Contraception_OCP

Question 1

When should women stop taking the combined oral contraceptive pill?

Answer 1

When 50, use protestin only method

Question 2

What is effective contraception for a breastfeeding mother?

Answer 2

If baby is <6 months old and mother has not had her period then breastfeeding is an effective form of contraception.

If mother is breastfeeding and above criteria don’t apply then need to put on a progestin-only method (eTG ref)

Question 3

What are the absolute contraindications for the OCP?

Answer 3

Migraine with Aura 
DVT or PE 
Previous stroke or TIA 
Ischemic Heart Disease (+HTN >160/100)
Liver disease
Gallbladder disease 
Breast Cancer

Breastfeeding (< 3 weeks with additional risk factors for VTE)
Smoking > or equal to 35yrs of age, > or equal to 15 cigarettes/day
+ve Antiphospholipid antibodies
(page 94 contraception: an australian clinical practice hbook)

Question 4

When can combined OCP / vaginal ring be initiated in miscarriage or abortion?

Answer 4

Can initiate immediately after miscarriage or abortion <24 wks
(page 95)

Question 5

When can combined OCP / vaginal ring be initiated in non breastfeeding woman post partum?

Answer 5

Restriction for the first 6 weeks as at increased risk of VTE.

After 6/52 UKMEC =1
(ref: 95)

Question 6

When can combined OCP / vaginal ring be initiated in breastfeeding woman post partum?

Answer 6

Contraindicated in 1st 6 /52 postpartum
Benefits outweigh risks between 6/52 to 6/12
Nil restriction after 6/12

(ref: 95)

Question 7

Combined Contraceptive Hormones –> How long before major surgery should they be changed?

Answer 7

4/52 before major elective surgery with prolonged Immbolisation, CHC users should change to another contraceptive method, (e.g. surgery lasting >30mins)
(ref 95)

Question 8

What is the UKMEC on HTN?

Answer 8

> 140/90 even when it is well controlled is cateogry 3

–> inc risk of arterial vascular disease + haemorraghic stroke

Question 9

What is the UKMEC on migraine?

Answer 9

Migraine with Aura = 4

Migraine with Aura history with nil episodes in 5 yrs ->3 (page 96)

Question 10

1/ chronic Hep b and C and the Combined hormonal contraception?
2/ decompensated cirrhosis, adenoma

Answer 10

1/Nil restriction, unless experiencing flare –> UKMEC =3
If flare –> can use progesterone only pill
2/ UKMEC = 4

Question 11

For BMI equal or greater than 35, UKMEC?

Answer 11

3 (risks outweigh the benefits)

Question 12

Which hormone pills are the highest risk to miss and why?

Answer 12

Hormone pills closest to the inactive tablets = highest risk to miss as they prlong the pill free interval & increase risk of break-through ovulation.

• -> 7 consecutive hormone pills are sufficient to suppress ovulation
• -> more than 7 pill-free days are needed for ovulation to occur

Question 13

What happens if a COCP is missed in the first 7 days of hormone pills after active pills and unprotected inervourse has occured in last 5/7?

Answer 13

Take emergency ocp, cocp + condoms (page 109)

Question 14

If missed pills are last 7 days of hormone pills ?

Answer 14

omit the pill free interval and continue to active pills (page 109)

Question 15

What is the MEC criteria for: 
1/ current history of breast Ca
2/ past hx of breast ca
3/family hx of breast ca 
4/ undx'd mass or breast sx

Answer 15

1/ 4
2/ 3
3/ 1
4/3

(ref 93)

Question 16

Can the COCP be taken when at altitude?

Answer 16

Yes unless spending more than 1/52 at altitudes >4500m should consider non estrogen containing method.

Question 17

Definition of a:
1/ Late Pill
2/ Missed Pill 
3/ Early cycle missed pill
4/ Late cycle missed Pill 

(Ref: oral hormonal contraception, page 731 racgp)

Answer 17

1/ pill taken <24 hrs late. Take the late pill asap then continue taking the pills

2/ pill taken >24 hrs late.
Additional contraception or abstinence till 7 consecutive pills taken

3/ pill missed in 1st seven active pill days after placebo.
Emergency contraception should be considered if unprotected sex in last 5/7

4/ pill missed in 7 days of active pills before the next placebo pill, skip the placebos and continue to active pills without a break