Contraception

Question 1

Progesterone: Action

Answer 1

Suppresses ovulation
thickens endometrium
thickens cervical mucus

Question 2

Progesterone: Time

Answer 2

Take one tablet once a day at roughly same time
Desogestrel: 12 hour window each day
LNG, norethisterone: 3 hours
If you miss a dose, take it as soon as you remember even if you end up taking 2 pills in one day. dont take more than 2 though!! then use barrier protection if window missed

No breaks, take every day

Question 3

Progesterone: SE

Answer 3

irregular bleeding
breast tenderness
acne
libido

Question 4

Progesterone: Complications

Answer 4

Breast cancer (current or past)
liver cirrhoos
CYP450 inducers:

Question 5

COCP: Action

Answer 5

suppresses ovulation
thins endometrium
thickens cervical mucus

Question 6

COCP: Timing, Length of time, effect start in…

Answer 6

take one tablet once a day, doesnt matter when
take for 3 weeks then 1 week off
start day 1- 5 of cycle
If after day 5, use condoms for a week

missed pill:
One (over 24 hours)- take missed pill asap, even if it means taking two in one day
Two or consecutive (48+hours) - take last pill you missed, miss out earlier ones.
Use condom for 7 days.
day 1-7: use emergency contraception
day 8 -14: no need for additional protection, use condoms
day 15- 21: take the following pill back straight away without pill- free break.

Question 7

COCP: SE

Answer 7

Mood swings
Headaches
Reduced libido
Breast tenderness and enlargement
Nausea and bloated feeling
IMPORTANT- red, hot swollen leg may be a VTE

Question 8

COCP: contrindications

Answer 8

increased risk of breast cancer and cervical cancer

BMI >40
breastfeeding: can't use for first 6 weeks. 
Smoking 15+ if age >35
Hypertension: 160/ 110
Migraine with aura
Current breast cancer
VTE risk: history of CVD, stroke, AF

Question 9

POP implant- Nexplanon. Action

Answer 9

Prevents ovulation
thickens cervical mucus
Thins endometrium

Question 10

POP implant- Timings

Answer 10

lasts for 3 years
inserted day 1- 5 of cycle: Effective immediately
after day 5- abstain or use condom for next 7 days

Question 11

POP: SE

Answer 11

Infrequent bleeding (<1/4 have regular bleeding) but this should resolve
Progesteron effects: headache, nausea, breast pain, acne
brusing and infecting at site of implantation

Question 12

POP: Contraindications

Answer 12

Enzyme inducers

past/ current breast cancer, liver cirrhosis, liver cancer

Question 13

Depot injection : progesterone. Action

Answer 13

Prevents ovulation
Thickens cervical mucus
Thins endometrium

Question 14

Depot injection: how to take

Answer 14

IM injection into buttocks, arm, leg or abdomen

Question 15

Depot injection: timings

Answer 15

every 12 weeks

if inserted day 1- 5: effective immediately as contraception, if inserted after day 5, use condoms for next 7 days

Question 16

Depot injection: SE

Answer 16

Only contraception with proven link to weight gain
Irregular bleeding (70% become amenorrhoeic)
Risk of osteoporosis
When you stop taking it, periods do not return for 6 months

Question 17

Depot injection: contraindications

Answer 17

Any other risk factors for osteoporosis:
Vit D deficient 
Hyperparathyroidism
Hyper thyroidism
Low oestrogen levels
Rheumatoid arthritis, Hep C

Question 18

Mirena

Answer 18

Thickens cervical mucus
Thins endometrium- acts locally
Does not prevent ovulation

Question 19

Mirena: Timings

Answer 19

Lasts 3- 5 years.

effective 7 days after insertion

Question 20

Mirena: SE

Answer 20

Irregular bleeding
Headahce
Breast tenderness
Nausea
Acne

Question 21

Mirena: Contraindications

Answer 21

Expulsion in first 3 months 
Uterine perforation (1/1000)
Ectopic pregnancy (1/ 2000)

Question 22

IUD, Copper coil: action

Answer 22

prevents egg implanting in womb, spermotoxic

Question 23

IUD, copper coil: timings

Answer 23

lasts 5- 10 years
wait 4 weeks after giving birth to have it fitted
Effective as emergency contraception upto 120 hours after UPSI
Can be fitted 5 days after ovulation

Question 24

IUD, SE

Answer 24

heavier, longer more painful periods

higher risk of ectopic (1/20)

Question 25

IUD, Contraindications

Answer 25

bleeding, cervical/ uterine cancer, PID

Question 26

Emergency Contraception: types

Answer 26

Levernotgestrol- progesterone pill
Copper Coil
Ulipristal acetate (UPA)- pill

Question 27

Emergency contraception: Progesterone

Answer 27

72hours after UPSI.
very safe can double dose- for fat people
If vomiting occurs within 2 hours of ingesting- need to repeat dose
Should be used for woman on COCP who have forgotten to take for the last few days
Less effective than UPA
action: inhibits ovulation in early cycle

Question 28

Contraindications of POEP:

Answer 28

Acute porphyria, severe liver disease, malabsorption

Question 29

UPA: Timing benefits and con

Answer 29

Can be taken up to 5 days after UPSI
Very few side effects
Con: Some people feel N and V. if you vomit within 3 hours come back as you might need another one
changes to period, if don’t have period of within one week of when you expect take preggers test

Question 30

Copper coil:

Answer 30

Can be implanted up to 5 days after UPSI
Also the only one that is effective after ovulation
Has inhibitory effect on both implantation and fertilisation
Cons: irregular and heavy bleeding and painful.
Painful insertion
Risk of infection
Ectopic pregnancy
Expulsion of IUD
Damage to the womb
Patients who have not had a normal period within 7 days of their next expected period date .