Contraception PassMed

Question 1

Injectable contraceptive example

Answer 1

Depo Provera is the main injectable contraceptive used in the UK*. It contains medroxyprogesterone acetate 150mg. It is given via in intramuscular injection every 12 weeks. It can however be given up to 14 weeks after the last dose without the need for extra precautions

Question 2

Injectable contraceptive main method of action

Answer 2

The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.

Question 3

Adverse effects of injectable contraceptives

Answer 3

• irregular bleeding
• weight gain (Depo Provera)
• may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
• not quickly reversible and fertility may return after a varying time (maybe up to 12 months)

Question 4

Contraindications to injectable contraceptives

Answer 4

breast cancer: current breast cancer is UKMEC 4, past breast cancer is UKMEC 3

Question 5

POP Counselling: potential adverse effects and other potential problems

Answer 5

Potential adverse effects

irregular vaginal bleeding is the most common problem

Other potential problems

• diarrhoea and vomiting: continue taking POP but assume pills have been missed - see above
• antibiotics: have no effect on the POP** (unless P450 enzyme inducer such as rifampicin)
• liver enzyme inducers may reduce the effectiveness

Question 6

POP: starting and taking

Answer 6

Starting the POP

• if commenced up to and including day 5 of the cycle it provides immediate protection, otherwise additional contraceptive methods (e.g. condoms) should be used for the first 2 days
• if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)

Question 7

POP missed pill rules

Answer 7

Question 8

What to do if UPSI after a missed POP and within 48 hours of restarting the POP

Answer 8

Emergency contraception

Question 9

Contraceptives: time tunnel effective (if not first day period)

Answer 9

• instant: IUD
• 2 days: POP
• 7 days: COC, injection, implant, IUS

Question 10

Hx of endometriosis, acute abdomen and pelvis filled with fluid →?

Answer 10

ruptured endometrioma

Question 11

Fibroids vs endometriosis

Answer 11

Fibroids are rarely painful, 50% are asymptomatic, with the remainder usually presenting with HMB.

• Larger fibroids may be palpable on examination, which was not the case here.
• Tenderness on examination is not a feature of fibroids.
• In the case of endometriosis, repeated bleeding + healing can result in adhesions, causing pain on examination as well
• endometriosis deep in the pouch of Douglas can cause deep dyspareunia

Question 12

Hyperemesis gravidarum ummary

Answer 12

Question 13

Menstrual cycle

Answer 13

The thecal cells secrete androgen (progesterone) and the granulosa cells secrete oestrogen.

Answer 14

The thecal cells secrete androgen (progesterone) and the granulosa cells secrete oestrogen.

Question 15

LNG-releasing IUS (mirena coil)

Answer 15

Provides long term contraception

Good for oligomenorrhoea → intervals between menstruation of more than 3 months (or fewer than 4 per year) increase the risk of endometrial hyperplasia and carcinoma. Therefore inducing a withdrawal bleed every 3-4 months or preventing proliferation of the endometrium is recommended.