Contraception

Question 1

Method of action of COCP?

Answer 1

Primary method: Acts on the HPA axis to prevent secretion of FSH and LH - to stop ovulation

Thickens cervical mucus

Reduces endometrial receptivity

Question 2

COCP problems?

Answer 2

Breakthrough bleeding, breast tenderness and mood swings

VTE risk

MI and stroke risk

Increased breast cancer risk, maybe cervical cancer

Question 3

Method of action of progesterone only pill?

Answer 3

Ovulation is inhibited to varying degrees

Transport of ovum is delayed

Cervical mucus thickening

Reduces endometrial receptivity

Question 4

Problems with progesterone only pill?

Answer 4

Can’t miss a pill really at all.

Amenorrhoea & Breakthrough bleeding.

Increased risk of ovarian cysts

Increased risk of breast cancer

Slightly increased risk of ectopic pregnancy

Question 5

Primary mode of action of progesterone only injectables (e.g. depo-provera)?

Answer 5

Suppress ovulation

Question 6

Problems with depo injections (progesterone only)?

Answer 6

Not easily reversible

Loss of bone density
- can’t use if under 18, or if any osteoporosis risk

Irregular bleeding, with amenorrhoea eventually

Some weight gain may occur

Possibly risk of breast and cervical cancer

Question 7

Progesterone only implant mode of action?

Answer 7

Inhibit ovulation

Question 8

Problems with implant?

Answer 8

Not many,

• Irregular bleeding common for a year

Question 9

IUD mode of action? How long can it remain/

Answer 9

IUD = device (COPPER)

Toxic to sperm and ova
Thickened cervical mucus
Endometrium gets shit

10 years

Question 10

Problems with IUD?

Answer 10

Insertion may be unpleasant

Spotting & bleeding in-between periods

Short term increase risk of PID

Question 11

IUS mode of action, how long can it remain?

Answer 11

Mirena is 5 years

Progesterone t shaped device works by reducing endometrial growth and preventing implantation (local progesterone effects)

Thickens cervical mucus

Does NOT affect ovulation.

Question 12

Problems with the IUS?

Answer 12

Insertion may be unpleasant

Can get menstrual irregularities for the first year, but them amenorrhoea or no bleeding.

Typical progestogenic side-effects (potentially acne/breast tenderness/headache/mood changes

Question 13

Difference in a diaphragm and cap?

Answer 13

Diaphragms should lie diagonally between the posterior fornix and behind the pubic bone

Caps are smaller than diaphragms, fitting closely over the cervix

Question 14

Most effective contraception?

Answer 14

Implant

Question 15

What dose does the patch release?

Answer 15

20mcg of ethinyl oestradiol and 150mg norelgestromin daily

Question 16

What do you need to ask in a Hx for IUD?

Answer 16

Fibroids
Pelvic infection
Last menstrual period

Generally everything:

• Menstrual/obstetric/sexual Hx
• Problems in the past

Question 17

Primary mode of action of the patch?

Answer 17

Suppress ovulation

Question 18

Benefits of COCP?

Answer 18

Reduced colorectal cancer risk

Reduced risk of ovarian and endometrial cancer

Improved acne

Question 19

Can you use tampons with the ring?

Answer 19

Yes

Question 20

How long after expulsion should you re-insert the vaginal ring?

Answer 20

48 hours

Question 21

What contraceptives can be used with liver enzyme inducing drugs?

Answer 21

IUD, Depo and IUS.

Can use double dose of levonorgestrel EC

Question 22

What would contraindicate CHC use? (UKMEC 3 & 4)

Answer 22

HTN (even if controlled)
0-6 weeks postpartum and breastfeeding
0-3 weeks postpartum non-breastfeeding
Migraine with aura
>35 and smoker (UKMEC2 if >1 year ago)
Stroke/IHD
High VTE risk
Breast Cancer

Question 23

Examples of liver enzyme inducing drugs?

Answer 23

St johns wort, Phenytoin, Rifampicin, Carbamazepine, modafinil.

Question 24

UKMEC 3 & 4 for progesterone only medication?

Answer 24

Depo - R/F for CVD, stroke, IHD

All - current and past breast cancer, hepatocellular Cancer

Question 25

IUC UKMEC 3 & 4?

Answer 25

48hrs - 4weeks postpartum

Post-abortion sepsis

Long QT

Initiation w/ infection

Question 26

Risk of intrauterine perforation in IUD insertion?

Answer 26

2 in 1000

Question 27

How long before a change in IUD should a woman use extra precaution?

Answer 27

5 Days

Question 28

How long is Levonorgestrel EC licensed for?

Answer 28

72 hours (3 days)

Question 29

How long after UPSI is UPA EC licensed for?

Answer 29

120 Hours (5 days)

Question 30

How long after UPSI is IUD licensed for?

Answer 30

120 Hours (5 days)

Question 31

How does Levonorgestrel affect UPA and vice versa?

Answer 31

If UPA has been taken then can’t take Levonorgestrel in the next 5 days

If Levonorgestrel has been taken then UPA may not work for the next 7 days