Contraception

Question 1

When does pregnancy occur?

Answer 1

Implantation

Question 2

What is the pearl index:

Answer 2

Measurement of contraceptive effectiveness. It measures the n. of pregnancies that occur when 100 women use a certain contraception for 1 year.

e.g. 3/100 in 1 yr = P.I. 3.0

Question 3

What is LARC?

Answer 3

Long-acting reversible contraceptions.

Question 4

UK MEC: describe the 4 stages.

Answer 4

1(A): Always can give
2(B): Benefits > risks
3(C): caution risks > benefit - need specialist
4(D): Don’t think about it: unacceptable health risk

Question 5

Contraceptive consultation:

What is the patient/HCP perspective

Answer 5

pt perspective
Side effect:
- bleeding, weight, pain?
Risks:
- future fertility
How effective it is
How it works

HCP

• patinent choice
• dangerous patients
• compliance (method/user failure) & (understanding)

Question 6

What differents between different OCP

Answer 6

the progesterone (monophasic, biphasic, triphasic)

Question 7

Mode of action of OCP

Answer 7

• inhib ovulation
• EE ↓ FSH
• Progesterone prevents LH surge
• Cervical mucus effects

Question 8

Drug interactions of COC

Answer 8

CYP450 inducers
Antibiotics:
- Rifampicin
-Rifabutin

Antidepressants:
- St. John’s Wort
Antiepileptics:
-Carbemazepine
-Oxcarbazepine
-Phenytoin, Primidone, Topiramate,Phenobarbitol

Antifungals:

• Griseofulvin,
• ?Imidazoles & Triazoles

Anti-retrovirals(HIV Rx)

Other
Bosentan, Modafinil, Tracolimus

these can reduce efficacy of COCP (as can D&V)

Question 9

Other benefit of OCP

Answer 9

Reduction in menstrual disorders
 	¯ functional ovarian cysts x 92%
	¯ menorrhagia, irregular bleeding x 50%
	¯ dysmenorrhoea x 40%
 	¯ PMS
 ¯ Iron deficiency anaemia x 50%
 ¯ PID x 50%
 ¯ Ectopic pregnancy x 90% 
 ¯ Fibroids x 30%
  ¯  Benign breast disease x 50 - 75%
 Symptomatic relief / treatment of endometriosis
 ¯  Climacteric symptoms/ ↑ protection from      osteoporosis
 ¯  Rheumatoid arthritis x 50%
 ¯  Endometrial cancer x 50%
 ¯  Ovarian cancer x 40%
 ¯  Colorectal cancer x 20%

Question 10

How many conceptions are unplanned?

How many women request a TOP? How many per yr in UL

Answer 10

50%

33%, >200,000

Question 11

TOP:
upper gestational limit:
How many medical practitioners?

Answer 11

24 weeks

2 registered

Question 12

If patient has unplanned pregnancy:

OSCE station

Answer 12

• confirm pregnancy by PT
• Arrange USS: viability, gestational age, singleton/multiple, exclude molar/ectopic

Counselling
non directive/non judgemental

Discuss both options:

• continuation
• termination: tell of all options medical or surgical
• adoption if >24wks

Allow time for decision

Risk of STI: STI
discuss future contraception,

written/website info for both options.
Follow up appointment

Question 13

What are they 3 stages/gestations of medical TOP

Answer 13

< 9 weeks: Early medication abortion (EMA):

9-12 weeks: Late Early medical abortion

12-24 w: Mid trimester medical abortion

Question 14

What & when can u use surgical TOP methods

Answer 14

Manual vacuum aspiration: 9-12weeks: avoid if < 7 weeks, ↑ risk of failure.

Surgical evacuation under GA: 7-15

dilatation/evacuation GA 15-18

Surgical with fetocide (KCL into heart) 22-24wks

Question 15

What drugs are used for medical

Answer 15

Mifipristone (anti progesterone) 200mg PO
24-48hrs later
Misoprostol (prostaglandin) 800mg PO/PV

allowed home for 2nd drug.
24 hr help
follow up in 4 weeks for PT

Question 16

headache on pill

Answer 16

ensure not migrant (if so, stop): auras, photo sensitive

headache, could ↓ dose, take packs back to back or stop

Question 17

missed pill

Answer 17

take as soon as you remember

if > 2 use condoms for 7 days,
if had sex emergency contraception and PT in 3 weeks

Question 18

starting pill

Answer 18

if in first 5 days of cycle- covered straight away

7 days COP
2 day: mini pill

always give leaflets

Question 19

girls comes had unprotected sex 2 days ago, would like a pregnancy test.

Answer 19

• give emergency contraception (120hr window) & come back in 3 weeks for PT. No point giving PT.

Question 20

implant: what warning to give

Answer 20

bleeding irregularly 3-6months

can have combined pill to stop this or can have it removed. Similar to spotting.

same with EPO injection

Question 21

Main warning for DEPO

Answer 21

can delay fertility 3-6 months, plan ahead stop earlier

Question 22

which form of contraception is not effected by enzyme inducers

Answer 22

DEPO injection

Question 23

Ellaone (ulipristal) emergency contraception interacts with what
how long is it effective for after unprotected sex

Answer 23

• Pill- effects ella one

- 5 days- does not get less effective with time

Question 24

What options are there for emergency contraception

Answer 24

Emergency Pill

• Ulipristal (ellaOne): 5 days
• Levonorgestrel (Levonelle): 72 hours

Copper coil (can’t use if STI)

Question 25

Q’s before emergency

Answer 25

Have you had emergency c. before? When?
LMP, on time? regular?
What is normal cycle length.

When did she have sex?

Question 26

Questions according to UKMEC about IUD.

1. How long postpartum can IUD be fitted?
2. Current breast cancer or >5 year
3. Known prolonged QT interval
4. What must be excluded before insertion

Answer 26

1. 4 weeks (3 before 4 weeks)
2. For IUS 4 for current, 3 for > 5 years
3. 3. Cervical stimulation can induce vasovagal. Bradycardia can increase risk of cardiac event in those with long QT interval.
4. Exclude pregnancy and PID before insertion

Question 27

When are COC graded 4

Answer 27

• Migrane with aura: 2-4 times risk of CVA
• Breast feeding <6w post-partum
• Smoke > 15 a day
• BP >160/95
• Abnormal cardiac function
• SLE
• Major surgery or immobilisation