Progesterone-only Contraception

Question 1

Types of Progesterone-only Contraception

Answer 1

1. POP - Levenorgestrel 30mcg, Norethisterone 350mcg, effective after 3 tabs
2. Implants - Etonogestrel (Implanon NXT)
3. IUCD - Copper, Levenorgestrol 52(mirena)/19mg(Kyleena))
4. Injectables - DMPA 150mg IM every 3 months +/- 2 wks, in first 5 days of cycle

Question 2

Types and recommended time of use for Progesterone-only Contraception

Answer 2

1. POP - effective after 3 days ?6wks
2. Implanon nxt - 3yrs
3. IUCD
   Copper - 5-10 yrs
   Mirena - 5yrs
4. DMPA - 3months +/- 2 weeks
5. After abortion -
   If taken with in 5 days = contraception If >5days = 7days abstinence

Question 3

Can you start Progesterone-only Contraception in breast feeding woman?

Answer 3

Yes

Question 4

When can you start POP after delivery?

Answer 4

From 6 weeks

Question 5

Absolute contraindication of Progesterone-only Contraception i.e., MEC (Medical eligibility criteria) - 4

Answer 5

Active Breast Carcinoma *within past 5 yrs

Question 6

MEC - 3 or relative contraindications in Progesterone-only Contraception?

Answer 6

1. Past Breast Carcinoma
2. SLE - APA positive
3. Vaginal bleeding
4. Ischemic heart disease
5. Stroke
6. Severe Cirrhosis
7. Hepatocellular carcinoma or adenoma
8. Women on liver enzyme inducing drugs {Phenytoin, carbamazepine, rifampicin, rifabutine} - IUD,DMPA can be given
9. Ovarian cyst

Question 7

Can you give estrogen while breast feeding?

Answer 7

No

Question 8

Can you give progesterone while breast feeding?

Answer 8

Yes

Question 9

Estrogen for contraception is contraindicated in?

Answer 9

1. Breast Carcinoma
2. DVT - Deep vein thrombosis
3. Breast feeding

Question 10

Mechanism of action of Progesterone-only Contraception?

Answer 10

1. Cervical mucous thickening (primary mech of POP)
2. Ovulation inhibition
3. Mech barrier (IUCD)

Question 11

Side effects of Progesterone-only Contraception

Answer 11

1. Amenorrhoea/Heavy bleed
2. Infrequent bleeding
3. Breast tenderness
4. Mood swings

IUD - Ectopic pregnancy, sepsis, pain, PID, perforation within 1st yr, esp in C-Section cases/6 months postpartum/Breastfeeding

Question 12

What tests are done for lost IUD?

Answer 12

X-ray and USG

Question 13

Which infertility methods are not recommended after 50yrs of age

Answer 13

1. Estrogen containing contraceptives
2. DMPA

Question 14

Implanon

Answer 14

1. Etonogestrel implant (subdermal)
2. 3yrs protection
3. LOWEST PREG RATES
4. S/E: irregular(mc)/heavy/no(22%) bleed

Question 15

IUCD

Answer 15

1. Mirena commonly used (5yrs)
2. C/I: Absolute:
   -Active PID
   -Undiagnosed abnormal uterine bleed
   -Breast CA h/o
3. S/E:
   -Copper - heavy bleed(mc), subsides in 3-6 months. (Mirena - helps in ↓heavy bleed)
   -Pain
   -PID in 20 days of insertion
   -Perforation
4. Can be used in Premenopause

Question 16

Most effective rx in heavy menstrual bleeding

Answer 16

Mirena IUCD

Question 17

Pregnancy with IUCD use

Answer 17

Abortion
Sepsis (esp 2nd trimester)
Ectopic preg

Remove IUCD immediately

Question 18

DMPA

Answer 18

1. Injectable 150mg IM
2. 3months
3. Not immediately reversible, takes 8 months (unlike IUCD/Implanon)
4. S/E:
   -Wt gain, breast tenderness, mood changes
   -Accelerated bone loss *Not used in >45yrs or <18

Question 19

Women on liver enzyme inducing drugs, which POP is advisable? Emergency contraception

Answer 19

1. Liver enzyme inducing drugs:
   Anti epileptics (Phenytoin, carbamazepine), Rifampicin,
   Rifabutin St Johns wort
2. IUD/DMPA used
3. Emergency contraception:
   Levenorgestrel double dose
4. If using CHC, use EE-50mcg