GU: Contraceptives, hormonal + Obstetrics

Question 1

Intra-uterine devices are a highly effective method of contraception but may produce undesirable local side-effects. They may be used in women of all ages irrespective of parity, but are less appropriate for those with an increased risk of what?

Answer 1

Intra-uterine devices are a highly effective method of contraception but may produce undesirable local side-effects. They may be used in women of all ages irrespective of parity, but are less appropriate for those with an increased risk of pelvic inflammatory disease.

The younger.

Question 2

Phasic COC are normally reserved for who?

Answer 2

Women who either do not have withdrawal bleeding or who have breakthrough bleeding with monophasic products.

Question 3

Oestrogen containing contraceptives should preferrably be discontinued (and adequate alternative contraceptive arrangements made) how long before surgery?

Answer 3

4 weeks before and recommenced at the first menses occuring at least 2 weeks after full mobilisation.

Question 4

Which of the following is not a reason to stop the COC or HRT immediately?

Sudden severe chest pain.
Severe stomach pain.
Unexplained swelling or severe pain in calf of one lef
Blood pressure above systolic 150mmHg or diastolic 85mmHg
Prolonged immobility after surgery or leg injury.

Answer 4

blood pressure above systolic 160 mmHg or diastolic 95 mmHg; (in adolescents stop if blood pressure very high);

Question 5

How do POP work?

Answer 5

Alter cervical mucus to prevent sperm penetration and may inhibit ovulation in some women.

Question 6

Medroxyprogestogerone acetate is what type of contraceptive?

Answer 6

Long-acting progestogen given by injection.

Question 7

The etonogestrel-releasing implant (Nexplanon) lasts for how long?

Answer 7

3 years.
The manufacturer advises that in heavier women, blood-etonogestrel concentrations are lower and therefore the implant may not provide effective contraception during the third year; they advise that earlier replacement may be considered in such patients—however, evidence to support this recommendation is lacking.

Question 8

The progestogen-only intra-uterine systems Mirena, Jaydess and Levosert release what directly into the uterine cavity?

Answer 8

The progestogen-only intra-uterine systems Mirena®, Jaydess® and Levosert® release levonorgestrel directly into the uterine cavity.

Question 9

Mirena is licensed for what? (3)

Answer 9

1. Use as a contraceptive
2. Treatment of primary menorrhagia
3. Prevention of endometrial hyperplasia during oestrogen replacement therapy.

Question 10

What drug, a prostaglandin administered vaginally as pessaries, is suitable for the medical induction of late therapeutic abortion?

Answer 10

Gemeprost, a prostaglandin administered vaginally as pessaries, is suitable for the medical induction of late therapeutic abortion; gemeprost is also used to ripen the cervix before surgical abortion, particularly in primigravidas.

Question 11

What drug, a prostaglandin is given by mouth, buccally, sublingually, or vaginally to induce medical abortion?

Answer 11

The prostaglandin misoprostol is given by mouth, buccally, sublingually, or vaginally, to induce medical abortion [unlicensed indication]; intravaginal use ripens the cervix before surgical abortion [unlicensed indication].

Question 12

Pre-treatment with what drug can facilitate the process of medical abortion?

It serves to sensitise the uterus to subsequent administration of a prostaglandin and, therefore, abortion occurs in a shorter time and with a lower dose of prostaglandin.

Answer 12

Mifepristone

Question 13

Which synthetic prostaglandin that has antisecretory and mucosal protective properties, promoting the healing of gastric and duodenal ulcers is used to induce labor?

Answer 13

Misoprostol

Question 14

What drug ending in -tocin is used to induce or augment labour?

Answer 14

Oxytocin

Question 15

Which of the following patients would need EHC?

Cerazette (desogestrel), 9 hours late taking pill and had UPSI

Noriday (norehisterone), 2 hours late taking the pill and had UPSI

Microgynon 30 (levonorgestrel with ethinylestradiol), missed 2 tablets from the first 7 tablets in the packet and had UPSI

Qlaira (Dienogest with estradiol valerate), 11 hours late taking the pill and had UPSI

Zoely (Estradiol with nomegestrol), 4 hours late taking her pill and had UPSI

Answer 15

For the COC, a missed pill is one that is 12 hours or late.

Emergency contraception is recommended if 2 or more combined oral contraceptives tabs are missed from the first 7 tablets in a packer and UPSI has occured since finishing the last packet.

Missed pill for Qlaira or Zoely is: 12 hours or more late.

For Noriday (norethisterone - a progestogen) a missed pill is one that is 3 hours or more late: take it as soon as possible and carry on with next pill at the right time.

For progestogen only contraception, if a pill was more than 3 hours late you were not protected apart from desogestrel.

Question 16

For the COC a missed pill is one that is how late?

Answer 16

12 (according to NICE) hrs or more.

Question 17

For a woman taking either Qlaira (dienorgest with estradiol valerate) or Zoely (estradiol with nomegestrol) is one that is how late?

Answer 17

12 hours or more late.

Question 18

For progestogen-only contraceptives a missed pill is how late?

What exception?

Answer 18

For POP, the advice is if you forget a pill, take it as soon as you remember and carry on with the next pill at the right time. If the pill was more than 3 hours (12 hours for desogestrel) overdue then you are not protected.

Question 19

Which of the following is the least appropriate statement about the intrauterine device (IUD)?

Heavier bleeding and/or dysmenorrhoea are likely with IUD use.

Copper IUD use may cause slight weight gain.

IUDs act by preventing fertilisation and implantation

Testing for Chlamydia should be undertaken before IUD insertion

There is no evidence of a delay in the return of fertility following removal or expulsion of IUD

Answer 19

There is no evidence of weight gain in the copper IUD as it does not contain any hormone.