Contraception

Question 1

What are the contraindications for Implanon?

Answer 1

Active breast cancer
skin site infection

Relative but risks outweigh harm:
Prior hx breast ca
unexplained vaginal bleeding
severe cirrhosis

Question 2

What are the contraindications for IUD?

Answer 2

Pregnancy
Current PID
after Septic abortion
large fibroid
endometrial cancer
unexplained vaginal bleeding
gestational trophoblast disease with rising BHCG

Question 3

What are the important points for counselling for a Implanon?

Answer 3

1/5 ammenorrhoea
3/5 irregular/infrequent bleeding  -  half get better in 3/12
1/5 increased bleeding
70% improved in dysmenorrhoea
SE - mood, acne, weight gain,

Question 4

What are the options for irregular bleeding after starting COCP?

Answer 4

Exclude pregnancy, STI, vaginal/cervical/endometrial pathology
Increase estrogen dose
change progesterone type
change delivery method - ring
Reassure, can be common for first 3-4 months

Question 5

What are the options for irregular bleeding after starting LARC?

Answer 5

Exclude pathology, pregnancy, expulsion of IUD (>4cm string)
add COCP
bleeding control, mefenamic acid 500mg BD/TDS or transexamic acid 500mg BD both 5 days
add another progesterone norethisterone 5mg TDS for 21 days
Bleeding with copper IUD extensive and thus NSAID use helps

Question 6

What are the emergency contraception options in Australia?

What are the Pros and cons of each?

Answer 6

Levonorgestrel 1.5mg

• Within 72 hours
• 97.8% effective
• Good if breast feeding, need to take more contraception straight away
• double dose if on liver enzyme inducing medications

Ulipristal acetate 30mg

• good for 120 hours (5 days)
• slightly more expensive
• 98.6% effective
• cannot take any progesterone containing contraception for 5 days afterward
• SE: nausea, headache, vomiting, altered vaginal bleeding
• better for women BMI > 30

Copper IUD

• most expensive and need a trained inserter
• 99.9% effective upto 5 days esp BMI >30
• SE: irregular bleeding, dysmenhorrea, infection, perforation
• good contraception cover for 10 years
• can be inserted 4 weeks postnatally
• only effective method if patient thinks ovulation has occured

Question 7

When should a lady start emergency contraception in regards to the major types of contraception?

Answer 7

unprotected sex with..

COCP
-missed >2 pills, especially in first week or last week

POP
->3 hour window missed pill or within 48 hours of starting pill

Depo
->14 weeks after last insertion or within 1 week of missed insertion

Mirena/IUD

• if not inserted within 7 days of first day of bleeding
• within 7 days prior to removal, expulsion, perforation