Contraception

Question 1

Time until contraceptives are effective (if not 1st d of period) (3)

Answer 1

instantly: IUD
2d: POP
7d: COC, implant, injection, IUS

Question 2

Features of IUD (2)

Answer 2

inhibits implantation/fertilisation, copper is poisonous to sperm. it decreases their motility and survival

can be used as emergency contraception <120h

Question 3

Problems w. IUD (3)

Answer 3

may be rejected by nulliparous/distorted uterus

increased risk of pelvic infection and subfertility following STI.

may develop menorrhagia and dysmenorrhoea

Question 4

CIs for IUD (4)

Answer 4

pregnancy: 50% chance of miscarriage

current Pelvic infection/STI or w/i last 3mo

ovarian/endometrial/cervical ca.

distorted uterus

(caution in HIV due to increased risk of STIs)

Question 5

Insertion of IUD (2)

Answer 5

sublingual misoprostol 1hr before to dilate cervix

insert uterine sound to measure length of uterus and insert device into fundus

Question 6

Mechanism of IUS

Answer 6

mirena (levonorgestrel)

prevents endometrial proliferation+thickens cervical mucus

may have initial spotting then bleeding becomes absent

Question 7

Other uses for the IUS (3)

Answer 7

endometriosis/adenomyosis: relieves pain

fibroids

endometrial hyperplasia

Question 8

Mechanism of action of combined contraceptive (microgynon)

Answer 8

oestrogen+progesterone -vely feeds back to inhibit LH and prevent ovulation

Question 9

how to take COCP (4)

Answer 9

ideally on 1st day of period-works instantly

if started on any other time, use barrier methods for 7d

use =/>2wks after being fully mobile post-major surgey

may mask menopause so ideally stop at 50yrs and use non-hormonal methods (however can help maintain bone density throughout menopause)

Question 10

If two pills missed (4)

Answer 10

take last pill even if it means taking two in one day. leave any earlier missed pills and continue taking pills daily. use condoms until pills have been taken for 7d

If missed in wk 1, consider emergency contraception

if missed in wk 2 after 7 consecutive days of taking the pill, there is no need for emergency contraception

if missed in wk3, finish pills in current pack and start new pack omitting pill-free break

Question 11

benefits of COCP (5)

Answer 11

good for heavy periods

less PMS

improves menopausal Sx

improves acne

decreased risk of ovarian/endometrial ca.

Question 12

risks of COCP (2)

Answer 12

increased risk of aterial and venous disease

increased risk of breast/cervical ca.

Question 13

monitoring while on COCP (2)

Answer 13

BP, BMI and health status after 3mo then annually

chlamydia screen if breakthrough bleeds

Question 14

mechanism of action of POP (2)

Answer 14

low dose progesterone thickens cervical mucus

desogestrel (cerazette) inhibits ovulation

Question 15

Process of taking POP (2)

Answer 15

must take at same time of day +/- 3hrs or +/-12hrs for desogestrel

no pill free break

Question 16

CI for POP (2)

Answer 16

breast ca. in last 5yrs

pregnancy

(can be used in most women w. CI for COCP)

Question 17

SEs of POP (3)

Answer 17

irregular bleeding

risk of ovarian cysts

hormonal Sx: decreased libido, breast swelling, fluid retention

Question 18

Other uses for POP

Answer 18

norethisterone can be used to put off periods. start 3d before you want bleeding to stop till the day itself

Question 19

Depot contraceptives, mechanisms (4)

Answer 19

methoxyprogesterone acete (depot provera):

• take days 1-5 of cycle
• IM 12-weekly

norethisterone enanthate-8wkly IM

thickens cervical mucus and inhibits ovulation

use condoms if injections >2wks late

Question 20

CIs for depot contraceptives (6)

Answer 20

pregnancy

breast ca.

undiagnosed vaginal bleeding

acute liver disease

severe cardiac disease

trophoblastic disease

Question 21

SEs of depot contraceptives (3)

Answer 21

vaginal bleeding-settles around 6wks>amenorrhoea

wt. gain

takes a while for fertility to return

Question 22

Indications for depot contraceptives (4)

Answer 22

sickle cell-reduces incidence of crises

covering major surgery

epileptics-reduces incidence of fits and doesn’t interact w. enzyme inducers

bowel disease where oral absorption is compromised

Question 23

Features of implant contraceptive (4)

Answer 23

progesterone implant>3yrs contraception

non-dominant arm, subdermal

nexplanon contains etonorgestrel

inhibits ovulation and thickens cervical mucus

Question 24

SEs of implants (2)

Answer 24

infrequent/heavy/absent bleeding

progesterone-only side effects: headache, breast pain, nausea

Question 25

CIs for implantable contraceptive (4)

Answer 25

current breast ca.

may not be effective in 3rd yr in obese women

enzyme inducers

UKMEC 3:

• ischaemic HD/stroke
• severe liver cirrhosis
• liver ca.
• past breast ca.
• unexplained vaginal bleeding
• antiphospholipid syndrome

Question 26

Features of contraceptive patches (3)

Answer 26

oestrogen+progesterone

may experience breast pain and breakthrough bleeds in first 2 cycles

affected by enzyme inducers