Contraception

Question 1

SOME factors to consider with COCP

Answer 1

Smoking - MEC 3 >35 years and <15, MEC 4 if >35 and >15
Obesity - MEC 3 >35kg/m2
Migraine - MEC4
Epilepsy - Most AEDs with COCP MEC 3

Question 2

Outline UKMEC system (2-4)

Answer 2

UKMEC 2: advantages generally outweigh the disadvantages
UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk

Question 3

Preferred contraception in epilepsy

Answer 3

Depo-Provera, IUD, IUS

Question 4

Advantages of COCP in women >40

Answer 4

COCP use in the perimenopausal period may help to maintain bone mineral density
COCP use may help reduce menopausal symptoms

Question 5

Women of 46 with IUCD has amenorrhoea, when can she stop?

Answer 5

after 2 years of amenorrhoea

Question 6

Woman of 50 on COCP, what should be done?

Answer 6

Switch to non-hormonal or progestogen-only method

Question 7

Types of emergency contraceptives

Answer 7

Levonogestrel
EllaOne
IUCD

Question 8

Levonogestrel time window

Answer 8

<72 hours

Question 9

EllaOne time window

Answer 9

<120 hours

Question 10

IUCD time window

Answer 10

5 days or 5 days from ovulation date

Question 11

CI to IUCD

Answer 11

Pelvic inflammatory disease history
pregnancy
puerperal sepsis
immediate post-septic abortion
distorted uterine cavity (any congenital or acquired abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) including uterine fibroids

Question 12

When to women require contraception post-partum?

Answer 12

Day 21

Question 13

When can the POP be started postpartum?

Answer 13

Any day

Question 14

When can the COCP be used postpartum?

Answer 14

Absolutely CI until 6 weeks

Question 15

how long is lactational amenorrhoea effective?

Answer 15

6 months post-partum

Question 16

Advantages COCP

Answer 16

highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial and colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts, benign breast disease, acne vulgaris

Question 17

Disadvantages of COCP

Answer 17

people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen

Question 18

4 points of advice on taking the COCP

Answer 18

if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
should be taken at the same time everyday
taken for 21 days then stopped for 7 days - similar uterine bleeding to menstruation
advice that intercourse during the pill-free period is only safe if the next pack is started on time

Question 19

What happens if woman missed 2 pills in a row?

Answer 19

If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day

the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’

Question 20

Give 5 absolute contraindications to COCP

Answer 20

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

Question 21

Give five relative contraindications to COCP

Answer 21

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 22

When is early menopause

Answer 22

<45

Question 23

When is premature menopause

Answer 23

<40

Question 24

When is average menopause

Answer 24

51

Question 25

What is range for usual menopause

Answer 25

45-55

Question 26

When should HRT not be given??

Answer 26

Age over 60

Question 27

What are four key risks of HRT?

Answer 27

Stroke
VTE
Breast cancer
Endometrial cancer (Oestrogen only)

Question 28

Give four types of patient in which you should be cautious prescribing HRT

Answer 28

1) There is sudden change in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding - refer for endometrial assessment.
2) There is a personal or family history of VTE - a thrombophilia screen may be helpful.
3) There is a high risk of breast cancer - consider mammography or MRI scan; refer to NICE guidance on familial breast cancer.[34]
4) The woman has arterial disease or risk factors for arterial disease - consider checking lipid profile.