Contraception

Question 1

What is the most effective form of contraception?

Answer 1

Hormonal contraception however it is linked with various major and minor side effects.

Question 2

Give some examples of barrier contraception.

Answer 2

Condoms, diaphragms, caps.

Question 3

What hormones are included in combined hormonal contraception preparations?

Answer 3

Oestrogen and progestogen.

Question 4

What are the advantages to combined hormonal contraception preparations?

Answer 4

Reliable and reversible. Reduced dysmenorrhoea and menorrhagia. Reduced incidence of premenstrual tension. Fewer symptomatic fibroids and functional ovarian cysts. Less benign breast disease. Reduce risk of ovarian and endometrial cancer. Reduced risk of pelvic inflammatory disease.

Question 5

When choosing which CHC preparation to use, what is the key consideration?

Answer 5

To choose a preparation with the lowest oestrogen and progestogen content which gives good cycle control and minimal side effects.

Question 6

Above what age are CHC preparations not recommended and why?

Answer 6

Above the age of 50 as other more appropriate alternatives are available.

Question 7

Low strength CHC preparations are most appropriate for which women? What may also be considered?

Answer 7

Women with risk factors for circulatory disease. See progestogen only preparations.

Question 8

Which drugs may be considered to replace CHC preparations if the patient experiences side effects such as acne, headaches, depression, breast symptoms, breakthrough bleeding?

Answer 8

Desogestrel, drospirenone, gestodene (in combination with ethinylestradiol).

Question 9

What are some reasons to stop CHC immediately?

Answer 9

Sudden severe chest pain. Sudden breathlessness or cough with blood. Unexplained swelling or severe pain in one leg. Severe stomach pain. Serious neurological effects. Hepatitis, jaundice, liver enlargement. Blood pressure above systolic 160 mmHg or diastolic 95 mmHg. Prolonged immobility after surgery or leg injury. Detection of contraindicatory risk factors.

Question 10

How may the increased risk of VTE when patients on CHC travel for long periods (3 hours +) be mitigated?

Answer 10

By appropriate exercise and use of graduated compression hosiery.

Question 11

There is a risk of VTE when using CHC. Which factors would lead to increased caution when using?

Answer 11

Family history of VTE in first degree relative aged under 45 years. Obesity (avoid if BMI greater than 35). Long-term immobility. History of superficial thrombophlebitis. Age over 35 years. Smoking.

Question 12

Which factors increase the risk of arterial disease when using CHC?

Answer 12

Family history of arterial disease in first degree relative under 45 years. Diabetes mellitus. Hypertension (BP over 160/95). Smoking. Age over 35 years. Obesity. Migraine without aura (avoid if aura).

Question 13

There is a small increase in the risk of breast cancer in women taking CHC. How long after stopping does the risk diminish and then disappear?

Answer 13

The risk diminishes after stopping and disappears after 10 years.

Question 14

Use of CHC for how long is associated with a small increase in the risk of cervical cancer? How does the risk diminish?

Answer 14

Use for 5 years or more is associated with an increased risk of cervical cancer. The risk diminishes after stopping and disappears by about 10 years.

Question 15

When is the risk of losing contraceptive protection greatest with regards to missing a pill?

Answer 15

When the pill is omitted at the start or end of the cycle.

Question 16

Define a missed contraceptive pill?

Answer 16

One that is 24 hours or more late.

Question 17

What should a woman do if they miss only one pill?

Answer 17

They should take an active pill as soon as they remember and then resume normal pill taking (even if this means taking two pills together). No other precautions should be taken.

Question 18

What should a woman do if they miss two or more pills (especially from the first 7 in the pack)?

Answer 18

They may not be protected. They should take an active pill as soon as they remember and then resume normal pill taking. As they may not be protected, additional barrier methods or abstinence should be used for the next seven days. If these seven days run past the end of the pack, the next should be started whilst omitting the pill-free period.

Question 19

When should emergency contraception be considered with regards to missed contraceptive pills?

Answer 19

If two or more COC tablets have been missed from the first 7 of the pack and unprotected intercourse has occurred.

Question 20

What course of action should be taken if a woman on COC vomits within 2 hours of taking their pill?

Answer 20

Another pill should be taken as soon as possible.

Question 21

What course of action should be taken if a patient on COC experiences persistent vomiting or diarrhoea lasting over 24 hours?

Answer 21

Additional contraceptive measures should be taken for 7 days after recovery. If the vomiting or diarrhoea occurs in the last seven tablets, the pill free period should be omitted.

Question 22

When are progestogen only pills preferred to COC pills?

Answer 22

In those with VTE or a history. Heavy smokers. Hypertension above 160/95 mmHg. Valvular heart disease. Diabetes mellitus w/ complications. Migraine w/ aura.

Question 23

Which two drugs are seen in hormonal emergency contraception preparations?

Answer 23

Levonorgestrel and ulipristal.

Question 24

When are levonorgestrel EHC preparations effective?

Answer 24

If taken within 72 hours after unprotected sex.

Question 25

When are ulipristal EHC preparations effective?

Answer 25

If taken within 120 hours (5 days).

Question 26

What is the timeframe for the insertion of an intrauterine device for EC purposes for it to be effective?

Answer 26

120 hours (5 days).

Question 27

If unprotected sex occurs over 5 days before the insertion of an IUD for EC, what should be done?

Answer 27

The device can still be inserted up to 5 days after the earliest likely calculated ovulation.

Question 28

What other measures should be carried out when inserting an IUD for EC?

Answer 28

STI tests and Abx prophylaxis.

Question 29

What is the time frame for the risk of infection when inserting an IUD?

Answer 29

20 days from insertion, believed to be related to the existing carriage of an STI.

Question 30

What are the risk factors for developing an infection after insertion of an IUD?

Answer 30

Age under 25 years. Age over 25 years and have a new partner, or had over one partner in the past year, or their regular partner has other partners.

Question 31

What signs and symptoms indicate uterine perforation when using an IUD, requiring medical attention?

Answer 31

Severe pelvic pain, increased bleeding, period changes, pain during sex.