contraception - drugs and devices and important safety info

Question 1

MHRA - IUD uterine perforation (for any IUD or IUS)

Answer 1

uterine perforation most often occurs during insertion, but it might not be detected until sometime later
risk of perforation increased when device is inserted up to 36 weeks PP or in pt who are BF

Question 2

before inserted an IUD e.g copper IUD, or LVNGRL IUS inform patients of the signs and symptoms to look out for which may indicate uterine perforation

Answer 2

severe pelvic pain after insertion (worse than period cramps);
pain or increased bleeding after insertion which continues for more than a few weeks;
sudden changes in periods;
pain during intercourse;
unable to feel the threads.

Question 3

when does uterine perforation occur more often (for IUD)

Answer 3

risk increased when device inserted up to 36 weeks PP or in pt who are BF

Question 4

patient cant feel their threads. they should arrange a check up if the threads cant be felt, esp if …

Answer 4

significant pain also

Question 5

Threads of IUD can be felt but the patient is in severe pain. Can this still indicate perforation of uterus?

Answer 5

Partial perforation may occur even if the threads can be seen; consider this if there is severe pain following insertion and perform an ultrasound.

Question 6

when is IUD CI

Answer 6

genital malignancy
PID
recent STI if not fully investigated and treated
severe anaemia
unexplained uterine bleeding

Question 7

if someone has menorrhagia (excess bleeding) which device may be preferable

Answer 7

progestogen IUD

Question 8

if CU IUD is schedules for removal after day 7 of menstrual cycle (day 1-5 is period, 14 is ovulation) then what should you do

Answer 8

intercourse should be avoided or another method of contraception used for at least 7 days before removal of intra-uterine device.

Question 9

CU IUD
the main excess risk of pelvic infection occurs when ? and what is it believed to be related to ?

Answer 9

occurs in the first 3 weeks after insertion and is believed to be related to existing carriage of a sexually transmitted infection.

Question 10

Patient is on IUD but it has failed and they are pregnant. But they decide they want to continue with pregnancy to full term. So what should you do.

Answer 10

If an intra-uterine device fails and the woman wishes to continue to full-term the device should be removed in the first trimester if possible.

Remove device; if pregnancy occurs, increased likelihood that it may be ectopic.

Question 11

what is the dose of ulipristal for EHC

Answer 11

30 mg for 1 dose, to be taken as soon as possible after coitus, but no later than after 120 hours.

Question 12

what else is ulipristal indicated for

Answer 12

Uterine fibroids (under expert supervision)

Question 13

MHRA safety info for ulipristal re liver issues

Answer 13

risk of serious liver injury has been reported for the brand used for symptoms of uterine fibroids

however this is NOT the case with EllaOne (used for EHC)

Question 14

when ulipristal is used for EHC, when can you restart BF

Answer 14

Avoid for 1 week after administration—present in milk.

Question 15

what to do if patient vomits after taking ulipristal for EHC

Answer 15

if vomiting occurs within 3 hours of taking a dose, a replacement dose should be taken;

Question 16

patient has lower abdominal pain after taking ulipristal for EHC

Answer 16

seek medical attention promptly if any lower abdominal pain occurs because this could signify an ectopic pregnancy.

Question 17

patient took ulipristal for EHC. they are worried because their period hasnt come yet. what do you advice

Answer 17

that their next period may be early or late;
that a pregnancy test should be performed if the next menstrual period is delayed by more than 7 days, is lighter than usual, or is associated with abdominal pain that is not typical of the woman’s usual dysmenorrhoea

Question 18

when is double dose of levonorgestrel needed

Answer 18

BMI >26
weight >70kg

unlicensed

Question 19

how often should you do gynaecoloigcal exam when you are inserting IUD

Answer 19

Gynaecological examination before insertion, 4–6 weeks after insertion, then annually.

Question 20

what to do if vomiting after taking levonorgestrel for CONTRACEPTION - NOT EHC

Answer 20

If vomiting occurs within 2 hours of taking an oral progestogen-only contraceptive, another pill should be taken as soon as possible. If a replacement pill is not taken within 3 hours of the normal time for taking the progestogen-only pill, or in cases of persistent vomiting or very severe diarrhoea, additional precautions should be used during illness and for 2 days after recovery.

Question 21

what can interere with absorption of oral POC including EHC

Answer 21

Vomiting and persistent, severe diarrhoea

Question 22

what to do if patient vomits after taking levornorgestrel for EHC

Answer 22

if vomiting occurs within 3 hours, a replacement dose should be taken;

Question 23

missed doses for progestogen contraceptive pill

Answer 23

When used as an oral contraceptive, the following advice is recommended ‘If you forget a pill, take it as soon as you remember and carry on with the next pill at the right time (this may mean taking 2 pills at the same time). If the pill was more than 3 hours overdue you are not protected. Continue normal pill-taking but you must also use another method, such as the condom, for the next 2 days’.

Question 24

Lenoelle One Step can be sold to what age

Answer 24

Levonelle® One Step can be sold to women over 16 years; when supplying emergency contraception to the public, pharmacists should refer to guidance issued by the Royal Pharmaceutical Society.

Question 25

oral POC can be started 21 days PP. do you need additionall contraceptive precautions?

Answer 25

Oral progestogen-only contraceptives can be started before 21 days postpartum without the need for additional contraceptive precautions. If started 21 days or more postpartum, additional contraceptive precautions are required for 2 days.

Question 26

which progestogen contraceptive was linked to a higher tumour risk (meningioma, brain tumour mostly non cancerous)

Answer 26

MDP aka Depo provera

Question 27

how often is MDP given (by deep IM and SC) for long term contraception

Answer 27

deep IM = every 12 weeks
SC injection = every 13 weeks

Question 28

how long can Nexplanon (etonorgestrel) be left in place for

Answer 28

3 years

Question 29

nexplanon - when you insert it when do you need extra precautions

if no hormonal contraceptive use in previous month

Answer 29

when inserted during the first 5 days of cycle, no additional contraceptive precautions are needed, when inserted at any other time, additional precautions (e.g. barrier methods) advised for next 7 days.

Question 30

nexplanon - when you insert it when do you need extra precautions

when its used postpartum

Answer 30

when inserted within 20 days after delivery (or up to 6 months postpartum if fully breast-feeding and amenorrhoeic), no additional contraceptive precautions are needed, when inserted at any other time, additional precautions (e.g. barrier methods) advised for next 7 days.

Question 31

MHRA safety info - nexplanon, new insertion site to reduce rare risk of neurovascular injury and implant migration

Answer 31

Correct subdermal insertion by an appropriately trained and accredited healthcare professional is recommended to reduce the risk of these events.
Patients should be advised on how to locate the implant, informed to check this occasionally and report any concerns. An implant that cannot be palpated at its insertion site should be located and removed as soon as possible; if unable to locate implant within the arm, the MHRA recommends using chest imaging. Implants inserted at a previous site that can be palpated should not pose a risk and should only be replaced if there are issues with its location or if a routine replacement is due.

Question 32

what cancer does P contracetpions increase risk of

Answer 32

breast cancer
small increased risk