Contraception Flashcards
Question
Susie wants to start on the COCP. Which one feature of her history most makes you reluctant to prescribe the COCP:
- were over the age of 35 and smoker more than 15/day;
- had a first degree relative with history of VTE under 45yrs;
- was a known carrier of high risk gene for breast cancer – eg BRCA1
- was 6 months post-natal and fully breast feeding
correct
She is 2 weeks post-natal and currently breast-feeding
She is 19 and smokes 20/day
Her grandmother has had a DVT at the age of 80
Her mother has recently been diagnosed with breast cancer at the age of 45
She has had Chlamydia twice in the past
Which method of contraception would you ideally want to AVOID in the ff women:
32 year old woman wanting contraception now but considering starting a family in 6 months
Which method of contraception would you ideally want to AVOID in the ff women:
copper-bearing intra-uterine device (CU-IUD)
Which method of contraception would you ideally want to AVOID in the ff women:
18 year old with epilepsy on an enzyme-inducing anti-epileptic
combined oral contraceptive pill (COCP)
Which method of contraception would you ideally want to AVOID in the ff women:
19 year old with a positive diagnosis of Chlamydia and abdominal pain
Depot medroxyprogesterone acetate (DMPA)
The IUD may be inserted in women with a previous history of Chlamydia or pelvic inflammatory disease (PID) but it should not be inserted in the presence of acute or current infection. If this 19 year old has a positive diagnosis of chlamydia and is complaining of abdominal pain, PID should be ruled out and treated before inserting an IUD.
DMPA may result in a delay in return of fertility of up to a year, therefore you may wish to avoid this in a woman that is eager to start a family in the next 6 months. The COCP and IUD do not delay return of fertility.
Enzyme inducing drugs may increase the hepatic clearance of COCPs resulting in a reduced efficacy. They do not affect DMPA or the IUD.
Which of the following are considered long-acting reversible contraceptive (LARC) methods? More than one or none may be correct.
contraceptive patch contraceptive implant contraceptive vaginal ring copper intra-uterine device levornorgestrel-releasing intra-uterine system
copper intra-uterine device
levornorgestrel-releasing intra-uterine system
contraceptive implant
LARC methods are defined as methods which require administering less than once per month
Which method of contraception would be the most appropriate for each of the following women
- 28 year old lady currently taking rifampicin for pulmonary TB
IUS
Implanon
POP cerazette
POP
Rifampicin is a potent live enzyme inducer. The IUS is the only method in the list which would not be affected by liver enzyme induction. The IUS is licensed for use in treating women with heavy menstrual bleeds. By 1 year of use, 65% of users will be oligo - or a-menorrhoeic. The IUS and implant are both devices which require separate insertion and removal procedures.
Which method of contraception would be the most appropriate for each of the following women
- 35 year old with regular heavy menstrual loss
IUS
Implanon
POP cerazette
IUS
Rifampicin is a potent live enzyme inducer. The IUS is the only method in the list which would not be affected by liver enzyme induction. The IUS is licensed for use in treating women with heavy menstrual bleeds. By 1 year of use, 65% of users will be oligo - or a-menorrhoeic. The IUS and implant are both devices which require separate insertion and removal procedures.
Which method of contraception would be the most appropriate for each of the following women
- 26 yr old who has reviewed all the options and does not want a “foreign body” device
IUS
Implanon
POP cerazette
IUS
Rifampicin is a potent live enzyme inducer. The IUS is the only method in the list which would not be affected by liver enzyme induction. The IUS is licensed for use in treating women with heavy menstrual bleeds. By 1 year of use, 65% of users will be oligo - or a-menorrhoeic. The IUS and implant are both devices which require separate insertion and removal procedures.
- It is recommended that condoms are used in conjunction with spermicide True False
F
condoms are not used in conjunction with spermicide following a WHO technical report which concluded that repeated and frequent use of the spermicide nonoxynol-9 was associated with micro-epithelial abrasions which increase risk of STI and HIV tranmission
- It is recommended that diaphragms are used in conjunction with spermicide True False
T
caps and diaphragms must be used in conjunction with spermicide as they form an incomplete barrier to sperm
- The diaphragm is left in situ for a maximum of 2 hours AFTER sexual intercourse True False
F
the diaphragm and cap must be left in for a minimum of 6 hours after sexual intercourse
- Condoms are weakened using water-based lubricants such as aqua-gel True False
F
condoms may be weakened by oil-based lubricants. Water-based lubricants are safe to use
- Women or men with latex allergies may use the female condom – Femidom
T
the female condom is made from poly-urethane and is latex-free
A 22 year old, GoPo, had unprotected sexual intercourse 4 days ago. Which of the following statements is correct: (more than one or none of the statements may be correct)
1. A CU-IUD would be the most effective form of emergency contraception 2. A CU-IUD is not suitable given the fact that she is a nullip 3. An IUS may be considered as emergency contraception up to 120 hours after unprotected sexual intercourse 4. All forms of emergency contraception offer ongoing contraceptive cover for the rest of the cycle 5. Up to 20% of women that take EHC experience nausea and vomiting
1 and 3
The IUD may be used without restriction in nullips
The IUS is not used for emergency contraception
The EHC does not provide ongoing contraceptive cover for the remainder of the cycle
Less than 5% of women taling EHC will experience nausea and vomiting
Question
Absolute contraindications to the COCP include: (more than one or none may be correct)
- current DVT
T
Question
Absolute contraindications to the COCP include: (more than one or none may be correct)
- current PID
F
Question
Absolute contraindications to the COCP include: (more than one or none may be correct)
current breast cancer –receiving treatment
T
Question
Absolute contraindications to the COCP include: (more than one or none may be correct)
current diabetes – well controlled
F
Question
Absolute contraindications to the COCP include: (more than one or none may be correct)
- current HIV - not on anti-retrovirals
F
Question
The progestogen-only pill may be used without restriction in the following women:
non-enzyme inducing anti-biotics do not affect the efficacy of the POP ( progestogen-only pill)
Question
The progestogen-only pill may be used without restriction in the following women:
19 year old taking trimethoprim for a urinary tract infection
non-enzyme inducing anti-biotics do not affect the efficacy of the POP ( progestogen-only pill)
Question
The progestogen-only pill may be used without restriction in the following women:
19 year old taking the enzyme inducing St Johns Wort for depression
without restriction
a POP may be started immediately after termination of pregnancy or miscarriage
Question
The progestogen-only pill may be used without restriction in the following women:
19 year old 2 weeks post termination of pregnancy
without restriction
a POP may be started immediately after termination of pregnancy or miscarriage
Question
The progestogen-only pill may be used without restriction in the following women:
19 year old, breast feeding, 6 months post-partum
without restriction
a POP may be safely used in lactating women
Question
The progestogen-only pill may be used without restriction in the following women:
a 45 year old
without restriction
a POP may be used in women until the menopause
Question
Indicate the most appropriate route of hormone delivery for each of the following methods of hormonal contraception:
contraceptive implant - Implanon
oral transdermal subdermal vaginal s/c IM intrauterine
The CU- IUD may result in heavier and more painful periods; the CU-IUD does not contain hormones; the primary mechanism of action is to prevent fertilisation; women with a previous ectopic may use the IUD without restriction
This device can be used to treat heavy menstrual loss - True
A side effect of the device is an increase in acne due to small amount of systemic hormone release - False
This device is licensed for use as a contraceptive - False
The primary mechanism of action is to inhibit ovulation - False
Women who have had a previous ectopic pregnancy may not use this method of contraception - False
prevent ovulation
= implant
prevent fertilisation =
IUD
prevent implanation =
IUS
Long-acting methods (LARC) are more effective than combined oral methods BECAUSE LARC methods have lower typical use failure rates
Long-acting methods (LARC) are more effective than combined oral methods BECAUSE LARC methods have lower typical use failure rates
Question
The failure rates of contraceptive methods may be affected by which of the following factors? More than one or none may be correct.
Frequency and timing of sexual intercourse Natural fecundity of the woman Concurrent use of enzyme inducing drugs User motivation and Compliance Efficacy of method
Question
The failure rates of contraceptive methods may be affected by which of the following factors? More than one or none may be correct.
Frequency and timing of sexual intercourse Natural fecundity of the woman Concurrent use of enzyme inducing drugs User motivation and Compliance Efficacy of method
This is an example of an intra-uterine device - False
The device provides contraceptive protection for up to 3 years - True
Acne may worsen or improve with this method - True
Irregular bleeding is the most common reason for early removal - True
Failure rates are relatively high with this method - False
This is an example of an intra-uterine device - False
The device provides contraceptive protection for up to 3 years - True
Acne may worsen or improve with this method - True
Irregular bleeding is the most common reason for early removal - True
Failure rates are relatively high with this method - False
Female condom
It is recommended that spermicide is used with the method True False
This is an example of a female barrier method of contraception True False
The typical use failure rates with this method are higher than for the implant True False
This is the most popular method of contraception in women over the age 40 True False
This method comes in varying sizes and women must be assessed to ensure a good fit before using as a contraceptive
- True
- True
- True
- False, Although this method is most commonly used by women over the age of 40, it is not the most commonly used method in this age group
- True
Progestogen Oestrogen or both
Contraceptive implant - progestogen only
Contraceptive injectable - DMPA - progestogen only
Contraceptive pill containing ethinyl estradiol and levonorgestrel - combined
Contraceptive vaginal ring - combined
Contraceptive desogestrel only pill - progestogen only
IUS – Mirena - progestogen only
Progestogen Oestrogen or both
Contraceptive implant - progestogen only
Contraceptive injectable - DMPA - progestogen only
Contraceptive pill containing ethinyl estradiol and levonorgestrel - combined
Contraceptive vaginal ring - combined
Contraceptive desogestrel only pill - progestogen only
IUS – Mirena - progestogen only
For lactational amenrohhoea to be effective the woman must be fully or nearly fully
she must be fully breast feeding
Rank the following in order of contraceptive efficacy ( 1=most effective; 4 = least)
contraceptive implant
condoms
injectable contraception
combined oral contraception
