contraception management

Question 1

What factors should be considered when choosing a method of contraception?

Answer 1

Consider needs and personal circumstances including preferred method of contraception, future plans for having children, and beliefs and views towards contraception. Assess risk factors such as smoking, history of VTE, migraine, breast cancer, stroke, hypertension, liver disease, family history of DVT/VTE, and STIs. Evaluate menstrual problems and allergies (including latex or anaesthetics).

Question 2

What are some key aspects of history to consider before prescribing contraception?

Answer 2

Consider needs and personal circumstances, risk factors (smoking, history of VTE, migraine, breast cancer, stroke, hypertension, liver disease, family history of DVT/VTE, STIs), menstrual problems, and allergies.

Question 3

How can contraception methods be divided?

Answer 3

Contraception methods can be divided into long-acting (IUS/IUD, Injection, Implant) and short-acting (Pills (POP vs COCP), Patches, Rings).

Question 4

What is the mechanism of action for the Copper Coil (Cu-IUD)?

Answer 4

The Copper Coil (Cu-IUD) causes sterile inflammation, making implantation impossible and acting as a spermicide.

Question 5

What are the side effects of the Copper Coil (Cu-IUD)?

Answer 5

Side effects of the Copper Coil (Cu-IUD) include heavy, painful periods, risk of expulsion, infection, perforation, and ectopic pregnancy.

Question 6

What is the mechanism of action for the Mirena (LNG-IUS)?

Answer 6

The Mirena (LNG-IUS) thins the lining of the womb and prevents implantation.

Question 7

What are the side effects and risks of the Mirena (LNG-IUS)?

Answer 7

Side effects and risks of the Mirena (LNG-IUS) include acne, breast tenderness, mood disturbance, headaches, risk of infection, ectopic pregnancy, perforation, and expulsion.

Question 8

What is Jaydess and how does it differ from Mirena?

Answer 8

Jaydess is a smaller form of the LNG-IUS that is effective for contraception but not for heavy periods. It lasts 3 years and is easier to insert, especially for nulliparous women.

Question 9

What is the mechanism of action for the Implant (Nexplanon)?

Answer 9

The Implant (Nexplanon) prevents ovulation, thickens cervical mucus, and thins the endometrium.

Question 10

What are the side effects of the Implant (Nexplanon)?

Answer 10

Side effects of the Implant (Nexplanon) include irregular bleeding, mood changes, breast tenderness, and nausea. It may be less effective when taken with antiepileptic drugs and rifampicin.

Question 11

What is the mechanism of action for the Injection (Depo-Provera, Sayana Press or Noristerat)?

Answer 11

The Injection (Depo-Provera, Sayana Press or Noristerat) prevents ovulation, thickens cervical mucus, and thins the endometrium.

Question 12

What are the side effects and risks of the Injection (Depo-Provera, Sayana Press or Noristerat)?

Answer 12

Side effects and risks of the Injection (Depo-Provera, Sayana Press or Noristerat) include irregular bleeding, weight gain, mood swings, headaches, and delayed return of fertility. It should be avoided in those with risk factors for osteoporosis.

Question 13

What are some absolute contraindications for the Combined Oral Contraceptive Pill (COCP)?

Answer 13

Absolute contraindications for the COCP include being < 6 weeks postpartum and breastfeeding, smoking over the age of 35, hypertension, coagulopathies, diabetes with complications, ischemic heart disease, history of cerebrovascular accident, migraine with aura, liver tumor, severe cirrhosis, current breast cancer, and SLE with positive antiphospholipid antibodies.

Question 14

What is the mechanism of action for the Combined Oral Contraceptive Pill (COCP)?

Answer 14

The COCP prevents ovulation.

Question 15

What are some benefits of the Combined Oral Contraceptive Pill (COCP)?

Answer 15

Benefits of the COCP include being very effective if taken properly, reversible upon stopping, usually making periods regular, lighter and less painful, and reducing the risk of ovarian, endometrial, and bowel cancer.

Question 16

What are some disadvantages and side effects of the Combined Oral Contraceptive Pill (COCP)?

Answer 16

Disadvantages and side effects of the COCP include forgetting to take it, no protection against STIs, increased risk of VTE, breast cancer, cervical cancer, stroke, IHD, headache, nausea, and breast tenderness.

Question 17

How should missed pills be managed for the Combined Oral Contraceptive Pill (COCP)?

Answer 17

For 1 missed pill (48-72 hours since last pill taken), take the missed pill ASAP and no additional precautions are needed. For 2 or more missed pills (>72 hours since last pill taken), in week 1 after pill-free week, consider emergency contraception if UPSI during pill-free period, and alternate contraception until 7 continuous days of COCP. In week 2 or 3 after pill-free week, emergency contraception is not required, take missed pill as soon as possible. For >7 missed pills, manage as new start contraception, consider emergency contraception.

Question 18

What is the mechanism of action for the Progesterone Only Pill (POP)?

Answer 18

The Progesterone Only Pill (POP) thickens cervical mucus and, in the case of desogestrel, also stops ovulation.

Question 19

What are some benefits and disadvantages of the Progesterone Only Pill (POP)?

Answer 19

Benefits of the POP include not having the risks of estrogen pills. Disadvantages include the need to be taken at the same time every day, irregular bleeding, and the risk of ovarian cysts.

Question 20

How should missed pills be managed for the Progesterone Only Pill (POP)?

Answer 20

For traditional POP, if the pill is < 3 hours late, continue as normal. If 3+ hours late, continue with the rest of the pack, use extra precautions (condoms) until 48 hours of continuous POP. For missed 2 or more pills, consider emergency contraception if UPSI during pill-free period, and alternate contraception until continuous 48 hours of POP. For Cerazette POP, the same rules apply but with a 12-hour window to take the pill if late.

Question 21

What is the hormone composition of the Combined Hormonal Transdermal Patch?

Answer 21

The Combined Hormonal Transdermal Patch contains norelgestromin and ethinyl oestradiol.

Question 22

How is the Combined Hormonal Transdermal Patch used?

Answer 22

The Combined Hormonal Transdermal Patch is applied for 3 weeks (replace the patch at the end of each week) and take 1 week off (withdrawal bleed).

Question 23

What should be done if the Combined Hormonal Transdermal Patch is changed late?

Answer 23

If the patch change is delayed < 48 hours, change immediately with no further precautions. If delayed > 48 hours in week 1 or 2, change immediately and use barrier contraception for 7 days (if UPSI within previous 5 days or during extended patch-free period, consider emergency contraception). If delayed > 48 hours in week 3, remove immediately and apply the next patch on the usual start date of the next cycle (no additional contraception needed). If delayed at the end of the patch-free week, use barrier contraception for 7 days.

Question 24

What is the hormone composition of the Combined Hormonal Ring?

Answer 24

The Combined Hormonal Ring contains etonogestrel and ethinyl oestradiol.

Question 25

How is the Combined Hormonal Ring used?

Answer 25

The Combined Hormonal Ring is inserted into the vagina and worn vaginally for 21 days followed by a 7-day hormone-free period.