Contraception

Question 1

What classifications do the UKMEC use for contraceptive safety?

Answer 1

1 = A = always use
2 = B = benefits outweight risk
3 = C = caution
4 = D = do not use

Question 2

What are the short acting contraceptives?

Answer 2

Pills
Patches
Rings

Question 3

What are the benefits of the COCP?

Answer 3

Treats benign gynaecological conditions
Reduced risk of benign breast disease and benign ovarian cysts
Reduced risk of ovarian and endometrial cancer

Question 4

What are the risks of the COCP?

Answer 4

VTE
Ischaemic stroke
Increased risk of breast and cervical cancer

Question 5

What are some of the contraindications to the COCP?

Answer 5

Smoking + 35+y/o
BMI 35+
BP >140/90
Previous thrombotic event
1st degree relative with VTE
IHD
Previous ischaemic event
Breast cancer (personal hx)
BRCA carrier
Migraine with aura
Liver disease
Complex congenital heart disease
AF

Question 6

When should the POP be offered?

Answer 6

When pill taking is desired by patient but CHC is contraindicated

Question 7

What are the two types of progesterone only pill and what are their windows for pill-taking accuracy?

Answer 7

Low dose mini pill - 3 hours

Desogestrel - 12 hours

Question 8

What are the contraindications to the POP?

Answer 8

Current or personal history of breast cancer

Liver disease

Question 9

What are the long acting reversible contraceptives?

Answer 9

Mirena IUS (LNG-IUS)
Copper IUD
Depo-Provera
Implant

Question 10

What are the primary and secondary modes of action of the copper IUD?

Answer 10

Primary: copper ion toxicity on sperm
Secondary: makes the endometrium unfavorable for implantation

Question 11

Describe the bleeding pattern in the Cu-IUD?

Answer 11

Heavier but regular periods.

Initially there may be some intermenstrual spotting.

Question 12

How long can the Cu-IUD be used for?

Answer 12

5-10 years depending on brand.

If fitted over 40y/o, it can remain inserted until the menopause is complete.

Question 13

What hormone is present in the LNG-IUS (Mirena)?

Answer 13

Levonorgestrel

Question 14

What is the mode of action of the LNG-IUS?

Answer 14

Thickens cervical mucus
Prevents endometrial proliferation
Prevents ovulation in SOME women
Local effect of foreign body in uterus

Question 15

What is the bleeding pattern in the LNG-IUS?

Answer 15

Irregular bleeding initially

Eventually, most women are amenorrhoeic

Question 16

How long can the different types of LNG-IUS be used for?

Answer 16

Mirena: 5 years
Levosert: 5 years
Jaydess: 3 years
Kyleena: 5 years

Question 17

What are the contraindications to IUD and IUS fittings?

Answer 17

Pregnancy
Undiagnosed bleeding
Cervical or uterine cancer (pre-treatment)
Active PID
Asymptomatic chlamydia
Uterine fibroids
Molar pregnancy
Long QT syndrome

Question 18

What is the most important factor when timing an IUD or IUS insertion?

Answer 18

Exclude a possible pregnancy

Question 19

When should an IUD or IUS be inserted?

Answer 19

Currently menstruating
Abstinence following LMP
Using another reliable method of contraception
No sex in last 3 weeks and PT is negative

Question 20

What are the complications of IUDs and IUS?

Answer 20

Vasovagal during insertion process
Expulsion
Perforation

Question 21

What is expulsion of IUD/IUS more likely to occur?

Answer 21

In first 3/12 after fitting

With heavy menstruation

Question 22

When is perforation with IUD/IUS most likely to occur?

Answer 22

Post-natal period in lactating women

Question 23

Does the IUD cause pelvic infections?

Answer 23

NO - the risk of contracting a pelvic infection is higher ONLY in the 3/52 following insertion

Question 24

What are the risks with IUD and IUS?

Answer 24

Ectopic pregnancy - if a pregnancy does occur it is more likely to be ectopic

Question 25

What happens if an intrauterine pregnancy occurs with an IUD or IUS in-situ?

Answer 25

The pregnancy can continue There is a higher risk of miscarriage The IUD/IUS can be removed if the strings can be seen prior to 12wks gestation

Question 26

What are is the mnemonic which should be used when counselling a patient about IUD and IUS insertion and use?

Answer 26

``` E and 6P's Expulsion Pregnancy (failure rate and risk of ectopic) Perforation Periods PID Procedure Progestogenic side effects (for IUS only; acne, mood changed) ```

Question 27

What is Nexplanon?

Answer 27

Progestogen implant

Question 28

What is the mode of action for the progestogen implant?

Answer 28

Prevents ovulation Thickens cervical mucus Reduces endometrial receptivity

Question 29

What is the bleeding pattern with the implant?

Answer 29

Variable: from spotting to amenorrhoea.

Question 30

What are the side effects of the implant?

Answer 30

Progestogenic side effects: acne, mood swings.

Question 31

What are the contraindications to the implant?

Answer 31

Current or active breast cancer Current use of enzyme inducers Liver disease

Question 32

What are the types of progestogen only injection called, how are they given and how long do they last?

Answer 32

Depo-Provera - IM injection - Given every 12 weeks, effective for up to 14 weeks Sayana Press - SC injection - Given every 13 weeks, effective up to 14 weeks

Question 33

What is the bleeding pattern of the progetogen injection?

Answer 33

Irregular bleeding at first | 70% of women will be amenorrhoeic by 1yr

Question 34

What are the side effects of the progestogen injection

Answer 34

Progestogenic side effects Weight gain (3kg in 2 years) Effect on bone mineral density - if use is less than 5 years, will recover

Question 35

What are the contraindications for the progestogen injection?

Answer 35

Breast cancer Multiple RF for CV disease Liver disease RF for osteoporosis

Question 36

Describe male sterilisation, the procedure and failure rate

Answer 36

Occlusion of the vas deferens, done under LA | Failure rate 1/2000

Question 37

Describe female sterilisation, the procedure and failure rate

Answer 37

Blocking or sealing of the fallopian tubes. Laparascopic - under GA Hysteroscopic - under LA Failure rate 1/200

Question 38

When does implantation occur?

Answer 38

Between 6 and 12 days post-fertilisation

Question 39

Define post-coital contraception

Answer 39

Intervening between 120hrs (day 5 of fertilisation)

Question 40

What are the indications for emergency contraception?

Answer 40

UPSI on any day of natural menstrual cycle UPSI from day 21 post-partum UPSI from day 5 after termination, miscarriage or ectopic management Compromisation of regular contraception

Question 41

What are the three emergency contraceptives?

Answer 41

Copper IUD Levonorgestrel Ullipristal acetate (aka EllaOne)

Question 42

When can the copper IUD be fitted as an emergency contraception?

Answer 42

5 days after earliest expected ovulation OR First UPSI in the cycle

Question 43

How does levonorgestrel work as emergency contraception?

Answer 43

Inhibits ovulation

Question 44

What is the dose of levonorgestrel as an emergency contraceptive?

Answer 44

1500mcg

Question 45

What is the efficacy period of levonorgestrel as an enzyme inducer?

Answer 45

Licensed up to 72hrs post UPSI | Can be effective up to 96hrs (4 days)

Question 46

What type of drug is ulipristal acetate?

Answer 46

Selective progesterone receptor modulator (SPRM)

Question 47

What is the correct dose of EllaOne for emergency contraception?

Answer 47

30mg

Question 48

What is the mode of action for EllaOne?

Answer 48

Inhibition or delay of ovulation - even if ovulation has already begun

Question 49

What is the efficacy period of ulipristal acetate as an emergency contraceptive?

Answer 49

Up to 120hrs post UPSI

Question 50

What drugs may affect the efficacy of EllaOne?

Answer 50

Oestrogens, if taken 7 days prior to or 5 days post emergency contraception