Contraception

Question 1

How effective is the COCP?

Answer 1

> 99%

Question 2

What is the mechanism of action of the COCP?

Answer 2

Inhibits ovulation
Increases cervical mucous
Thins endometrial lining

Question 3

COCP increases the risk of which types of cancer?

Answer 3

Breast

Cervical

Question 4

COCP decreases the risk of which types of cancer?

Answer 4

Endometrial

Ovarian

Question 5

The COCP is effective immediately if started when?

Answer 5

Within 5 days of the start of the menstrual cycle

Question 6

A girl comes in wanting to start the COCP. She is on day 13 of her cycle, what advice would you give her?

Answer 6

Start the COCP, however additional contraception (condoms or abstinence) is required for the first 7 days

Question 7

What are some absolute contraindications of the COCP?

Answer 7

BMI ≥ 40
Migraine with aura
Breastfeeding < 6 week postpartum 
35 years old + smoking ≥ 15 a day
Hx of CVA/IHD/ uncontrolled hypertension
Current breast ca 
Prolonged immobilisation/ recent surgery

Question 8

What advice would you give someone who has missed a COCP pill at any point in the pack?

Answer 8

Take the missed pill as soon as you remember, even if it means taking 2 in 1 day. Take next one as normal - no need for emergency contraception

If 2 missed - take 1 pill immediately and and use condoms for 7 days - further management depends on week of pack

Question 9

What advice would you give someone who has missed 2 COCP pills in week 1?

Answer 9

Will need emergency contraception if she had sex in pill free week or 1st week

Question 10

What advice would you give someone who has missed 2 COCP pills in week 2?

Answer 10

No emergency contraception required, use additional contraception for 7 days

Question 11

What advice would you give someone who has missed 2 COCP pills in week 3?

Answer 11

Omit the pill free week (i.e. back to back next packet)

No contraception required

Question 12

What drugs can reduce the efficacy of the COCP?

Answer 12

CYP450 inducers - 
Carbamazepine 
Rifampicin
Barbiturates 
Phenytoin 
St John's Wart

Question 13

What is the mechanism of action of the POP?

Answer 13

Thickens cervical mucous

Inhibits ovulation in 50%

Question 14

What advice about additional protection would you give someone commencing on the POP?

Answer 14

If starting within 5 days of starting period, POP effective immediately

If starting at any other point in the cycle, use condoms for 2 days

Question 15

What are common side effects of the POP?

Answer 15

Spotting, particularly in first few months

Weight gain

Question 16

What are some absolute contraindications to the POP?

Answer 16

Pregnant
Breast cancer in last 5 years

Undiagnosed PV bleeding is a relative contraindication

Question 17

What are the windows for taking the POP?

Answer 17

Normal - 3 hours, if ≥ 3 hours take missed pill and use condoms for 2 days

Cerazzete - 12 hour window

Question 18

What are the advantages of the POP compared to the COCP?

Answer 18

Lighter or absent periods

Not contraindicated in htn, CVD, migraine

Question 19

What are the E & 6Ps of IUD & IUS?

Answer 19

Expulsion - usually within first 3 months
Pregnancy
Perforation
PID
Periods - heavier on IUD, spotting on IUS
Procedure (pain)
Progestognenic side effects (IUS) - acne, weight gain, loss of libido etc

Question 20

What is the mechanism of action of Depo-provera and how often is it taken?

Answer 20

Inhibits ovulation –> causes amenorrhea (after initial spotting)
12 weeks

Question 21

The Nexplanon emits how much progesterone daily?

How often must it be changed?

Answer 21

~25-70mg

3 years

Question 22

What is the mechanism of action of the IUD?

Answer 22

Spermotoxic

Prevents implantation

Question 23

What is the mechanism of action of the IUS?

Answer 23

Inhibits ovulation

Question 24

What are the non-contraceptive uses of the IUS?

Answer 24

First line treatment of menorrhagia

Question 25

How long is the IUS effective for?

Answer 25

5 years

Question 26

IUS & IUD increase the risk of what?

Answer 26

PID if inserted whilst woman has an asymptomatic STI | Ectopic pregnancy if the woman becomes pregnant

Question 27

What effect does the IUD have on periods?

Answer 27

Heaver & prolonged

Question 28

How often must a women check for the strings of an IUS/IUD?

Answer 28

Monthly

Question 29

What contraception is available to all women immediately postpartum?

Answer 29

POP

Question 30

When do women require contraception after giving birth?

Answer 30

After 21 days (longer if breastfeeding)

Question 31

When can an IUD be inserted postpartum?

Answer 31

4 weeks

Question 32

How often is the patch changed?

Answer 32

weekly for 3 weeks then patch free week

Question 33

What is the generic name of Levonelle?

Answer 33

Levonorgestrel

Question 34

What is the generic name of EllaOne?

Answer 34

Ullipristal

Question 35

EllaOne can be taken how long after unprotected intercourse?

Answer 35

5 days

Question 36

Levonelle can be taken up to how long after unprotected intercourse?

Answer 36

3 days

Question 37

What is the most effective emergency contraceptive?

Answer 37

Copper coil

Question 38

When is the copper coil effective as emergency contraception?

Answer 38

5 days after intercourse 5 days after expected date of ovulation (if sex occurs 4 days before ovulation IUD can be fitted up to 9 days after intercourse)

Question 39

What should additionally be prescribed for the patient if the copper IUD is used as emergency contraception?

Answer 39

Antibiotic prophylaxis

Question 40

Which emergency contraceptive can only be used once per cycle?

Answer 40

Ullipristal/ EllaOne

Question 41

How long after being used as emergency contraception can the copper IUD be removed?

Answer 41

4 weeks

Question 42

Which emergency contraceptive inhibits the action of some contraceptives?

Answer 42

EllaOne/Ullipristal | Inhibits action of progestogens --> barrier contraception required until next period