Contraception: Introduction

Question 1

Describe what the UKMEC levels regarding contraception are [4]

Answer 1

It categorises the risks of starting different methods of contraception in different individuals.
UKMEC 1:
- No restriction in use (minimal risk)

UKMEC 2:
- Benefits generally outweigh the risks

UKMEC 3:
- Risks generally outweigh the benefits

UKMEC 4:
- Unacceptable risk (typically this means the method is contraindicated)

Question 2

Explain the effectiveness of different methods of contraception (perfect vs typical use) for the following:

Answer 2

Question 3

Exam questions frequently present an individual with specific risk factors and ask for the most suitable form of contraception for that person.

What are they and what should you avoid? [3]

Answer 3

Breast cancer:
- avoid any hormonal contraception and go for the copper coil or barrier methods

Cervical or endometrial cancer:
- avoid the intrauterine system (i.e. Mirena coil)

Wilson’s disease:
- avoid the copper coil

Question 4

Which specific risk factors make you avoid the COCP? [+]

Answer 4

• Uncontrolled hypertension (particularly ≥160 / ≥100)
• Migraine with aura
• History of VTE
• Aged over 35 smoking more than 15 cigarettes per day
• Major surgery with prolonged immobility
• Vascular disease or stroke
• Ischaemic heart disease, cardiomyopathy or atrial fibrillation
• Liver cirrhosis and liver tumours
• Systemic lupus erythematosus and antiphospholipid syndrome

Question 5

Women that are amenorrhoeic (no periods) when taking progestogen-only contraception should continue until when? [2]

Answer 5

• FSH blood test results are above 30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year)
• 55 years of age

Question 6

The progestogen-only injection is UK MEC 2 due to concerns about [1]

Answer 6

The progestogen-only injection is UK MEC 2 due to concerns about reduced bone mineral density

Question 7

Describe how effective lactational amenhorrhea is and for how long? [2]

What must be happening for this to occur? [2]

Answer 7

Lactational amenorrhea is over 98% effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods).

Question 8

Which contraceptive types are safe during breastfeeding? [2]

Answer 8

The progestogen-only pill and implant are considered safe in breastfeeding and can be started at any time after birth.

Question 9

Describe how you should counsel someone if they are asking for the IUS or copper coil implant after birth [2]

Answer 9

A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).

Question 10

TOM TIP: Remember that the combined pill should not be started before [] weeks after childbirth in women that are breastfeeding. The progestogen-only pill or implant can be started []

Answer 10

TOM TIP: Remember that the combined pill should not be started before 6 weeks after childbirth in women that are breastfeeding. The progestogen-only pill or implant can be started any time after birth.