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MRCOG Part 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the release rates of etonogestrel in Nexplanon vs DMPA?

A

Nexplanon- 68mg/3years

DMPA - 150mg/12 weeks

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2
Q

What is the release rate of levonorgestrel from the LNG-IUS?

A

Mean 14mcg/day over 5 years

Initially 20, reduced to 11 at end of 5 years

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3
Q

What is the amenorrhoea rate/regular periord rate and erratic bleeding rate for POP (Cerazette)?

A

Amenorrhoea 20%
Regular 40%
Erratic 40%

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4
Q

How many women achieve complete cessation of menstruation at 1 year with DMPA?

A

50%

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5
Q

What is the amenorrhoea rate and erratic bleeding rate with Nexplanon?

A

Amenorrhoea 20%

Erratic bleeding 50%

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6
Q

How many women achieve 5 years of reduced blood loss or amenorrhoea using LNG-IUS?

A

90%

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7
Q

Which cancers are at increased/decreased risk with COCP use?

A
  • Protective - ovarian and endometrial (15 years or more after stopping)
  • Decrease in colorectal cancer
  • Small additional risk of breast cancer, decreased to no risk after 10 years of stopping use (UKMEC 3 BRCA)
  • Small increase cervical - to no risk after 10 years cessation
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8
Q

What is the age cut off for smokers where risk outweighs benefit of COCP?

A

35

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9
Q

When is the recommended maximum age for DMPA (depo)?

How often should women be reviewed?

A

No upper limit but generally recommend 50 - UKMEC 2 >45
Caution with cardiovascular risk factors
Review every 2 years

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10
Q

When can non-hormonal contraception be stopped peri-menopausally?

A

After 1 year amenorrhoea if >50
After 2 years amenorrhoea if <50
55 if still bleeding
Cu-IUD if inserted over age of 40 can stay in until menopause or until contraception not required

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11
Q

When can hormonal contraception be stopped peri-menopausally?

A

FSH only if >50 and progesterone only method
6/52 apart and if both >=30 stop contraception after 1 year
If LNG-IUS inserted >=45 for 7 years if amenorrhoeic or until menopause
(If used as P component of HRT change at 5 years)
COCP - not reliable doing FSH

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12
Q

What is the rate of abortion in women >40 in England & Wales?

A

4/1000

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13
Q

What is the risk of cancer with progesterone only methods of contraception?

A

Breast - inconclusive

Cervical - slight increase with length of use but

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14
Q

How did LNG-IUS compare to other methods in Cochranre review for menorrhagia?

A

More effective than cyclical norethisterone
Smaller mean reduction in blood loss compared to ablation
QOL measures similar to ablation/hysterectomy but more progestogenic side effects

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15
Q

Which progestogenic contraception has the greatest effect on lipid metabolism (ie increase in vascular risk)

A

DMPA injectable

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16
Q

Which spermicide should not be used with condoms due to increased HIV transmission 2dry to mucosal irritation?

A

Nonoxinol-9 (N9)

17
Q

What are the methods of emergency contraception. how long after UPSI can they be used and which is most effective?

A

CuIUD - 5/7 after earliest expected ovulation regardless of no UPSI - 99% effective
Progesterone only (POEC) - levonorgestrel - licenced 3/7
P-receptor modulator ullipristal

18
Q

What is the probability of menstration (and ovulation) after 1 year amenorrhoea in women >45?

A

2-10%

19
Q

How many women continue to ovulate with LNG-IUS?

A

Up to 75%

20
Q

Sequential HRT inhibits ovulation in how many women with regular cycles (age 42-52)?

A

40%

21
Q

what contraception to be avoided in 30yr old nullip, with SLE

A

all hormonal contraceptives including mirena.
UKMEC=4 for CHC
UKMEC=3 for prog contraception

22
Q

what contraception to avoid in 33y/o woman with FHx VTE in 1st degree relative under age 45. pt has normal thrombophilia screen

A 
all CHC (COCpill/ ring/ patch).
UKMEC=3
23
Q

what contraception to avoid n 22 yr old with T1DM, neuropathy and microvascular disease

A

CHCs & DMPA

UKMEC=3/4 with CHCs
UKMEC=3 for DMPA

24
Q

What are the methods of emergency contraception in the UK and how long after UPSI can they be given?

A

Copper coil - 5/7
Levenorgestrel - 72 hours - can be given more than once a cycle
Ullipristal - Up to 5/7 but efficacy reduces after 72 hrs

25
Q

What % of 18-49 year olds who are married/in a partnership are using Fertility Awareness Method for contraception?

A

2%

MRCOG Part 2 (97 decks)

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