Contraception

Question 1

In a standard 28 day cycle, when is a woman most fertile?

Answer 1

Days 8 to 18

Question 2

3 criteria for using breast feeding as contraception?

Answer 2

• Exclusively breastfeeding
• less than 6/12 post natal
• amenorrhoeic

Question 3

UK MEC1

Answer 3

no restriction for the use of contraception method

Question 4

UK MEC2

Answer 4

Where the advantages of using the method generally outweigh the theoretical or proven risks

Question 5

UK MEC3

Answer 5

A condition where the theoretical or proven risks generally outweigh the advantages

Question 6

UK MEC4

Answer 6

A condition which represents unacceptable risk if the contraceptive method is used

Question 7

If you prescribe contraception, how often do you need to check it?

Answer 7

Annually

Question 8

Give an example of LARC

Answer 8

Depo injection

Question 9

Give 3 examples of VLARC

Answer 9

• implant
• IUD
• IUS

Question 10

How does depo work?

Answer 10

Inhibits ovulation

(also effects:

• cervical mucous
• endometrium)

Question 11

What checks must you do before giving depo?

Answer 11

• check BMI and BP
• check smear status if relevant
• consider risk factors for osteoporosis

Question 12

When can depo be started?

Answer 12

Up to and including day 5 of the cycle without the need for additional contraception

Question 13

What happens if a woman wants to start depo after day 5?

Answer 13

Can start depo after day 5, as long as she is ‘reasonably certain’ she is not pregnant and uses condoms/abstinence for 7 days

Question 14

A woman wants to start depo after having a baby, when can she start it?

Answer 14

Up to 21 days after having baby with immediate cover

Question 15

A woman wants to start depo after a TOP, when can she start it?

Answer 15

Up to day 5 since TOP

Question 16

Side effects of depo?

Answer 16

• weight gain
• delay in return of fertility
• irregular bleeding
• possible risk of osteoporosis!

Question 17

What is depo and how long does it work for?

Answer 17

• injection similar to progesterone

- works for 12 weeks

Question 18

Gold standard IUD

Answer 18

380mm^2 copper

Question 19

IUD primary mode of action

Answer 19

Prevents fertilisation

Inflammatory response in endometrium

Question 20

How long is an IUD licenced for?

Answer 20

5-10 years

Question 21

IUS primary mode of action?

Answer 21

Effect on implantation

also effect on cervical mucous and pre-fertilisation effects

Question 22

Contraindications to IUD/IUS

Answer 22

• Current pelvic infection
• Abnormal uterine anatomy
• Pregnancy!
• Sensitivity to any of the constituents
• Gestational trophoblastic disease when BHCG levels are abnormal
• Endometrial ca
• Cervical ca awaiting treatment

Question 23

What checks must you do before giving IUD/IUS?

Answer 23

PV to check uterine size/position

BP and pulse if condition indicates

Question 24

Can an IUD be used as emergency contraception?

Answer 24

Yes

Question 25

Can an IUS be used as emergency contraception?

Answer 25

No

Question 26

How long is the 52mg LNG-IUS licenced for?

Answer 26

5 years

Question 27

How long is the 13.5mg LNG-IUS licenced for?

Answer 27

3 years

Question 28

How long is the rod licenced for?

Answer 28

3 years

Question 29

How does the rod work?

Answer 29

Inhibits ovulation | -also effect on cervical mucous and endometrium

Question 30

When can an implant be fitted?

Answer 30

Within first 5 days of cycle

Question 31

You want to switch from depo to implant, is this okay?

Answer 31

Yes, if last depo within 14 weeks

Question 32

You want to switch from the pill to the implant, is this okay?

Answer 32

Yes, fit after last active pill in packet taken

Question 33

You want to switch from COC/patch/vaginal ring to the implant, is this okay?

Answer 33

Yes if you fit during weeks 2-3 of COC/patch/vaginal ring

Question 34

You want to switch from POP to implant is this okay?

Answer 34

Need to use protection for the first 7 days

Question 35

You want to switch from the LNG-IUS to the implant, is this okay?

Answer 35

Need to use protection for the first seven days

Question 36

This contraception improves the quality if breast milk postpartum

Answer 36

Depo

Question 37

Why does depo improve quality of breast milk?

Answer 37

Depo has high levels of pregestogens which improve milk production

Question 38

Recognised treatment of mennorhagia in smokers over the age of 35

Answer 38

Mirena coil (IUS) - releases minimal doses of levonorgestrel every day - slims down the endometrium thereby reducing menstrual loss over a time span of 4-9 months

Question 39

This contraception is contra-indicated in smokers over 35 years of age

Answer 39

COC | contains synthetic oestrogens and these increase risk of cardiovascular effects

Question 40

Progesterone effect on the GI tract

Answer 40

Delays gastric emptying Case example from pastest, not really contraception related: "a 25 year old woman who has been on methadone for the past 3 weeks has a convulsion, why?" Answer: drug and alcohol withdrawal -since gastric emptying is delayed due to the progesterone effect on the GI tract, insufficient drug levels in the plasma may be the cause for convulsion