Contraception + Sexual Health

Question 1

How can IUD and IUS affect periods

Answer 1

IUD: Periods may be heavier/ longer/ more painful

IUS;

• Periods often lighter/ shorter/ less painful. May become irregular/ stop completely
• Irregular bleeding/ spotting common in 1st 6mths

Question 2

You check WHOMEC before prescribing Barrier methods/ Sterilisation/ Natural family planning.

What do you check for other contraception prescriptions?

Answer 2

UKMEC

Question 3

How does the Implant work?

Describe how soon it offers protection after implantation

Answer 3

• Prevents Ovulation, Thickens Mucus, Thins lining
  (May reduce Heavy periods and pain)
• Immediate protection if put in during 1st 5 days of cycle, otherwise use condoms for 7days
• Immediate protection if put in <21 days after birth, otherwise use condoms for 7days

Question 4

The implant is safe during breastfeeding.

What are the ADRs

Answer 4

ADRs for 1st few months: Headaches, Nausea, Breast tenderness, Mood swings

Periods may be irregular/ stop completely. May be Spotting. 1/3 have Heavier bleeding

Acne/ acne deterioration

Question 5

How and how long does the Injection work?

Describe how soon it offers protection after injection and after abortion/ miscarriage

Answer 5

• Prevents Ovulation, Thickens Mucus, Thins lining. Can reduce periods and pain. Lasts for 13wks.
• Immediate protection if put in during 1st 5 days of cycle or <5days after abortion/ miscarriage, otherwise use condoms for 7days
• Immediate protection if put in <21 days after birth, otherwise use condoms for 7days

Question 6

List ADRs of the Injection

Answer 6

• ADRs: Weight gain, Headaches, Mood swings, Breast tenderness, Irregular bleeding, Low libido
• Can take upto 1yr for fertility to return to normal after effects wear off

Question 7

How does the COCP work?

Describe how soon it offers protection after starting it and after abortion/ miscarriage

Answer 7

• Prevents Ovulation, Thickens Mucus, Thins lining
• Immediate protection if started before day 5 of cycle, otherwise use condoms for 7days
• Immediate protection if < 5days after abortion/ miscarriage, otherwise condoms for 7days

(Use condoms if continued vomiting)

Question 8

When do you take an extra COCP?

Answer 8

• If missed 1 or Vomited within 3hrs of taking first one.

Question 9

List Contra-Is for COCP

Answer 9

• Pregnancy
• Smoke and 35+, 35+ and stopped smoking <1yr ago,
• Very overweight
• History of CVD/ Migraines/ Breast cancer/Gallbladder or liver disease
• Diabetic for 20yrs/ Diabetic with complications

Question 10

Describe the relationship between COCP and breastfeeding

Answer 10

• If breastfeeding, don’t take pill until 6wks after birth
• If not breastfeeding, can likely start pill 21 days after birth
• If breastfeeding and starting pill later than 21 days after birth, use condoms for 7 days

Question 11

COCP reduces the risk of Gynae cancer, PID, Fibroids, Ovarian cysts, Benign breast disease

What does it increase risk of?

Answer 11

• Increased BP

- Breast cancer, Stroke, VTE, CVD, Clots

Question 12

List ADRs of COCP

Answer 12

Headaches, Nausea, Breast tenderness, Mood swings, Spotting, Breakthrough bleeding

Question 13

The contraceptive patch lasts for 1wk. They can be used for 3wks then a week off is required, to allow bleeding.

List ADRs

Answer 13

• Skin irritation, itching, soreness

- Temporary ones (COCP, Spotting, Breakthrough bleeding)

Question 14

Describe how soon the patch provides protection

Answer 14

Immediate protection if started before day 5 of cycle, otherwise use condoms for 7days

Question 15

What do you do if the patch has fallen off for <48hrs?

Answer 15

Put on NEW patch, protected if used properly for last 7 days

Question 16

What do you do if the patch has fallen off for >48hrs

Answer 16

Put on NEW patch, Start NEW 4wk cycle if in week 3, use condoms until a patch has been on for 7 days in a row

Question 17

What if the Patch has been left on for <48hrs EXTRA?

Answer 17

Put on new one, change on normal day

Question 18

What if the patch has been left on for >48hrs EXTRA

Answer 18

Put on new one, use condoms until a patch has been on for 7 days in a row

Question 19

The IUD releases Cu into womb. It is safe during breastfeeding.

How does it work?

Answer 19

Thickens mucus, stops implantation

Question 20

How soon does the IUD work?

How long can it be left in, if fitted when 40+?

Answer 20

• Works immediately soon as put in

- If fitted at 40+, can be left in until reaching menopause/ contraception no longer needed

Question 21

The IUD is safe in breastfeeding, what are the hormonal ADRs?

Answer 21

None

Question 22

How does IUS work?

Describe how soon it works?

Answer 22

• Thickens Mucus, Thins lining, May prevent ovulation

- Immediate protection if put in before day 7 of cycle, otherwise use condoms for 7 days

Question 23

The IUS can be put in at any time. How long can it be left in, if it was fitted at 40+?

Answer 23

Until menopause/ contraception no longer needed

Question 24

List Contra-Is of IUS

Answer 24

• Breast/ Endometrial/ Cervical cancer
• Liver disease
• Untreated STI
• Unexplained IMB/ PCB

Question 25

List ADRs of the IUS

Answer 25

ADRs are temporary;

• Headaches
• Acne
• Breast tenderness
• Mood changes