Contraceptives

Question 1

Which age group are COCs contra-indicated in?

Answer 1

women over 50

Question 2

The oestrogen in COCs increases the risk of what?

Answer 2

• VTE (smoking, obese, >35, immobile)
• Arterial TE (DM, HTN, migraine)

avoid if 3 or more are present

Question 3

When travelling what should you do when on COCs?

Answer 3

• Stop for journeys longer than 3 hours

- Get compression stockings

Question 4

How soon before surgery should oestrogen containing contraceptives be discontinued?

Answer 4

• 4 weeks

Question 5

What would you do if a patient is not able to discontinue an oestrogen-containing contraceptive during major surgery?

Answer 5

• thromboprophylaxis with heparin

- this only counts with major surgery, not needed for minor

Question 6

What are reasons to stop COCs or HRT immediately?

Answer 6

• sudden chest pain/breathlessness
• unexplained swelling/severe pain in calf of one leg
• severe stomach pain
• high BP

Question 7

What is medroxyprogesterone acetate?

Answer 7

• long acting progesterone given by injection

- usually lasts 2 years

Question 8

Which risk factors should you consider a different type of contraception instead of medroxyprogesterone?

Answer 8

• women with osteoporosis

Question 9

What is norethisterone enantate (noristerat)?

Answer 9

• long acting progesterone given as oily injection that provides contraception for 8 weeks

Question 10

How long does the nexplanon implant provide contraception for?

Answer 10

• 3 years

Question 11

What are examples of progesterone only intra-uterine systems?

Answer 11

• mirena
• jaydess
• levosert

Question 12

What is Mirena licensed for?

Answer 12

• contraception
• primary menorrhagia
• prevention of endometrial hyperplasia during oestrogen replacement therapy

Question 13

Are progesterone only contraceptives ok to use before surgery?

Answer 13

• Yes

- Can be used instead of COCs

Question 14

When would spermicidal contraceptives not be suitable?

Answer 14

• People who have or at high risk of STIs

Question 15

When can emergency contraception be offered after child birth?

Answer 15

• 21 days after

Question 16

When can emergency contraception be offered after abortion/miscarriage/ectopic pregnancy?

Answer 16

• 5 days after

Question 17

How soon after unprotected sex can the IUD be inserted to prevent pregnancy?

Answer 17

• 120 hours after (5 days)

or up to 5 days after earliest likely ovulation

Question 18

What are examples of emergency hormonal contraception?

Answer 18

• levonorgestrel

- ulpristal

Question 19

When is levonorgestrel most effective?

Answer 19

• When taken within 3 days (72 hours)

Question 20

When is ulpristal most effective?

Answer 20

• When taken within 5 days (120 hours)

Question 21

If bMI was greater than 26 or body weight was greater than 70kg, which emergency hormonal contraceptive would you give?

Answer 21

• Ulpristal

Question 22

What would you do if someone was using short term enzyme inducing drug treatment (2 months or less)?

Answer 22

• Continue on the hormonal contraception but take extra precautions like use condoms

Question 23

What would you do if someone was using long term enzyme inducing drug treatment (more than 2 months)?

Answer 23

• use monophasic COC at a dose of ethinylestradiol (50mcg or more daily)

Question 24

What would you do if someone was using long term rifampicin or rifabutin?

Answer 24

• IUD