Contraception

Question 1

What cannot be used for contraception if breast feeding <6weeks post partum?

Answer 1

COCP

Question 2

When would you start contraception post partum?

Answer 2

Day 21

Question 3

Absolute CI to COCP

Relative CI?

Answer 3

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)

Question 4

Disadvantages of COCP

Answer 4

Forget to take
No STI protection
Increased risk of VTE
Increased risk of breast / Cervical ca

Headache, nausea and breast tenderness

Question 5

Which Abx has impact on POP

Answer 5

Those that affect p450 - rifampicin

Question 6

Mode of action of Levonorgesterel when used as emergency contraception?

Answer 6

Inhibits ovulation

Question 7

Main mechanism of 
COCP
Pop
Desogesterel only 
Injectable 
IUD 
IUS

Answer 7

Combined oral contraceptive pill Inhibits ovulation

Progestogen-only pill (excluding desogestrel) Thickens cervical mucus

Desogestrel-only pill Primary: Inhibits ovulation
Also: thickens cervical mucus

Injectable contraceptive (medroxyprogesterone acetate)	Primary: Inhibits ovulation 
Also: thickens cervical mucus

Implantable contraceptive (etonogestrel)	Primary: Inhibits ovulation 
Also: thickens cervical mucus

Intrauterine contraceptive device Decreases sperm motility and survival

Intrauterine system (levonorgestrel)	Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

Question 8

3 types of emergency contraception and basics

Answer 8

Levonorgesteral
Effective up to 72 hours
Can be used more than once in a cycle

Ulipristal - ellaOne

• may reduce effectiveness of hormonal contraception
• up to 5 days

IUD
Up to 5 days

Question 9

Key points to improve fertility

Answer 9

Folic acid
BMI 20-25
Sex every 2-3 days
Less smoking / drinking

Question 10

2 pills missed in COCP?

Answer 10

Take both pills

-condoms for 7 days

Question 11

Cocp and cancer

Answer 11

increased risk of breast and cervical cancer

protective against ovarian and endometrial cancer