Contraception

Question 1

COCP
risk increase

When should it be discontinued?

Missed pill rules

Answer 1

Inhibition of ovulation O + P suppres Lh + fsh
Increase VTE , Increase risk breast and cervical cancer
Start anytime but use condoms for 7 days
SHOULD BE DISCONTINUED 4 weeks before any surgery

Missed pill rules = not taken for 24 hours

1. Take 2nd ASAP
2. If >2 are missed,
   - Day 1-7 emergency contraception
   - Day 8-14 use condoms
   - Day 15-21 take following pack back to back

Use condoms 7 days after gastroenteritis

Question 2

Progesterone only pill

Answer 2

Work by local effect on cervical mucus and endometrium
= prevents implantation and sperm transport

Works within 48hrs so use condoms for 2 days
- If started day 1-5 of period, provides immediate protection

Question 3

Implanon

Answer 3

Effective immediate contracepton if inserted up to day 5
If after day 5, use condoms for 7 days

Lasts 3 years

Question 4

Depo injection

Answer 4

Injection every 12 weeks
Linked to weight gain
Takes 7 days to be effective

Question 5

IUD mirena

Answer 5

Effective 7 days after insertion
Reduction in menstrual blood loss
5 years

Question 6

Copper coil

Answer 6

Works for 10 years - starts right away because works by killing sperm
Periods can become heavier
Contraindications = Current STI or PID

Question 7

Women over 40 + UKMEC

Answer 7

COCP is UKMEC 2

ukmec 1 - no restriction
ukmec 2- adv outweight disadvantages
ukmec 3- disadvatnages outweight
ukmec 4- not allowed

Question 8

Emergency contraception

1. Levonogestrel
2. Ulipristal Acetate ella one
3. Copper Coil

Answer 8

1. Levonogetrol works within 72 hours/ 3 days, less effective if BMI over 26.
2. Ella one works within 120 hours/ 5 days. Can only be used once per menstrual cycle. Cant use if BMI > 30.
   Contraception with pill affected for 5 days after
3. Copper Coil : inserted within 5 days of UPSI/ post latest date of ovulaiton

Question 9

Termination of pregnancy

Answer 9

1. Medical
   - Mifipristone = give 1st
   - Misoprostol 2nd as PROSToglandin = contract uterus

miFirst, MiSecond

2. Surgical
   Up to 14 weeks = manual vaccum
   After 14 weeks dialtation and evucation

Question 10

Combined patch evra

Combined hormonal vaginal rings

Answer 10

Both take for 3 weeks then have 1 week off

Question 11

Ectopic treatment
expectant

medical

surgical

Answer 11

Can only have expectant if NO symptoms and

1. An unruptured embryo
   2) <35mm in size
   3) Have no heartbeat
   4) Have a B-hCG level of <1,000IU/L and declining

Medical if <35mm and no fetal heartbeat
Give the patient methotrexate and can only be done if the patient is willing to attend follow up.

Surgical management can involve salpingectomy or salpingotomy and >35mm + higher risks