progesterone contraception

Question 1

progesterone only pill - 2 treatment options

Answer 1

microlut (levonorgestrel) 30microg OD

micronor (norethisterone) 350microg OD

Question 2

progesterone only pill - which pill should you avoid if oestrogen is absolutely contraindicated, and why

Answer 2

micronor (norethisterone), its partly metabolised into ethinyloestradiol

Question 3

progesterone only pill
- how many tabs can you miss
- how many hours wrong can you be
before its ineffective

Answer 3

3 hours, 3 day rule
- every tablet within 3 hours of the last dose the day before
- 3 days (ie missed 2 tablets)
then you need extra contraception

Question 4

long acting reversible contraception - what proportion get amenorrhoea

Answer 4

around 1/5

Question 5

intrauterine devices - when is highest risk of PID to develop, and when does it return to baseline

Answer 5

first 20 days after insertion is highest risk

goes to baseline after that

Question 6

intrauterine device - managing PID in first 20 days

Answer 6

do not remove IUD
antibiotics
* ceftriaxone 500mg + 2mL 1% lignocaine IM
* metronidazole 400mg PO BD for 14 days
* doxycycline 100mg BD for 14 days \/ Azithromycin 1g PO stat, repeated at 1 week

Question 7

important IUD insertion complications

Answer 7

perforation
ectopic pregnancy
pelvic inflammatory disease
expulsion of IUD

Question 8

short term management of irregular bleeding on hormonal LARC

(first line x3), second-line x1, depot-specific

Answer 8

• add a combined oral contraceptive pill, continuous use
• ponstan 500mg PO TDS for 5 days
• tranexamic acid 500mg BD for 5 days
  second-line
  norethisterone 5mg PO TDS for 3 weeks
  depot - give it earlier, like at 10/52

Question 9

implanon - contraindications

Answer 9

having a cardiovascular event on implanon (IHD, CVD,, TIA)
breast cancer
liver diseases
* decompensated cirrhosis
* hepatocellular adenoma
* liver tumors
on liver enzyme inducing medication

Question 10

implanon

- some circumstances where this is safe, but other hormonal contraceptives are not (5)

Answer 10

migraine with aura
VTE
breastfeeding
postpartum
post abortion

Question 11

common side effects of implanon, and proportions affected

Answer 11

dysmenorrhoea - 85% improve with time
irregular bleeding
- 1 in 5 get no bleeding, 1 in 5 get heavy or frequent bleeding
- 3 in 5 get sporadic bleeds

Question 12

heavy bleeding with implanon - what proportion improve, over how long

Answer 12

50% will improve after 3 months

Question 13

implanon insertion - when is it immediately effective

Answer 13

day 1-5 of period

5 days after UPA emergency contraception

Question 14

implanon insertion - how long does it take before effective (when inserted outside of menstruation)

Answer 14

7 days

Question 15

implanon complication - how to manage

• a bent implant
• a broken implant
• implant that isn’t palpable

Answer 15

bent - leave it in, its still effect
broken - all of it needs to be removed, so refer to family planning specialist?
if its not palpable 
- don't try to remove it
- use xray or USS to try and find it
- arrange a pregnancy test

Question 16

implanon - investigations for patient with irregular bleeding

Answer 16

update CST, CT/NG PCR

Question 17

implanon - managing irregular bleeding

• heavy bleeding
• intermittent bleeding

Answer 17

heavy - COCP for 3/12 continuously, then stop
intermittent
* ponstan 500mg PO BD for 5/7
* tranexamic acid 500mg PO TDS for 5/7