GUM MHRA alerts

Question 1

The use of ulipristal acetate for uterine fibroids has been restricted due to concerns surrounding which organ system?

NOTE; this does not apply to EllaOne

Answer 1

Due to the risk of serious liver injury and liver failure, with some cases requiring liver transplantation.

This medicine should only be used for intermittent treatment of moderate to severe symptoms of uterine fibroids before menopause and when surgical procedures (including uterine fibroid embolisation) are not suitable or have failed.

Question 2

Finasteride may be associated with which psychological effects when used for BPH/hair loss?

Answer 2

Suicidal thoughts and depression

Question 3

Uterine perforation may occur with which form of contraception?

Answer 3

Intra-uterine contraception. but might not be detected until sometime later.

The risk is increased when the device is inserted up to 36 weeks postpartum or in patients who are breastfeeding.

Question 4

What are some of the symptoms associated with uterine perforation?

Answer 4

• Severe pelvic pain after insertion (worse than period cramps)
• Pain or increased bleeding after insertion which continues for more than a few weeks
• Sudden changes in periods
• Pain during intercourse
• Unable to feel the threads

Patients should be informed on how to check their treads and to arrange a check-up if threads cannot be felt, especially if they also have significant pain. Partial perforation may occur even if the threads can be seen; consider this if there is severe pain following insertion and perform an ultrasound.

Question 5

If the Nexplanon implant dislodges, what fatal effects could occur?

Answer 5

They may reach the lung via the pulmonary artery.

Question 6

The misoprostol vaginal delivery system may induce which type of contractions?

Answer 6

Uterine contractions unresponse to tocolytic therapy