will suffer other wise
- In best interests to provide treatment

Question 2

COC: MOA

Answer 2

• Inhibits ovulation, contains oestrogen + progestogen
• 99% effective but user dependent

Question 3

COC: first line

Answer 3

Monophasic: <30mg ethinylestradiol + levonorgestrel/norhisterone

Question 4

COC: patient factor

Answer 4

• Weight >90kg: NOT topical
• Malabsorption: NOT oral

Question 5

COC: how to take

Answer 5

One pill, same time each day
- Day 5+: condom for 7 days
- 21 day: 7 days pill free
- 28 day: 7 days inactive pill

Question 6

COC: missed pill

Answer 6

• missed pill >24H
• zoely/qlaira >12H
• 1 missed pill: take ASAP and next pill at normal time

-2+ missed pill
- Take ASAP + condom for 7 days
- 9 days if zoely/qlaira
- Missed in last 7 days: omit pill free interval
- Missed in first 7 days + sex: ECH

Question 7

COC: vomiting and diarrhoea

Answer 7

• Vomiting <3H of dose: follow missed pill
• Severe diarrhoea >24H: follow missed pill
• Persistent diarrhoea/vomiting: consider non-oral

Question 8

COC: CI

Answer 8

• Hx of VTE
• Smokers 35+
• Major surgery + immobilized
• CVD (stroke/TIA, angina + MI)
• AF
• Migraine w aura
• Severe hypertension: >160/>100

Question 9

COC: side effect

Answer 9

• Abnormal bleeding, weight gain, acne, headache (common)
• Cervical + breast cancer

Question 10

COC: surgery

Answer 10

Stop 4 weeks before

• For: Major surgery, legs or pelvis surgery that results in prolonged immobility of lower limbs
• Progestogen only contraceptive = alt
• Restart usual contraceptive on first menses at least 2 weeks after full mobilisation
• Thromboprophylaxis in emergency surgery or if COC was not stopped

Question 11

COC: travel

Answer 11

3H
- Counsel: risk of DVT, leg exercises + compression stockings

Question 12

POP: MOA

Answer 12

• Alters cervical mucus to prevent sperm penetration + may inhibit ovulation
• 99% effective, highly user dependent (oral)

Question 13

POP: drugs

Answer 13

POP:
- Desogestrel (cerelle, cerazette)
- Norethisterone (noriday)
- Levonorgestrel (emergency contraception)

Parenteral:
- Medroxyprogesterone (injection)
- Norethisterone (injection)

Intra-uterine device:
- Levonorgestrel

Question 14

POP: how to take

Answer 14

• One pill, same time each day
• Start day 1 of cycle
• Day 5+ (condom for 2 days)

Question 15

POP: side effect

Answer 15

• Menstrual irregularities (common)
• Breast cancer

Question 16

POP: missed pill

Answer 16

• Missed pill >3H
• Desogestrel >12H
• Take ASAP + condom for 2 days
• ECH: unprotected sex before 2 pills taken

Question 17

POP: Vomiting + diarrhoea

Answer 17

• Vomiting <2H: Take ASAP
• No replacement pill, persistent vomiting or severe diarrhoea: condom during + 2 days after illness

Question 18

POP: parenteral

Answer 18

Medroxyprogesterone injection - 12 weeks

• Delay in return to full fertility
• Osteoporosis

Norethisterone injection - 8 weeks

• Delay in return to full fertility

Etonogestrel implant - 3 years

Question 19

Contraceptive device: indication

Answer 19

Long term contraception (copper or levonorgestrel brand)

Question 20

Contraceptive device: side effect

Answer 20

Bleeding, menstrual irregularities, ectopic pregnancy

Uterine perforation
- MHRA: uterine perforation
- Counsel: report severe pelvic pain after insertion, sudden change in periods, pain during sex, pain or inc bleeding for more than few weeks or unable to feel threads

Infection + pelvic inflammatory disease
- Chlamydia screening if high risk (under 25 OR 25+ w multiple partners
- Abx prophylaxis w emergency contraception

Question 21

EC: first line

Answer 21

Copper IUD
- <120H (or <5 days after ovulation)

Question 22

EC: second line (levonorgestrel)

Answer 22

Levonorgestrel 1.5mg
- <72H
- Caution: malabsorption (crohn’s disease)
- Contraception: start asap + use condom until effective

Question 23

EC: second line (ulipristal)

Answer 23

Ulipristal 30mg (more effective )
- <120H
- Overweight: BMI >26/70kg
- CI: severe asthma on oral steroids
- Contraception: wait 5 days + use condom until effective

Question 24

EC: counselling

Answer 24

• Vomiting within 2 hrs - need replacement dose
• Next period may be early/late
• Use barrier methods
• If delayed periods >7 days, lighter + atypical abdominal pain → take pregnancy test

Question 25

Spermicides

Answer 25

• Does not provide enough protection alone
• Unsuitable if high risk of STIs

Question 26

Barrier methods

Answer 26

• Less effective than other contraceptive methods
• Protect against STIs

Question 27

Drug interactions

Answer 27

Enzyme inducers (carbamazepine, pheyntoin, phenobarbital, rifampicin) + COC/POP/CH → red effectiveness
- IUD (copper or levonorgestrel)
- Progestogen only injections
- EC: copper IUD OR 3mg levonorgestrel

MHRA: teratogenic drugs
- Use: IUD or Progestogen only implant