Contraception Flashcards

Question

List the UKMEC 4s for POP

Answer 1

Current breast cancer

Answer 2

Continuation of POP if IHD/stroke whilst on it Past breast cancer Severe (decompensated) liver cirrhosis Hepatocellular carcinoma/adenoma

Answer 3

Q/S, condoms 48hrs or day 1-5 of her next cycle and effective immediately

Answer 4

Q/S, condoms 48hrs or day 1-5 of her next cycle and effective immediately

Answer 5

Q/S, condoms 48hrs or day 1-5 of her next cycle and effective immediately Should consider EC IUD most effective Oral EC day 14 highest risk UPA and 5/7 delay to start condoms until POP 48hrs, PT 3/52 If unable to use condoms LNG EC and immediate Q/S condoms 48hrs and PT 3/52

Answer 6

She should continue her CHC until taken for 7 consecutive days then may start the POP on day 8 and no additional precautions are needed

Answer 7

She should restart her CHC for 7 days and then on the 8th day can switch to POP with no additional precautions are needed7 Rationale: UPSI since HFI starting ad not on day 1-2 of HFI.

Answer 8

Start POP today, no additional precautions required Rationale day 1-2 of HFI can q/s any method without EPs except IUS which can only q/s on day 1 of HFI without continuing method 7/7/

Answer 9

Start POP today, no additional precautions required Rationale week 2&3 of CHC can q/s any method without EP

Answer 10

None, POP is effective immediately of Q/S on the day of implant removal.

Answer 11

She should use condoms/abstain for 48hrs, pregnancy test today and 3/52 after the UPSI.

Answer 12

She should use condoms/abstain for 48hrs, pregnancy test today if negative no repeat needed as will be accurate

Answer 13

she should use condoms/abstain for 48hrs, no pregnancy testing required

Answer 14

Effective immediately, no EP needed

Answer 15

Effective immediately, no EP needed rationale: depo effective up to 13w6d therefore effective immediately, no EP needed

Answer 16

Condoms/abstain 48hrs. EC/PT not required as LSI within 13w6d

Answer 17

Should be offered EC, can have IUD. If declines discussed depo vs POP in q/s situation (no known fetal impact from depo but guideline suggests consider alternative) If accepts depo UPA EC and delay q/s 5/7 and condoms until depo insitu 7/7 (ie 13/7 from today) or if wants depo today LNG EC (although OOL as >72hrs) and q/s depo, condoms 7/7 PT 3/52 post last upsi

Answer 18

condoms for 48hrs after starting POP.

Answer 19

start pop today and keep the IUS a further 3/7 (7/7 no UPSI pre IUC removal). If she insists on immediate removal, LNG EC and q/s POP, EP 48hrs Can't have UPA as progestin use in IUS.

Answer 20

PT today and 3/52 after UPSI, remove and q/s, 48hrs EP. Technically out of date, hence the PT although failure rate likely to be low.

Answer 21

condoms for 48hrs after starting POP. Levosert licenced 6 years

Answer 22

Remove today and condoms from today

Answer 23

Keep until no UPSI >7/7 pre IUD removal - high risk of pregnancy given mid cycle LSI If would like immediate removal today offer EC (UPA unless CI) if not planning pregnancy and PT 3/52, condoms from today.

Answer 24

remove and condoms from today as LSI before LMP

Answer 25

PT today and if negative condoms/abstain 48hrs (LSI >3/52 ago, pt accurate)

Answer 26

PT today and in a week (3/52 since LSI), condoms 48hrs

Answer 27

May improve dysmenorrhea, potential to help with cyclical symptoms (eg mood/skin)

Answer 28

>5mg/day metabolises to EE (15mg/day = ~30mcg EE) so caution in VTE risk. However 350mcg unlikely to have effect.

Answer 29

1/10 although absolute risk is low.

Answer 30

Increase. For all progestin only methods of contraception, it is not uncommon for women using POPs to experience persistent ovarian follicles (ovarian cysts)

Answer 31

average time to ovulation is 17.2 days after stopping DSG.

Answer 32

5 in 10 women can expect to be amenorrhoeic or have infrequent bleeding 4 in 10 women can expect to have 3–5 bleeding spotting/episodes (regular) 1 in 10 women can expect >6 bleeding/spotting episodes (frequent bleeding). In addition: 2 in 10 women will experience bleeding/spotting episode lasting >14 days (prolonged bleeding).

Answer 33

Traditional POP users can be advised that frequent and irregular bleeding are common, while prolonged bleeding and amenorrhea are less likely 50–70% of cycles in women using the POP will be of ‘normal’ length, i.e. between 25 and 35 days; 25% of cycles will be shortened 5–10% of women will have persistent amenorrhoea

Answer 34

No evidence but if would like to try alternative it's reasonable

Answer 35

Contraception may be stopped age 55 with no further tests. If she would like to stop sooner, a woman who is amen on progestin only contraception can have their FSH levels checked, if >30iu/l continue contraception 1year, no need to repeat fsh

Answer 36

No continue for 6/12 if no further periods then can stop. <50 yo continue contraception until 2years or more after LMP

Answer 37

Yes can stop. >50 yo continue contraception until 1 year or more after LMP

Answer 38

Medical hx, medications (esp LEI), O&G hx, STI risk, allergies, previous contraception use. How to take; same time daily, no more than 12hrs late D&V V <2hrs, severe D Missed pills >12hrs late condoms 48hrs after restarting if UPSI after missed pill EC Risks minimal - hair, skin, mood, weight normally ok Bleeding pattern (50% amen, the rest frequent or infrequent irregular or prolonged) BMI and BP not strictly needed but helpful to compare if complain of gain in weight. 12/12 supply.

Answer 39

taking correctly, other mediations, ensure absorption, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or new onset). If all NAD reassure, consider switching method or alternative POP. Guidelines: no evidence for double DSG although often done OOL (small case series suggest 80% amen), no evidence for oestregen/TXA/mefenamic acid/vit C.

Answer 40

taking correctly, other mediations, ensure absorption, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or new onset). Consider EB (+/- hysteroscopy and USS) rationale: >45 and persistent BTB

Answer 41

taking correctly, other mediations, ensure absorption, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or new onset). Consider EB (+/- hysteroscopy and USS) rationale: >45 and change in bleeding pattern

Answer 42

taking correctly, other mediations, ensure absorption, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or new onset). OOL 150mcg DSG POP (not in guideline - exam will probably not use this!!) or switch if unhappy with spotting. Consider USS & EB Rationale: <45 and risk factors for endometrial hyperplasia - although likely iatrogenic secondary to DSG POP.

Answer 43

taking correctly, other mediations, ensure absorption, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, don't need to examine unless pain, heavy bleeds/dysparunia. If all NAD reassure, may settle with time and f/u in a couple of month - if persistent examine and if NAD reassure/change method if desired.

Answer 44

C 19 norethisterone derivative (gonane)

Answer 45

C 19-nortestosterone derivative (estrane)

Answer 46

C 19 norethisterone derivative (gonane)

Answer 47

17-hydroxyprogesterone derivatives (pregnane) (closest to progesterone)

Answer 48

Cyproterone, Drospirenone, Dienogest, Nomegestrol

Answer 49

levonorgestrel, NET DGS/gestrodene Drospirenone (Dienogest - qlaira) Cyproterone

Answer 50

levonorgestrel, NET DGS/gestrodene Drospirenone Cyproterone

Answer 51

2 per 10000 women years

Answer 52

5-7 per 10000 women years

Answer 53

9-12 per 10000 women years

Answer 54

9-12 per 10000 women years

Answer 55

6-12 per 10000 women years

Answer 56

6-12 per 10000 women years

Answer 57

17 -spirolactone (spironolactone has anti mineral corticoid effects) anti-androgenic potency is about 1/3 of cyproterone acetate

Answer 58

hybrid of 19-nortestosterone and progesterone derivatives. has a pronounced progestogenic effect on the endometrium with little affinity for oestrogen, glucocorticoid and mineralocorticoid receptors. Its anti-androgenicactivity is approximately 30% of that exhibited by cyproterone acetate Licenced for HMB and endometriosis alone or in combination with estradiol valerate

Answer 59

current breast cancer

Answer 60

Multiple risk factors for cardiovascular disease (CVD) Vascular disease (including coronary heart disease (CHD), pulmonary vascular disease (PVD), transient ischaemic attack (TIA) and hypertensive retinopathy) Current and history of ischaemic heart disease Stroke Unexplained vaginal bleeding Severe decompensated cirrhosis Benign hepatocellular adenoma Malignant hepatocellular carcinoma Past breast cancer

Answer 61

inhibits ovulation - primary MOA at pituitary level Cx mucus effect endomtrial changes

Answer 62

some evidence of weight gain - Women who gain more than 5% of their baseline body weight in the first 6 months of DMPA use are likely to experience continued weight gain. <18yo or BMI >30 are risk factors for weight gain of DMPA

Answer 63

Can be irregular, longer it is given for the more likely it is to cause amenorrhea 3/12: 10% amen 12/12: 40% amen 24/12: 68% amen

Answer 64

8 weekly, rarely used in UK

Answer 65

weight gain, reduced (reversible) BMD, weak link to ca Cx, injection site reaction, headache (x 2), mood change (limited evidence but possible)

Answer 66

age (<18/>45), smoker, Fhx of osteoporosis, low BMI, poor dietary intake, drugs (cabamazipine, HIV meds, valproate)

Answer 67

risk of developing osteoporosis in the next 10 years

Answer 68

age, sex, BMI, previous fracture, parents hip facture, smoker, glucocorticoids, rheumatoid arthritis, ETOH >3 units/day, BMD hip (if had dexa) secondary osteoporosis risk factors (eating disorder, thyroid disorder, POI, malnutrition, T1DM)

Answer 69

unfavourable; increases LDL and decreases HDL

Answer 70

possible increased fasting glucose but poor studies there for not causal Diabetics don't seem to have worsening of glucose control on it.

Answer 71

reversible reduction, most loss in first year or 2 of use. But not causal link with fracture In >18s 1.7-4.1% loss hip/spine/femoral at 2 years and up to 7% at 5 years. In <18s 2.5-3% loss of hip/spine/femoral head in first year of use and 2-6% loss hip/spine/femoral head by year 4. Compared to non-users who have a 2-6% increase hip/spine/femoral over 4 years. On average, adult women who use Depo have a BMD that is similar to that of non-Depo users within two to three years after stopping the injections

Answer 72

within 2-3 years

Answer 73

BMD risk, as at least 90 percent of peak bone mass is developed by age 18 and BMD starts to decline after 30yo

Answer 74

Medical hx, medications (esp LEI), O&G hx, STI risk, allergies, previous contraception use. preg risk and STI risk. Family plans (delayed return to fertility) BMI (BP not needed), How to take Failure rate Drug interactions (UPA) Side effects Bleeding pattern Missed dose Info about syanna press and IM, if syanna press chosen discuss lipoatrophy risk

Answer 75

happy, SEs, bleeding, weight enquiry, medical hx 2 yearly osteoporosis risk. BMI

Answer 76

no increase

Answer 77

UOQ dursogluteal or ventrogluteal If raised BMI consider deltoid as risk of non-IM administration

Answer 78

abdomen or upper thighs

Answer 79

day 1-5 natural cycle up to day 5 after early pregnancy loss Up to day 21 post delivery LMA criteria met but must continue LAM 7/7

Answer 80

effective immediately, no EP required.

Answer 81

Q/S 7/7 EP

Answer 82

can Q/S DMPA if doesn't want alternative bridging method. >5/7 since USPI therefore EC inappropriate PT today and if negative give depo and home PT 3/52. Condoms 7/7

Answer 83

can Q/S DMPA if doesn't want alternative bridging method. Offer LNG EC (circulating ENG levels may impact on UPA efficacy, IUD not suitable as preg risk) PT today and if negative give depo and home PT 3/52. Condoms 7/7

Answer 84

Q/S 7/7 EP

Answer 85

PT today, if neg Q/S 7/7 EP

Answer 86

Offer EC IUD suitable, if declines can Q/S DMPA if doesn't want alternative bridging method. Offer LNG EC (circulating ENG levels may impact on UPA efficacy, IUD not suitable as preg risk) PT today and if negative give depo and home PT 3/52. Condoms 7/7

Answer 87

effective immediately, no EP required

Answer 88

continue POP 7/7 or condoms 7/7 (cx mucus thickening only for traditional pop therefore time to effect)

Answer 89

No EC or PT needed as LSI whilst depo indate 7/7 EP as out of timeframe.

Answer 90

Too late for EC PT 3/52 can Q/S DMPA if doesn't want alternative bridging method.

Answer 91

Can remove today and start depo but 7/7 condom/abstain or depo today and rebook for ius removal 7/7 if doesn't wish condoms and planning SI.

Answer 92

depo today and rebook for ius removal 7/7 then no EP required. If wishes removal today offer oral EC and Q/S.

Answer 93

effective immediately, no EP required (day 1-5 of natural cycle)

Answer 94

Can remove today and start depo but 7/7 condom/abstain or depo today and rebook for iud removal 7/7 if doesn't wish condoms and planning SI.

Answer 95

depo today and rebook for iud removal 7/7 If wants removal today offer oral EC and QS.

Answer 96

ensure taking correctly, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (as >3/12 btb) Reassure may settle with time, offer COC if not CI, can reduce dosing interval to 10/52, short term mefenamic acid or TXA but will only help whilst on it.

Answer 97

ensure taking correctly, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (as >3/12 btb) As >45, uss and endometrial biopsy warranted (also PCOS is a risk factor)

Answer 98

Can only use depo. When family complete offer steri. BMD risk of depo with carbamazepine, suggest vit d and calcium supplementation.

Answer 99

UKMEC 3 - would need to consult with local onc team, suggest IUS as lowest dose and better evidence for heavy periods (most onc teams happy to use IUS if PR negative) Until then IUD or barrier methods.

Answer 100

<100000 non-mobile sperm/ml seen

Answer 101

Continue using alternative contraception, repeat at 6-7 months, if this is still inadequate = vasectomy failure. Needs to be <100000 motile sperm/ml

Answer 102

<3 years 74% preg rate.

Answer 103

7 days, if in HFI or day one should take for another 7 days after HFI or omit HFI and take 7/7

Answer 104

Can be removed on the day

Answer 105

Perform procedure within licence of depo

Answer 106

Retain 7/7 if upsi in past week.

Answer 107

False, retain 7/7

Answer 108

tubal ligation/salpingectomy – clips more likely to fail as fallopian tubes enlarged (failure rate: clips 1.7/1000, ligation 0.4/1000)

Answer 109

Filsche clips

Answer 110

Imaging (XR or USS) 3/12 to confirm placement or HSG if unable to confirm with USS/XR.

Answer 111

<1% (0.4%)

Answer 112

Basal body temperature cervical secretions calendar method

Answer 113

Track cycle for 12 months, and -10 from longest cycle and – 20 from shortest cycle for no UPSI window. Eg woman with cycle between 27 and 32 days should avoid UPSI day 17-22.

Answer 114

As soon as cx secretions start until 4 days after peak egg white like secretions

Answer 115

Simplified cx secretion monitoring – avoid UPSI until 3 days of no secretions.

Answer 116

Daily temp (before getting up and after min 3hrs rest), avoid UPSI until temp raised for 3 days in a row.

Answer 117

For people with cycles 26-32 days avoid UPSI dy 8-19 of cycle. 12-20% failure rate with typical use, 5% failure with perfect use.

Answer 118

Estrone-3-glucuronide and LH. Persona

Answer 119

Many! Analgesia, tetracyclines, antihistamines to name a few.

Answer 120

<6/12 post delivery, fully breast feeding <4hrs in day, <6 hrs at night, no top up feeds or expressing, amenorrhea

Answer 121

98% perfect use

Answer 122

5% perfect, 21% typical

Answer 123

2% perfect use, 18% typical use

Answer 124

Oil based products, creams, lubes, vaginal oestrogen

Answer 125

13.7% perfect, 17.8% typical

Answer 126

Non-latex, one size fits 80%

Answer 127

6% perfect and 12% typical

Answer 128

Spermicidal gel

Answer 129

Insert with spermicidal gel and leave in for 6hrs after SI (can stay in for longer if convenient (caya 24hrs, diaphragm 30hrs, cap 48hrs), any further episodes of SI should have reapplication of gel if >3hrs since insertion (2hrs for caya) or if insertion >3hrs before should apply more gel before SI (2hrs for caya)

Answer 130

less than 6 weeks postpartum or if previously used a diaphragm size of 85 mm or larger, or 60 mm or smaller, caution if previous toxic shock syndrome with diaphragm or tampons.

Answer 131

Check in date, stored correctly, kite marked and pack intact. Open, squeeze out air, apply to erect penis and role down to base, leaving small area at the top for seamen, Remove before erection lost and away from female, dispose in bin.

Answer 132

1/1000 (0.1%)

Answer 133

Copper IUD (day 20 is 5/7 after earliest predicted ovulation), can offer UPA/LNG but unlikely to be effective.

Answer 134

Prevents fertilisation and implantation

Answer 135

Next period or 3/52 and negative PT if period not on time or irregular.

Answer 136

13 days (earliest ovulation is day 8, 8+5 = 13 for implantation prevention)

Answer 137

5/7 after first upsi since 14 weeks since last depo

Answer 138

5/7 after first UPSI since removal (if no USPI in the 5 days before removal as ovulation not inhibited)

Answer 139

Inhibits/delays follicular rupture thus ovulation up till LH surge. Some luteal phase dysfunction bit not known to change endometrium.

Answer 140

3mg (>70kg = double dose)

Answer 141

No evidence of either being superior/inferior.

Answer 142

4 x higher therefore double dose recommended.

Answer 143

Selective progesterone receptor modulator, delayed ovulation up till ~2hrs before and after LH surge has started

Answer 144

same up till 120hrs ~5% total failure

Answer 145

Gastric pH altered, breastfeeding (must discard 7/7), serve hepatic impairment (but a one off dose better than unplanned pregnancy), severe asthma on glucocorticoids (antimineralcorticoid effect)

Answer 146

LNG 3mg as on liver enzyme inducer UPA is CI.

Answer 147

Nausea, vomiting, delayed menses/irregular bleeding, hormonal SE.

Answer 148

UPA 20% (LNG 10%)

Answer 149

Home PT 3/52 after last UPSI if menses delayed by >7days, unusual bleeding (light/heavy), pain.

Answer 150

Ensure doesn’t want IUD, UPA again as more likely to work periovulation but could have LNG as >5/7 since UPA.

Answer 151

EC - can have IUD (<13/7 since last CHC) or either oral (>7/7 since progestin). If IUD declined; Q/S CHC (if offering UPA wait 5/7 to q/s) condoms 7/7 Discuss LARC/memory aids for COC and requesting more. Check STI risk.

Answer 152

EC - can have IUD (<13/7 since last CHC) or either oral (>7/7 since progestin), if If IUD declined; Q/S CHC (if offering UPA wait 5/7 to q/s) condoms/abstain 7/7 of LNG EC 13/7 if UPA EC. Discuss LARC/memory aids for COC and requesting more. Check STI risk.

Answer 153

ENG release rate reduces gradually over time, from 60–70 µg/day in weeks 5–6 to 35–45 µg/day at the end of the first year, and 25–30 µg/day at the end of the third year

Answer 154

90 pg/m, within 24hrs

Answer 155

Current breast cancer

Answer 156

Current and history of ischaemic heart disease continuation (UKMEC2 for initiation) History of stroke continuation (UKMEC2 for initiation) Unexplained vaginal bleeding (before evaluation) Past breast cancer Severe (decompensated) cirrhosis Hepatocellular adenoma or carcinoma

Answer 157

Inhibits ovulation secondary: cx mucus effect and endometrial change

Answer 158

1999 until 2010

Answer 159

No evidence of reduction due to BMI. (some evidence they may have more problem bleeding)

Answer 160

ovulation supressed but some background follicular activity continues with variable oestradiol levels - usually in the early follicular range.

Answer 161

Likely to improve dysmenorrhea (70%+ improvement) Hair/skin/mood/libido - no good evidence. May improve or worsen. HMB/endo - no good evidence - may improve.

Answer 162

Liver enzyme inducers and Griseofulvin reduce contraception efficacy. (lamotrigine/implant no impact)

Answer 163

Not required for amenorrhea on any progestin only contraception Endometrium likely to be thinned on the implant, and oestrogen not unopposed as progestin in circulation

Answer 164

No evidence of increase But evidence is limited; RR 1.4. If stroke on implant UKMEC 3

Answer 165

No evidence But evidence is limited; RR 2.14. If MI on implant UKMEC 3

Answer 166

No evidence Some studies suggest may decrease a little but not causal link to fracture risk

Answer 167

No evidence of increased risk But evidence is limited. Analysis of all methods of contraception suggests RR of ca breast is 1.2 but this increased CHC.

Answer 168

No evidence of increased risk But evidence is limited. Endometrium is thinned with a thickness of 3.3mm after 12/12 use (11.3mm average pre-implant)

Answer 169

No evidence of increased risk But evidence is limited.

Answer 170

No evidence of increased risk But evidence is limited. RR for ovarian cancer and use of all progestin contraception is 0.72

Answer 171

Absolute risk is reduced as unlikely to get pregnant 2-5% of pregnancies on implant will be ectopic (background ectopic rate in UK is 1%)

Answer 172

Not fully understood The endometrial glands, stroma and vasculature are continuously exposed to progestogen and, at the same time, fluctuating levels of estrogen resulting from incomplete ovarian suppression. It is thought that this disturbs endometrial angiogenesis, resulting in thin-walled, distended, fragile superficial microvessels that bleed easily when subjected to minor stretching stresses. Progestogen exposure may cause the covering surface epithelium to detach from the underlying stroma, allowing subepithelial bleeds to become overt. Epithelial repair mechanisms may be defective, permitting light bleeding to persist

Answer 173

Unpredictable! Studies vary with reference periods and time. Typically= ~20% amen ~40% normal ~10% frequent ~ 30% infrequent ~ 20% prolonged (can be infrequent, frequent or normal frequency)

Answer 174

Likely to change from natural cycle Unpredictable during life span of implant May improve with time but first 3/12 use broadly predictive Less total days bleeding than a natural cycle or pill but not predictable. Can have medicines to try to settle bleeding instead of removal if would like to keep the implant

Answer 175

ensure palpable, check for drug interactions, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or pain/dysparunia) If >45, endometrial biopsy warranted or if <45 an risk factors for endometrial ca

Answer 176

ensure palpable, check for drug interactions, cx screening up to date, impact on life and what she would like to do about it if it's a SE and pathology excluded. STI screen, PT, examine to assess cx (if >3/12 btb or pain/dysparunia) As >45, if STI/PT and cx negative, endometrial biopsy warranted

Answer 177

COC if no CI for 3/12(can extend COC use according to professional judgement) Mefenamic acid 500 mg three times daily for 5 days may be considered Desogestrel POP - no evidence but common practice. There is evidence for tamoxifen, mifepristone and UPA but possible reduced efficacy of contraception and expensive Doxycycline - conflicting evidence

Answer 178

Variable - better/worse/same 4% users discontinue due to acne implant users report 17% acne compared to IUD 13% Existing acne: 60% improve 30% same 10% worse

Answer 179

No causative association 1.6% users discontinue due to headache

Answer 180

No evidence base of weight gain

Answer 181

Safe to do today if PT neg, EC not required (failure rate in year 4 comparable to COC/POP use), condoms 7/7, pt 3/52

Answer 182

No EC not required (failure rate in year 4 comparable to COC/POP use)

Answer 183

Yes, LNG EC Condoms 7/7, follow up PT

Answer 184

Safe, effective immediately.

Answer 185

No EC, 7 days until effective

Answer 186

No PT/EC required Continue CHC 7/7 after HFI

Answer 187

No EC or PT required Either condoms 7/7 or continue CHC 7/7 after HFI

Answer 188

Effective immediately No EC or PT required

Answer 189

Effective immediately No EC or PT required

Answer 190

continue CHC 7/7 No EC or PT required

Answer 191

No EC or PT required Either condoms 7/7 or continue CHC 7/7 after HFI

Answer 192

No EC or PT required Effective immediately

Answer 193

LNG EC, unable to offer UPA (interaction) or IUD (??when ovulation would happen with sporadic CHC use) Q/S implant and condoms 7/7 (efficacy of CHC not good) F/U PT

Answer 194

No EC required PT today (accurate) q/s implant condoms 7/7

Answer 195

No EC/PT required (<13w6d since last depo) Effective immediately

Answer 196

EC today (LNG or IUD), q/s implant, condoms 7/7, pt 3/52

Answer 197

PT today (accurate), q/s implant, condoms 7/7 No f/u PT, no EC.

Answer 198

No EC or PT Q/S implant and continue pop 7/7 or condoms 7/7

Answer 199

No EC or PT Implant effective immediately

Answer 200

Not eligible for EC PT today and 3/52 Q/S implant and condoms 7/7 (in theory if has used POP correctly for 48hrs could also continue POP 7/7 as alternative to condoms but forgetful already)

Answer 201

PT today and 3/52 Q/S implant and condoms 7/7 (in theory if has used POP correctly for 48hrs could also continue POP 7/7 as alternative to condoms but forgetful already)

Answer 202

Keep ius 7/7 No PT, no EC

Answer 203

condoms 7/7 or keep IUS 7/7

Answer 204

PT today Condoms or retain IUS 7/7 Consider PT 3/52 after LSI year 5-7 use rules only applies to 52mg IUS not 19.5mg or 13.5mg

Answer 205

PT today Condoms AND retain IUS 7/7 Consider PT 3/52 year 5-7 use rules only applies to 52mg IUS not 19.5mg or 13.5mg

Answer 206

PT, EC, Condoms for 7 days (consider retaining IUS as UPSI ≤7 days ago) PT 3/52 after UPSI

Answer 207

PT today if neg q/s and condoms 7/7, Can remove IUS today.

Answer 208

8–10 cm proximally from the medial epicondyle along the sulcal line and then 3–5 cm posteriorly (over triceps), perpendicular to the sulcal line.

Answer 209

No maximum as only as new tract via incision site

Answer 210

No need to replace early but when due should move to new position

Answer 211

No need to replace early if definitely in situ but will need deep implant specialist removal

Answer 212

EC if required, bridge with POP (could fit new implant in other arm but can cause difficulty locating old one if not clear which are it is in and if etonogestrel levels are required) and refer to deep implant service to locate and remove

Answer 213

Safe to fit, EC not required, PT on the IUS fit day MUST be negative, Condoms for 7 days. PT 21 days after last UPSI

Answer 214

safe to fit if PT negative, condoms 7/7 No EC, No FU PT

Answer 215

safe to fit if PT negative, condoms 7/7 No EC, No FU PT

Answer 216

Consider EC Delay insertion until pregnancy excluded by negative PT 21 days after last UPSI consider bridging method

Answer 217

Start immediately Condoms for 2 days PT 21 days after last UPSI

Answer 218

Insert immediately (PT MUST be negative) No additional precautions Consider PT 21 days after last UPSI

Answer 219

Insert immediately (PT MUST be negative) No additional precautions

Answer 220

If UPSI between 5 and 21 days ago, delay insertion until pregnancy excluded by negative PT 21 days after last UPSI Consider oral EC Consider bridging method

Answer 221

If all UPSI either ≥21 days ago or <5 days ago, insert immediately (As EC IUD)

Answer 222

Ok to fit in community but delay until >2/52 (loading dose is higher), fit just before the time she takes the apixiban, counsel about bruising and bleeding

Answer 223

>50x10^9/L

Answer 224

technically no, pt may prefer.

Answer 225

EC/bridge/PT USS or XR to locate - if present refer deep implant service If not present serum etonogestrel level - if present MRI to locate if not present implant not in situ.

Answer 226

No known harm to fetus but accepted practice to remove. Case by case MDT discussion about keeping as postnatal contraception if pt accepts. Unlikely true failure

Answer 227

assess for cause of failure, if true failure consider alternative method as may fail again.

Answer 228

Check INR 72hrs pre-fit. INR >3.5 fit in hospital observe 30min post fit Do not stop warfarin without haem input Advise against NSAID use (increases bleeding)

Answer 229

Don't fit in first 2/52 apixaban use (bleeding risk higher) Fit shortly before dose due (tough level) observe 30min post fit Do not stop NOAC without haem input Advise against NSAID use (increases bleeding)

Answer 230

effective immediately

Answer 231

Can change today if PT neg, needs to abstain 7/7 and PT 3/52 Year 5-7 this is acceptable.

Answer 232

delay change until abstained/condoms 7/7, then effective immediately if unable to abstain/use condoms consider short term POP

Answer 233

day 1-5 cycle (technically SPC states up to day 7 but FSRH switching guide = day 5) CHC Day 1 HFI or week 2-3 POP DSG Indate IUS to IUS IUD day 1-5 cycle (technically SPC states up to day 7 but FSRH switching guide = day 5) up to 5/7 post early preg loss (technically SPC states up to day 7 but FSRH switching guide = day 5) up to day 21 post delivery (although shouldn't be fitted 48hrs-28days due to perf risk) LAM criteria met Indate implant Indate depo

Answer 234

Endometrial thinning Possible cx mucus and foreign body effect

Answer 235

52mg 20mcg --> 5mcg at 5 years 19.5mg 17.5mcg --> 7.4mcg at 5 years 13.5mg 14mcg --> 5mcg at 3 years

Answer 236

52mg 25% amen, rest irregular usually infrequent after the first few months of use 19.5mg 12-19--22% amen (year 1-5), rest irregular usually infrequent after the first few months of use 13.5mg ~13% amen, 20% infrequent, 4-12% frequent, 15-25% Irregular bleeding, 2-14% prolonged

Answer 237

Irregular bleeding, ovarian cysts (~10%), abdo pain, expulsion, breast tenderness, No evidence for hair/skin/mood - individual

Answer 238

Delay fitting and treat - risk of severe infection/nec

Answer 239

Doesn't require treatment unless preg related. No need to delay fitting

Answer 240

This is her last one! If fitted after 45yo can remain until 55 when infertility is assumed, if using for HRT must be <5 years old.

Answer 241

Leave in situ! If fitted after 45yo can remain until 55 when infertility is assumed, if using for HRT must be <5 years old.

Answer 242

PT and examine to assess for tenderness and visible threads, if all NAD likely to settle with time, if continuing 3-6/12 post insertion consider USS to ensure correctly sited.

Answer 243

no evidence of increased risk

Answer 244

Possible association with recurrence, non-hormonal methods advised and discussion with breast/onc team but usually is progesterone receptor negative breast ca - then IUS is acceptable for contraception/HMB/endo hyperplasia without atypia tx

Answer 245

Pain, bleeding, infection (PID 0.5%), perforation (1-2/1000 non-breastfeeding), expulsion (5%), vasovagal/cx shock

Answer 246

Unpredictable bleeding, hormonal SE, abdo pain ectopic pregnancy, NVT

Answer 247

No association Although candida biofilm possible

Answer 248

4-6/52 speculum Long threads - trim Device partially expelled (remove and replace if safe) NVT - EC/bridge/USS

Answer 249

Self check threads; routine coil checks not recommended

Answer 250

Cervical block - good evidence Instillagel - no evidence NSAIDs no evidence but post procedure pain reduced

Answer 251

Nil - misoprostol SE Expert opinion progestins soften - if unable to fit bridge with POP and return often easier.

Answer 252

No, use no touch technique

Answer 253

Absolute risk low, but up to 50% pregnancies with IUC in situ will be ectopic

Answer 254

Levosert 4.8mm Mirena 4.4mm Kyleena/Jaydress 3.8mm

Answer 255

No action required if asymp. Colonised but not infected.

Answer 256

PT, EC (LNG as levonogestrel in circulation), bridge, organise USS. F/U PT If insitu correctly; leave until time to replace. If partial perf/embedded hysteroscopy or laparoscopy depending on location. LA or GA. If total perf - laparoscopy If not seen abdo xr expelled - if seen in abdo = perf -->laparoscopy

Answer 257

Possible perf/partial perf/malposition Examine, assess if low and if threads visible (NVT increases suspicion of malposition), bimanual, urgent USS (as in pain) to assess location. If correctly sited, may resolve with time or require change to alternative depending on pt preference If partial perf/embedded hysteroscopy or laparoscopy depending on locaiton

Answer 258

Remove in first trimester - counsel of risk of miscarriage If NVT best to leave in situ and do not instrument uterus if continuing, if not continuing, remove at stop or allow to come out at MTOP (could remove pre-procedure - matter of professional judgement but if uterus instrumented disrupts pregnancy and essentially procuring abortion - STOP may be less complicated)

Answer 259

Leave in situ in second trimester

Answer 260

>20mm from fundus

Answer 261

FSRH guidelines COC 3/12 Often will settle with time - esp with a year of use. Beyond the guidelines can think about POP to settle Consider method switch

Answer 262

Call for help Stop procedure ABCDE assessment Loosen clothing, oxygen, raise legs, BP/HR/SpO2 Most usually respond to this. If doesn't respond - consider removal IUC but weigh up with risk of re-exciting the cx. If remaining bradycardic (HR <60 and BP low) or risk factors for cardiac arrest (recent arrest, heart block, ventricular pause) consider atropine 500-600mcg IV (can be IM if no access, takes longer to respond). Max 3mg total dose.

Answer 263

Copper toxic to sperm and oocyte, prevents implantation

Answer 264

Some association, alkaline blood increases vagianl pH, if getting recurrently consider switching method

Answer 265

May be linked with recurrent candida as biofilm formation/colonisation of device possible

Answer 266

first 6/12 quite common CHC or NSAIDs in FSRH guideline. Ensure not low/malpostioned

Answer 267

If fitted 40yo or older >1yr since LMP if >50 >2yrs since LMP if <50

Answer 268

Consider need to increase steroids for stress of procedure.

Answer 269

UKMEC 3 long QT Fit in conjunction with cardiology advice in hospital setting.

Answer 270

Initiation and PID/pelvic infection/post partum sepsis/post abortion sepsis/cx cancer awaiting tx/endometrial ca/symptomatic GC and CT Unexplained vaginal bleeding GTD: Persistent HCG or malignant disease Current ca breast

Answer 271

>48hrs-28 days post natal initiation and complicated solid organ transplant Continuation and stroke/IHD Long QT and initiation Decreasing HCG GDT and initiation Radial trachelectomy and initiation past ca breast fibroid and uterine cavity distortion uterine cavity distortion Pelvic infections continuation Asym GC/CT severe cirrhosis hepatocellular adenoma/carcinoma HIV CD4 <200

Answer 272

Initiation and PID/pelvic infection/post partum sepsis/post abortion sepsis/cx cancer awaiting tx/endometrial ca/symptomatic GC and CT Unexplained vaginal bleeding GTD: Persistent HCG or malignant disease

Answer 273

>48hrs-28 days post natal initiation and complicated solid organ transplant Long QT and initiation Decreasing HCG GDT and initiation Radial trachelectomy and initiation fibroid and uterine cavity distortion uterine cavity distortion Pelvic infections continuation Asym GC/CT HIV CD4 <200

Answer 274

Implant >3yrs but < 4yrs is ok to fit today and will be effective immediately, she should have a PT today and in 3/52. Rationale failure rate is 1/200 in yr 3-4, better than many people's pill use. If >4 years 21/7 no UPSI and neg PT needed for IUD/IUS fit

Answer 275

Safe to fit, effective immediately. STI screen?

Answer 276

Safe to fit (<5/7 since depo expired) effective immediately.

Answer 277

NO need to PT as depo was indate Can fit IUD effective immediately. Can remain in situ untl 55 or LMP >1year if over 50, >2years if under 50.

Answer 278

VTE x 2-6 (progestin dependent) CVE x 2 Breast cancer x 1.25 (in under 40s) Cervical cancer 5 years use low 10 years = x 2

Answer 279

Reduced menstrual loss Reduced menstrual pain Acne improvement PMS management PCOS management Management of catamenial exacerbations of chronic conditions Ovarian, endometrial and colorectal cancer reduction (halved!) Ovarian cyst reduction

Answer 280

If late restarting/forgets/runs out; protected for 8 hormone free days ie: ≥9/7 since last COC consider EC if UPSI in HFI & condoms/abstain 7/7 Better ovarian suppression Less likely escape ovulation (reduced pregnancy risk) Improved hormone stability (catamenial exacerbations) Reduced hormone withdrawal symptoms (PMS) Reduced bleeding volume/pain (endo/HMB) No increase in VTE No delay to fertility (94.7% cycles return in 60/7, 98% within 90/7)

Answer 281

Nausea Bloating Weight gain (water retention) Vaginal discharge (no infection) Breast enlargement/tenderness Some headaches Chloasma Photosensitivity

Answer 282

Acne Greasy hair Hirsutism Weight gain (increased appetite) Depression Loss of libido Vaginal dryness

Answer 283

Common in first 3/12 (~20%) Pregnancy test STI screen Taking correctly Drug interaction Absorption issues (inc D&V) Only examine if Dysmenorrhea/PCB/discharge/dyspareunia/new onset bleeding >3/12 use/woman requests If persists > 3/12 examine If examination NAD May reduce with time or increase EE dose or consider change to CVR/Qlaira

Answer 284

45-60/10000 women years

Answer 285

Progestins converted to dihydrotestosterone/occupy binding sites in SHBG and increases free testosterone Solution: change to less androgenic progestin eg: Levonorgestrel to Desogestrel or Gestodene

Answer 286

Progestin occupies binding sites in SHBG and increases free testosterone Solution: change to less androgenic progestin eg: Levonorgestrel to Desogestrel or Gestodene

Answer 287

oestrogen gastric emptying slowed (EXCLUDE PREGNANCY!) Solution: 1. Change timing of pill to bedtime 2. Reduce oestrogen dose (may get BTB) 3. Change to non-oral route

Answer 288

Oestrogen or Progestin Why: fluid retention or constipation Solution: 1. Reduce Oestrogen dose 2. Change to less androgenic progestin 3. Change to Drospirenone (mild diuretic) 4. Consider natural oestrogen (Qlaira/Zoely) (different pill rules)

Answer 289

Oestrogen or Progestin Why? Fluid retention or breast tissue growth Solution: 1: Decrease oestrogen dose 2: Change type of progestin

Answer 290

Oestrogen or inadequate Progestin Why: “stabilises” endometrium (decidual reaction, blood vessel atrophy) Exclude: pregnancy and STI, examine if >3/12 Solution: If taking 20mcg oestrogen – increase oestrogen dose to a maximum of 35mcg Change to Etonogestrel containing pill Vaginal ring (best cycle control) Phased preparations (Qlaira) Natural oestrogen (Qlaira/Zoely)

Answer 291

Progestin (not HFI) or Oestrogen (if in HFI) When? All the time or HFI Why? Progestin converted to testosterone or Withdrawal of oestrogen or Progestin effect on neurotransmitters Solution: 1. Change to less androgenic progestin eg: Levonorgestrel to Desogestrol or Gestrodene then to Drosperinone 2. Shorten/remove HFI (may get BTB)

Answer 292

Withdrawal bleed (vessel spasm and myometrial contraction) Solution: 1: Extend the pill use, inducing endometrial atrophy 2: Abolish cycle – depo/IUS Though caution with IUS in women with pain 3. Consider endometriosis (1/10 women)

Answer 293

Progestin Why: female desire complicated… through to be oestrogen dominated Solution: 1. Change progestin to less androgenic progestin 2. Consider alternative to COC 3. IUS (less systemic) 4. IUD (non-hormonal) 5. Change the partner - Ryan Reynolds/Brad Pitt ?!

Answer 294

Oestrogen or hormonal withdrawal or progestin Why? Depends on headache timing… Constant dull/worse on HFI; Progestin Solution: Switch progestin Low/non-hormonal (IUS/IUD) Worse on HFI: withdrawal of hormones Solution: Extend COC use Continuous progestin only Low/non-hormonal (IUS/IUD) Migraine like/non HFI: Oestrogen Solution: Reduce dose of oestrogen (may get BTB) Remove oestrogen! Low/non-hormonal (IUS/IUD) ‘Natural’ Oestrogen (Qlaira/Zoely)

Answer 295

Patch Possible reduction >90kg - choose alternative

Answer 296

primarily inhibits ovulation some cx mucus effect and endometrial change

Answer 297

FSH not accurate as on CHC. Guidelines suggest switching to POP 6/52 and measuring. Some evidence to suggest gonadotrophins including FSH return to near pre-CHC levels by day 28

Answer 298

Change to less androgenic CHC (one step along the ladder eg desgoestrel or gestrodene containing, if this fails escalate to drosp containing and if that fails consider cyproterone containing - but suggest progestin only or non-hormonal method before cyproterone

Answer 299

Discontinue 3 months after acne has been controlled, to lower VTE risk CHC such as drosp/dsg/gest containing, accepting a repeat cycle may be needed.

Answer 300

20mcg 1.56 30-40mcg 1.75

Answer 301

3.28 (hence all CHC are <35mcg now)

Answer 302

2-6x (baseline 2/10000, on CHC = 5-12/10000)

Answer 303

approximately doubles RR 1.9 Returns to baseline within 10 years of discontinuation

Answer 304

Small increased RR 1.19 Returns to baseline within 10 years of discontinuation

Answer 305

progestin only would be a safer method In theory short term CHC use is possible but not first line as ca breast risk is 65-79% by age 80 in BRCA 1 carriers, however chc is likely to half ovarian ca risk.

Answer 306

Increased dose EE --> increased stroke risk 20mcg RR 1.56, 30-40mcg RR 1.75, >50mcg RR 3.28 Progestin type not linked to stroke risk

Answer 307

EE <35mcg similar risks Progestin type linked, first and second generation lower risk than 3rd and newer

Answer 308

reduces by ~20%

Answer 309

reduces by~ 50% over 10 years use

Answer 310

reduces by~ 50%

Answer 311

No evidence. Some theory in adolescent years cyclical oestrogen is important for bone formation

Answer 312

Not usually, screening only picks up known thrombophilia. Very occasionally if Fhx and intolerant of progesterone only methods.

Answer 313

2.5/100,000

Answer 314

6.3/100,000 (OR 2.2)

Answer 315

25/100,000

Answer 316

37/100,000

Answer 317

6-12/10000

Answer 318

9-12/10000

Answer 319

9 or more days since last chc

Answer 320

EC not required, as long as used correctly in week before HFI and restarted on time. No EP required

Answer 321

EC not required, no additional EC, have HFI as planned

Answer 322

EC not required Take the most recent missed pill as soon as possible Continue the remaining pills at the usual time Omit the HFI EP 7/7 (this is over cautious in case of future misuse)

Answer 323

EC (UPSI in HFI, IUD or LNG) Take next pill EP 7/7 PT 3/52

Answer 324

CHC containing oestradiol and nomestrol (monophasic) with 24 active pills and 4 placebo >12hrs late is late

Answer 325

Take asap, omit inactive pills (this rule applies for missed pills day 18-24)

Answer 326

CHC containing oestradiol and dienogest in a quadraphasic preparation

Answer 327

Day 25/26 and day 27/28

Answer 328

8 or more days since last had ring in

Answer 329

48hrs or more

Answer 330

7 days (up to an including 28 days since insertion, 4 weeks)

Answer 331

No EC needed, omit HFI, 7/7 EP (FSRH overcautious).

Answer 332

EC if UPSI since week 5, omit HFI, additional precautions 7/7, f/u PT

Answer 333

<48hrs out no EC or EP required

Answer 334

<48hrs out no EC or EP required

Answer 335

>48hrs out, EC not required, insert new ring, condoms 7/7

Answer 336

>48hrs out, EC not required, insert new ring, omit HFI, condoms 7/7

Answer 337

EC as UPSI in week one Insert ring as soon as possible Keep ring in until scheduled ring removal day Condoms should be used or sex avoided until new ring has been used for 7 consecutive days Follow up pregnancy test

Answer 338

48hrs or more

Answer 339

8 or more days

Answer 340

No EP or EC

Answer 341

If week one EC if UPSI in HFI or week one and F/U PT EP 7/7 IF week 2-3 no EC, EP 7/7. if unscheduled removal ≥48 hours occurred in the week prior to a scheduled HFI, omit the HFI

Answer 342

No causal link, although individual JAMA 2016 article RR COC 1.2 RR Patch 2.0 RR ring 1.6

Answer 343

Traditional 21/7 Shortened HFI 21/4 Tricycle 63/4-7 HFI Bleed led - take until spotting 3-4/7, then HFI 4-7/7 Continuous - continue regardless of bleeding

Answer 344

Less bleeding days (good for HMB/dysmen LEss hormone withdrawal SE Less risk of escape ovulation (as less follicular activity in shorted HFI)

Answer 345

drospirenone containing oral contraception particularly in renal impairment and potassium sparing diuretics

Answer 346

Should be strangely advised against becoming pregnant, ideally switch to a larc or chc and condoms. Also lipid monitoring as CHC and retinoids together may worsen lipids.

Answer 347

Ideally switch to progestin only as CHC increased BP likely in renal patients, if remaining in CHC tacrolimus levels required as EE may increase.

Answer 348

Levels reduced by CHC, then in HFI may increase and cause toxicity

Answer 349

If on implant/pop or CHC should switch to depo/ius/iud If short term (~<2/12) use could use condoms and for 28/7 after finishing course Occasionally 70mcg EE (ie double dose CHC) under expert guidance but preg risk possible and VTE risk ++

Answer 350

Takes 3/12 for ovarian activity to be suppressed fully - although anovulatory within 7/7 use. Background ovarian activity = hormone fluctuations = BTB

Answer 351

More OR 1.56 compared to 30mcg.

Answer 352

Assess eligibility BMI/age/smoking/medical hx/FHx (VTE/MI/breast ca) Medications (drug interactions) STI and pregnancy risk cx screening previous contraception experience Discuss risks and benefits and alternatives inc LARC How to take (inc tailored use), time to effect, missed pills (and D&V) EC Emergency supply via pharmacy/online services GP and ISHS also able to give BMI and BP 12/12 supply and annual r/v

Answer 353

Assess eligibility Any changes to hx/meds/fhx BMI and BP Compliance Side effects Discuss LARC

Answer 354

30mgc EE and LNG cheap Good cycle control lower VTE risk suits 70% users

Answer 355

>4500m for >7/7

Answer 356

>12hrs 1/560 risk

Answer 357

Can continue Stay mobile and hydrated Red flags for VTE (TEDS not recommended)

Answer 358

Major surgery with prolonged immobilisation Stop 4/52 before and restart 2/52 after fully mobile.

Answer 359

Urgent: SOB/calf pain/swelling - PE/DVT Less urgent : New migraine New breast lump Persistent BTB

Answer 360

Post partum and breastfeeding 0-6 weeks Post partum and not breastfeeding with VTE risks 0-3 weeks >35yo and smoking >15/day Vascular disease Hx of VTE Current VTE surgery with prolonged immobilisation Known thromboembolic mutation (factor V leiden/protein c/s deficiency anti-thrombin deficiency) BP >160/100 Current stroke Previous stroke Complicated valvular or congenital heart disease AF Cardiomyopathy with impaired cardiac function Migraine with aura (unless >5 years since) current breast cancer SLE with lupus antibodies severe decompensated liver cirrhosis Hepatocellular carcinoma Hepatocellular adenoma

Answer 361

Post partum and NOT breastfeeding 0-3 weeks with no other VTE risks Post partum and NOT breastfeeding 3-6 weeks with other VTE risks >35yo smoking <15/day >35yo stopped smoking <1 year ago BMI >35 BMI >35 after bariatric surgery Complicated organ transplant Controlled HTN BP >140/90 FHx VTE <45yo Immobility (eg wheelchair user) Multiple CVD risk factors Migraine without aura developed on CHC Migraine with aura >5years since migraine undiagnosed breast symptoms BRCA carrier past ca breast retinopathy/neuropathy/nephropathy Vascular disease Current gallbladder disease gallbladder disease medically tx COC related cholestasis Initiation whilst acute or flare hepatitis

Answer 362

IUD first choice LNG double dose ad MMF thought to reduce LNG levels UPA CI

Answer 363

stasis, hyperviscosity, endothelial injury - resulting in increased clot formation

Answer 364

avoid for 6/12 after discontinuing TNF-α inhibitors

Answer 365

Avoid 3/12 after discontinuing

Answer 366

avoid 6/52 after discontinuing

Answer 367

avoid 3/12 after discontinuing

Answer 368

avoid 3/12 after discontinuing

Answer 369

ok to conceive but have 5mg folic acid as sulphasalazine interferes with absorption.

Answer 370

if disease activity is low at time of conception if is likely to be low in pregnancy but if uncontrolled at conception likely to be uncontrolled in pregnancy.

Answer 371

if absorption poor (esp in chron's) consider non-oral

Answer 372

gestational hypertension, diabetes, pre-eclampsia, caesarean delivery, postpartum haemorrhage, and fetal complications such as growth restriction, macrosomia, neural tube defects, and stillbirth

Answer 373

Microprolactinoma can use all methods including CHC. Prolactin levels should be monitored and share info with endocrinology.

Answer 374

Prolactin levels and inform endocrinology of use, d/w endocrinology if uncertain or labile prolactin levels.

Answer 375

oral contraceptives may be less effective is vomiting or laxative use.

Answer 376

Yes, amenorrhea doesn't mean infertility

Answer 377

osteopenia 90% osteoporosis 40%

Answer 378

yes testosterone and GnRHa are not contraceptive. Avoid CHC as EE with counteract the testosterone, discuss his preferences for amenorrhea - POP or IUS are good options if examination is acceptable for him - may need some vaginal local oestregen and should have smears still as has a cervix.

Answer 379

CHC is a UKMEC 3 when BMI >35, should offer progestin only methods. To discuss weight ask her permission first and dicuss risks in third person I would like to talk about weight with you, would that be ok? Some methods of contraception including CHC have some risks attached to them such as increasing the change of clots in the legs or lungs and stroke> We also know that people with a BMI over 35 have an increased risk of these without chc. With CHC the risk is higher and not very safe therefore we don't recommend it but have safer options which I would like to discuss with you.

Answer 380

absorption