Patient semester 1 : contraception

Question 1

when is day 1 of the cycle ?

Answer 1

For women not taking HC, day 1 is the first day of the period
For women taking HC, day 1 is the first day of the packet

Question 2

what happens when too many pills are missed

Answer 2

ovaries no longer dormant, become active again

Question 3

HFI is

Answer 3

hormone free interval - typically break for period (withdrawal bleed)
still have contraceptive cover
but oestrogen break needed

Question 4

Ed pills

Answer 4

sugar placebo pills taken in 7 day break

Question 5

ethanol estradial (EE)

Answer 5

type of oestrogen

Question 6

Levonorgestrel

Answer 6

used in a lot pills

also EHC

Question 7

transdermal patch

Answer 7

replaced weekly, combined so need 1 week without patch

releases oestrogen and progesterone

Question 8

vaginal ring

Answer 8

inserted for 21 days , 7 days

releases oestrogen and progesterone

Question 9

unopposed oestrogen

Answer 9

uncontrolled uterine lining growth

Question 10

PO tablet

Answer 10

28 daily - no pill free period

very light/ no period

Question 11

DPMA

Answer 11

injection - must be bang on every 8 or 12 weeks

Question 12

Noroethisterone

Answer 12

injection - low doses 350mcg

Question 13

implant

Answer 13

lasts for 3 years
LARC
eteongestral

Question 14

intrauterine device system (IUS)

Answer 14

slow release/ long acting reversible contraceptives (LARC)

Levonorgestrel

Question 15

describe the different type of contraceptives devices available

Answer 15

spermicidal gel to be used in conjunction with barrier methods e.g. condom, diaphragm (keep in place for 6 hours)
IUD- can be hormonal (copper) or non hormonal (plastic) replaced every 5-10 years

Question 16

what are the groups of hormonal contraceptives

Answer 16

combined hormonal contraceptives (oestrogen and progesterone)
Progesterone only contraceptives
devices

Question 17

what does triphasic and biphasic mean

Answer 17

tri- 3 diff pills taken ,

bi - 2 different types of tablets

Question 18

describe mechanism of action for CHC

Answer 18

• Primary action - inhibit ovulation  
Thickened cervical mucus and altered endometrium
	• Oestrogen – 
	• endometrial proliferation
 progestogen opposes proliferation

Hormonal contraceptives inhibit or stop ovulation however if an egg is released then it will slow it down ,
Synthetic oestrogens inhibit FSH release by negative feedback – supressing follicular development.

Question 19

describe mechanism of action for POC

Answer 19

• Suppression of ovulation
• Thickens cervical mucus, stops/delays ovum transport, renders endometrium hostile to implantation,
reduced cilia activity in FT ( iff egg released slows egg movement to uterus, more likely to miss the uterine implantation period)
• Various mechanisms to various degrees

Question 20

give an example of a triphasic pill

Answer 20

zoely - 4 day bleed

Question 21

name 2 progesterone like drugs

Answer 21

norothisterone and desogestral

Question 22

what are the most effective contraceptives

Answer 22

formulations independent of user e.g. injection (least because done every 3 months), implant,IUD, IUS more reliable

CHC and POC 8% fail rare

Question 23

can breastfeeding prevent pregnancy?

Answer 23

yes LAM
if your are fully breastfeeding
baby under 6 months
no periods

Question 24

what determines contraceptive choice?

Answer 24

patient choice
• Medical conditions ?
• Medication ? DDI?
• UKMEC* categories for contraindications (valproate)
• Advise on other suitable methods and offer if appropriate
• Discuss advantages, disadvantages, risks, efficacy, adverse effects and when to seek advice
• Advise on how to start HC
• CHC regimens – standard and tailored
• Advise on missed/late pill/use of vaginal ring
• Need for ‘Quick-starting’ contraception - start at any point in period
• Start at any point of the cycle
• Most people are started on the day of their period or within 5 days of it starting
• Quick-starting contraception – exclude pregnancy and advise additional precautions

Question 25

name advantages of COC?

Answer 25

menstrual period regular, lighter, less painful reduction in acne reduced risk of ovarian, uterine and colon cancer

Question 26

name disadvantages of COC?

Answer 26

minor ADRs - nausea, tender breasts, cyclical weight gain loss of libido, vaginal discharge, breakthrough bleeding increased risk of high blood pressure , MI, stroke, venous thromboembolism, breast cancer, cervical cancer because of oestrogen mainly

Question 27

advantages of POC?

Answer 27

high efficacy | less likely to get endometrial cancer, benign treat disease, uterine fibroids, anaemia

Question 28

Disadvantages of POC

Answer 28

ADRs - acne, headache,depression, loss of.libido , weight gain ,vaginal dryness, menstrual irregularities reduced efficacy in obesity increase risk of functional ovarian cyst, ectopic pregnancy, breast cancer

Question 29

when taking COC what is the definition of a missed pill?

Answer 29

24 hours late or more if 2 pills are missed i.e. more than 24 hours late - no cover , UPSI needs EHC if started on day 6 or later ice, quick starting build cover again (7 days

Question 30

when taking POP what is the definition of a missed pill?

Answer 30

3hrs (old) /12 hours if you miss one pills ,cover comprimised continue pills with 2 days extra precaution

Question 31

what UKMEC category can't be prescribed COC

Answer 31

``` category 4 : breast feeding and 6 week post partum over 35 +15 cigs a day multiple CVS rise consistently elevated BP vascular disease and history of VTE migraine with aura (flashing light) current breast cancer diabetes ( nephropathy,retinopathy,neruopathy) lupus ```

Question 32

which contraception increases cardio risk?

Answer 32

COC - likely oestrogen related

Question 33

how would you advise a patient starting a COC on day 3 of their natural cycle?

Answer 33

no additional precautions needed - day 1-5 effective immediately as starting within period/withdrawal bleed

Question 34

how would you advise a patient starting a COC on day 6 of their natural cycle?

Answer 34

patient is quick starting additional precautions needed | will take 7 days to build cover up

Question 35

how would you advise a patient starting a POP on day 3 of their natural cycle?

Answer 35

no additional precautions needed - day 1-5 effective immediately

Question 36

how would you advise a patient starting a POP on day 14 of their natural cycle?

Answer 36

patient is quick starting additional precautions needed will take 2 days to build cover up starting in the middle of cycle also delays next period (if it comes)

Question 37

desogestrel (cerazette) is an example of what type of contraceptive?

Answer 37

a POP

Question 38

how do you advise a patient changing from a COC to a POP?

Answer 38

``` ensure they were taking COC correctly exclude pregnancy additional precautions for 2 days take all your active pills and then skip pill free period and start the POP immediately new pill is effective immediately ``` if they are already in their pill free period, start POP immediately and use additional precautions for 2 days

Question 39

how do you advise a patient changing from a POP to a COC?

Answer 39

will require 7 days to rebuild cover, additional precautions needed Qlaira, triphasic pill needs additional precautions for 9 days

Question 40

describe what advice to give if a patient misses 1 zoely active pill?

Answer 40

if it is more than 12 hours late then EHC indicated

Question 41

what advice is given for vomiting and diarrhoea

Answer 41

vomiting within 2 hours or persistent diarrhoea over 24 hrs,

Question 42

name the 3 different options for emergency contraception

Answer 42

nono hormonal copper iud levonelle - 1.5mg levonorgestrel ellaone - 30mg ulipristal acetate

Question 43

Courtney takes logynon ED she missed day 1,14, and 24. sexual intercourse day 25 does she need EHC

Answer 43

no, cover not compromised day 1 - elongated pill free period, built up cover again day 24 is placebo pill

Question 44

Courtney takes logynon ED she missed day 13,14, and 24 sexual intercourse on day 19 does she need EHC

Answer 44

yes | cover hast been built back up since day 14

Question 45

Courtney takes logynon ED she missed day 13,14, and 24 sexual intercourse on day 25 does she need EHC

Answer 45

no cover built sufficiently

Question 46

Khloe takes Noriday (POP) (traditional ). she missed one pill on day 6 and had sex on day 9. does she need EHC

Answer 46

no | cover has been built back up (2 day +