Contraception

Question 1

COCP - Side effects

Answer 1

Nausea
Breast pain
Headache
Initial irregular bleeding

Question 2

COCP - Benefits

Answer 2

• Decrease in ovarian cysts and benign breast disease
• Decreased risk inside Ca - Ovarian and endometrial
• Control of bleeding

Question 3

COCP - Risks

Answer 3

• VTE, stroke, MI (smoker)
• Ca breast and cervix

cOcp increase risk of Outside cancers

Question 4

UK MEC 4 - COCP

Answer 4

• smoking >15 day >35 years
• BP <160/95
• Migraine with aura
• CVA
• Breast Ca
• Liver disease

Question 5

Starting COCP

Answer 5

Day 1-5 effective immediately

> 5 = condoms and abstain for 1 week

Question 6

Missed Pill

Answer 6

Take pill as soon as remember, even if taking 2 pills in one day

2 or more pills (use condoms for 7 days)

• 1st week: need EC
• 2nd week: continue as normal
• 3rd week: run next pack back to back

Question 7

POP - Side effects

Answer 7

• Irregular bleeding
• Mood changes
• Weight gain
• Headaches
• Acne

Question 8

POP - UK MEC 4

Answer 8

Breast Ca in last 5 years
CVA
Cirrhosis/hepatoma
P450 inducer use (decrease effectivity of POP)

Question 9

Starting POP

Answer 9

Day 1-5 effective immediatly

> 5 extra precautions for 2 days

Question 10

POP - Missed Pill

Answer 10

Cerazette - 12 hour window

Missed pill = extra precautions for 48 hours

Question 11

Implant

• SE
• F rate
• Drug Interactions

Answer 11

3 years

• irregular bleeding
• 0.05% failure
• Enzyme inducer interaction

Question 12

IUS

• SE
• F rate
• Drug Interactions

Answer 12

5 years
- lighter, irregular bleeding
<1% over 5 years

Question 13

Depo

• SE
• F rate
• Drug Interactions

Answer 13

12 weekly

• 3 kg weight gain in 2 years
• 6-12 month fertility delay
• 0.4% failure rate

Very good for HIV/Epilepsy as no interactions

Question 14

Starting a LARC

Answer 14

Day 1-5: effective immediately

> 5 = condoms for 7 days

Question 15

IUS/IUD - before fitting

Answer 15

On period/no sex since period
Other reliable method (not condoms)
No sex in last 3 weeks and negative PT

• Negative STI screen

Question 16

IUS - E and 6 P’s

Answer 16

• Expulsion (1 in 20, first 3 months)
• Procedure ( Pain when fitting)
• Progestogenic side effects
• Periods (irregular bleeding)
• Pregnancy (FR and ectopic risk)
• PID (increased risk only first 3 weeks)
• Perforations (1 in 1000, immediate or over time)

Question 17

IUD/IUS UK MEC 4

Answer 17

• Pregnancy
• Undiagnosed bleeding
• Cervical/uterine Ca pre treatment
• Active PID in previous 3 months
• Current chlamydia/gonorrhoea
• Gestational trophoblastic disease

MEC 3

• Uterine abnormality
• Long QT

Question 18

Emergency Contraception - Pill

Answer 18

Levonelle 1500mcg
- 3 days, delays ovulation

Ella One (Ullipristal 30mg)

• 5 days, delays ovulation
• Not effective >1 in same cycle
• Not in asthmatics

Question 19

Emergency Contraception - Pill Side Effects

Answer 19

• N&V
• Breast tenderness
• Bleed after you take it
• Menstrual disturbance (delayed more than 7 days, contact GP)
• Dizziness, headache, tiredness

Question 20

Emergency IUD

Answer 20

5 Days

• Must exclude pregnancy/STIs
• If patient has ovulated in previous 5 days - USE IT!
• Good for mid cycle

Question 21

Termination - Medical

Answer 21

Mifepristone and Misoprostol

<9 weeks

Question 22

Termination - Surgical

Answer 22

Manual vaccuum aspiration 9-12 weeks

Surgical Evac 7-15 weeks (GA)