Genito-Urinary Tract System - Medium

Question 1

Which form of oestrogen is most commonly used in preparations of combined oral contraceptive?

Answer 1

Ethinylestradiol

Question 2

A combined oral contraceptive containing a fixed amount of oestrogen and progestogen is known as what?

Answer 2

Monophasic

Question 3

A combined oral contraceptive with varying amounts of both the oestrogen and progestogen is known as what?

Answer 3

Multiphasic

Question 4

What is normally the first line choice combined oral contraceptive and why?

Answer 4

A monophasic preparation of 30 micrograms or less of ethinylestradiol with either levonorgestrel or norethisterone.
This choice minimises cardiovascular risk

Question 5

Besides the more traditional 21 day continuous use and 7 day HFI regimen, what regimens are available to patients using combined oral contraceptives?

Answer 5

• Shortened HFI = 21 days continuous use followed by 4 day HFI
• Flexible extended use = 21 days continuous use followed by 4 day HFI when breakthrough bleeding occurs
• Extended use (tricycling) = 9 weeks continuous use followed by a 4 or 7 day HFI
• Continuous use with no HFI

Question 6

Use of a traditional combined hormonal contraceptive regimen may be associated with what adverse effects?

Answer 6

• Heavy and/or painful withdrawal bleeds
• Headaches
• Mood changes
• Increased risk of misuse and subsequent unplanned pregnancy

Question 7

Progestogen-only oral contraceptives may contain which hormone APIs?

Answer 7

Levonorgestrel
Norethisterone
Desogestrel

Question 8

How often is depot medroxyprogesterone administered?

Answer 8

Every 13 weeks

Question 9

Which hormone is used in the contraceptive implant?

Answer 9

Etonogestrel

Question 10

Which hormone is used in contraceptive IUS’?

Answer 10

Levonorgestrel

Question 11

What is the most effective form of emergency contraception and should be offered to all women who have unprotected sexual intercourse?

Answer 11

Copper intrauterine device

Can be inserted 5 days after he first incidence of unprotected sex in the menstrual cycle, or 5 days after the earliest due date of ovulation

Question 12

Which progestogens are used as oral emergency contraception and within how long from the incidence of unprotected sex can they be used?

Answer 12

Levonorgestrel - within 72 - 94 hours
Ulipristal - within 5 days

Question 13

What is the first line emergency oral contraceptive for women who have had unprotected sexual intercourse in the last 96 - 120 hours?

Answer 13

Ulipristal acetate

Question 14

What is the first line emergency contraceptive for women who have missed a dose/s of regular combined hormonal contraceptive within he first week of restarting their contraceptive regimen?

Answer 14

Levonorgestrel

Question 15

Can ulipristal and levonorgestrel be used as emergency contraceptives more than once in the same cycle?

Answer 15

Yes

Question 16

Which form of contraception provides effective ongoing contraception immediately after a women has taken emergency contraception?

Answer 16

Copper IUS

Question 17

How should a women who does not use regular hormonal contraception start hormonal contraception after receiving ulipistral as emergency contraception?

Answer 17

She must wait 5 days to start regular hormonal contraceptives, during which she must either use condoms or abstain from sex until the contraceptive is effective

Question 18

How should a women who does not use regular hormonal contraception start hormonal contraception after receiving levonorgestrel as emergency contraception?

Answer 18

She must start hormonal contraception immediately and either use condoms or abstain until the contraceptive is effective

Question 19

How should a women who does use regular hormonal contraception start hormonal contraception after receiving ulipistral as emergency contraception after missing contraception within the first week of restarting it?

Answer 19

She can start regular hormonal contraception immediately, however she must use condoms or abstain from sex for 7 days until the contraceptive become effective

Question 20

List some drugs that, when used concurrently with hormonal contraceptives reduce their efficacy

Answer 20

Enzyme inducers:
- Rifampicin
- Carbemazepine
- Phenytoin
- Phenobarbital
- Ritonavir
- Topiramate

Question 21

Which forms of contraceptives are not affected by enzyme inducers?

Answer 21

• Parenteral progesterogens
• Levonorgestrel IUD

These should be continued up to 4 weeks after the cessation of enzyme inducer therapy

Question 22

During a short term (<2 months) course of enzyme inducing drugs, what hormonal contraceptive treatments can be used?

Answer 22

• Combined oral contraceptives can be used, but only with the consistent use of condoms during and for 4 weeks after treatment
• Long term course of enzyme inducers (>2 months) excluding rifampicin and rifabutin - Use of a monophasic COC at a dose of >50 micrograms of ethinylestradiol using either a tricycling regimen during and for 4 weeks after treatment

Question 23

What is the main non-drug related factor which may affect the efficacy of hormonal emergency contraceptives?

Levonorgestrel and ulipistral

Answer 23

High BMI - may require a double dose of levonorgestrel

Ulipistral is still first line and can be given at the normal dose

Question 24

During long term therapy (>2 months) using enzyme inducing drugs (excluding rifampicin and rifabutin) what hormonal contraceptive measures can be used?

Answer 24

Use of a monophasic combined oral contraceptive at a dose of >50 micrograms of ethinylestradiol using a tricycling regimen during and for 4 weeks after treatment

Question 25

During long term therapy (>2 months) using rifampicin or rifabutin what hormonal contraceptive measures can be used?

Answer 25

An alternative method of contraception (such as an IUD) must be used instead of combined hormonal contraceptives as they are such potent enzyme inducers

Question 26

Can oral progestogen-only contraceptives be used in combination with enzyme inducing drugs?

Answer 26

No, an alternative contraceptive method must be used

Question 27

Can IM norethisterone and medroxyprogesterone be used in combination with enzyme inducing drugs suchas rifampicin and phenytoin?

Answer 27

Yes, they are unaffected by enzyme inducing drugs

Question 29

What is the MHRA warning associated with the use of copper intrauterine devices?

Answer 29

Updated information os risk factors for uterine perforation (

Question 30

What is the MHRA warning associated with the use of ulipristal acetate 5mg (ESMYA)?

Answer 30

Further restrictions due to the risk of serious liver injury (February 2021)