Sexual and Reproductive Health Flashcards
After how many months of amenorrhoea can women over 50 safely be advised they no longer require contraception (assuming they are not already using hormonal methods)?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
e. Irrespective of duration of amenorrhoea, women should be advised to continue contraception until age 55
B - 12 months
After how many months of amenorrhoea can women under 50 safely be advised they no longer require contraception (assuming they are not already using hormonal methods)?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
e. Irrespective of duration of amenorrhoea, women should be advised to continue contraception until age 55
D - 24 months
A 51 year old women using the combined pill for contraception wishes to have a blood test done to determine whether or not she still requires contraception. How long should the combined pill be stopped prior to measuring FSH levels in women for this indication?
a. FSH can be measured while taking the combined pill
b. 1 week
c. 2 weeks
d. 4 weeks
e. 6 weeks
C - 2 weeks
A 51 year old women using the Depo-Provera progesterone injection for contraception wishes to have a blood test done to determine whether or not she still requires contraception. How long should the injection be stopped prior to measuring FSH levels in women for this indication?
a. FSH can be measured while on the injection
b. 2 weeks from date of missed injection
c. 4 weeks from date of missed injection
d. 6 months from date of missed injection
e. 12 months from date of missed injection
E - 12 months from date of missed injection
There is a delay in return of ovulation following cessation of the progesterone-only injection thus 1 year should elapse since stopping prior to measuring FSH levels in women to determine menopausal status.
No such delay is indicated in women using either the implant or intra-uterine system (Mirena) - these women should be advised to continue contraception for 1 year after recording 2 FSH readings >30iU/L taken at least 6 weeks apart.
At what age can women be advised to stop contraception irrespective of menstrual cycle?
a. 50 years
b. 52 years
c. 55 years
d. 58 years
e. 60 years
C - 55 years
Very few women continue to have fertile ovulation beyond this age though it is impossible to completely guarantee infertility.
Which of the following progesterone only pills has the longest window within which the pill may be taken each day?
a. Levonorgestrel
b. Desogestrel
c. Norethisterone
d. Norgestimate
e. Etonorgestrel
B - Desogestrel
The ‘missed pill’ window for most progesterone only contraceptives is only 3 hours with the exception of desogestrel which is 12 hours.
A patient wishes to use the progesterone only implant for contraception. She attends the sexual health clinic to have this fitted on day 14 of a regular cycle. Pregnancy test prior to insertion is negative. For how many days does she require additional contraceptive cover?
a. None
b. 5 days
c. 7 days
d. 9 days
e. Until next menstrual period
C - 7 days
When not started within the first 5 days of a menstrual cycle, users of the implant or injection require additional contraceptive cover for 7 days
A patient wishes to use the progesterone only injection for contraception. She attends the sexual health clinic to have this fitted on day 14 of a regular cycle. Pregnancy test prior to injection is negative. For how many days does she require additional contraceptive cover?
a. None
b. 2 days
c. 7 days
d. 9 days
e. Until next menstrual period
C - 7 days
When not started within the first 5 days of a menstrual cycle, users of the implant or injection require additional contraceptive cover for 7 days
A patient wishes to use the progesterone only pill for contraception. She attends the sexual health clinic to have this prescribed on day 14 of a regular cycle. Pregnancy test prior to issue is negative. For how many days does she require additional contraceptive cover?
a. None
b. 2 days
c. 7 days
d. 9 days
e. Until next menstrual period
B - 2 days
When not started in the first 5 days of the menstrual cycle, users of the progesterone only pill should be advised of the need to take additional contraceptive precautions for 2 days.
A patient wishes to use the combined pill Microgynon for contraception. She attends the sexual health clinic to have this prescribed on day 14 of a regular cycle. Pregnancy test prior to issue is negative. For how many days does she require additional contraceptive cover?
a. None
b. 3 days
c. 5 days
d. 7 days
e. Until next menstrual period
D - 7 days
When not started within the first 5 days of the menstrual cycle, users of the combined pill should be advised of the need for additional contraceptive precautions for 7 days.
There are 2 exceptions to this rule:
- Zoely - for which 7 days precautions are required when started on any day but the first day of the cycle
- Qlaira - for which 9 days of precautions are required when started on any day but the first day of the cycle
A patient wishes to use the Levonorgestrel intra-uterine system for contraception. She attends the sexual health clinic to have this fitted on day 14 of a regular cycle. Pregnancy test prior to fitting is negative. For how many days does she require additional contraceptive cover?
a. None
b. 3 days
c. 5 days
d. 7 days
e. Until next menstrual period
D - 7 days
The LNG-IUS can be fitted without the need for additional contraceptive cover within the first 7 days of the menstrual cycle; beyond this, 7 days of additional contraceptive cover are required.
What is the principal reason for women to have the progesterone only implant removed within the first year after fitting?
a. New onset dysmenorrhoea
b. Pain/discomfort around insertion site
c. Weight gain
d. Menstrual irregularity
e. Effect on mood
D - Menstrual Irregularity
20% is the number to remember for the implant:
- 20% have amenorrhoea
- 20% have the device removed in the first year due to irregular or persistent bleeding
What is the standard dose of levonorgestrel contained within Mirena and Levosert systems?
a. 13.5mg
b. 52mg
c. 150mg
d. 302mg
e. 520mg
B - 52mg
A 39 year women requests hysteroscopic sterilisation under local anaesthetic as she no longer wishes to use hormonal methods and does not wish to undergo a general anaesthetic in order to have laparoscopic tubal sterilisation. For how long following hysteroscopic sterilisation should women be advised of the need to use additional contraception?
a. 7 days
b. 1 month
c. 3 months
d. 6 months
e. No need for additional contraceptive cover
C - 3 months
Women undergoing hysteroscopic sterilisation should take additional contraceptive precautions for 3 months until undergoing a test of tubal occlusion
A 47 year old woman seeks advice about continuing the combined oral contraceptive (COCP). She is normotensive and a non-smoker with a BMI of 25. She has no other medical history and no significant family history. She is concerned that the COCP may give her additional health risks. Which of the following malignancies would you advise she may have a small additional risk of developing due to taking the COCP?
a. Breast
b. Colorectal
c. Endometrial
d. Lung
e. Ovarian
A - Breast Cancer
The COCP provides a protective effect against ovarian and endometrial cancer that persists for 15 years or more after stopping the pill. Women can be advised that there may be a small increased risk of breast cancer which reduces to no risk 10 years after stopping
A 22 year old medical student presents with a request for contraception. Her menstrual cycle is irregular and she complains of acne and hirsuitism. Previous investigations have diagnosed polycystic ovarian syndrome (PCOS). She wishes to have a combined oral contraceptive with the best risk profile and most impact on her androgenic symptoms. Which of the following is best for her?
a. Cilest (ethinyl estradiol/norgestimate)
b. Loestrin (ethinyl estradiol/levonorgestrel)
c. Marvelon (ethinyl estradiol/desogestrel)
d. Microgynon (ethinyl estradiol/norethisterone)
e. Yasmin (ethinyl estradiol/drosperinone)
E – Yasmin (ethinyl estradiol/drosperinone)
From the given list, Yasmin is more beneficial in terms of management of acne and hirsuitism associated with PCOS. Women with PCOS may also be given Marvelon or Mercilon as contraception. Yasmin contains 3mg of drosperinone which has some anti-androgenic properties. Dianette is also useful as it contains cyproterone acetate which is also anti-androgenic. Care must be taken for women with a high BMI.
A 26 year old woman presents to the emergency gynaecology clinic requesting emergency contraception. She had unprotected sexual intercourse 6 days ago. She is not currently using any contraception having not had a partner for a year. She has a regular 28 day cycle which can be heavy. The first day of her last period was 15 days ago. What emergency contraception option, if any, would you advise?
a. A copper bearing intrauterine device
b. A Mirena coil
c. It is too late for emergency contraception
d. Levonelle
e. Ulipristal acetate
A – A copper bearing intrauterine device
Choice of emergency contraception depends on the length of time since SI. All forms are not effective after 6 days EXCEPT for the Copper IUD and only in the circumstance that it is within 5 days of the earliest estimated date of ovulation
A 25 year old woman with a bicornuate uterus attends the emergency gynaecology unit requesting emergency contraception. She has been on holiday and forgot to take her pill for 3 days in the first week of the calendar pack and had unprotected sexual intercourse four days ago. She is in good health. Which of the following is recommended?
a. Copper IUCD
b. Mirena IUS
c. Levonorgestrel
d. Mifepristone
e. Ulipristal acetate
E - Ulipristal acetate
Mirena is not licensed for EC; lNG can be used only if within 72 hours. Copper IUCD can be used up to 5 days though not in the presence of a uterine abnormality. Mifepristone is not licensed for this in the UK. Ulipristal acetate is licensed and safe up to 5 days from UPDI thus is the recommended dose.
A 15 year old girl attends sexual health clinic requesting termination of pregnancy. She is 7 weeks pregnant. Her boyfriend is also 15 years old and studies in the same school. She has not informed anyone of the pregnancy. What is your most likely immediate action?
a. Encourage her to inform her parents
b. Inform specialist youth worker
c. Inform her GP
d. Inform the school head teacher
e. Reject the request without parental consent
A – Encourage her to inform her parents
Fraser guidelines relate to a case in 1984 (Gillick vs. West Norfolk) and provide a framework for dealing with children aged under 16. It revolves around whether or not the child is capable of making a reasonable assessment of the advantages and disadvantages of treatment and thus their ability to consent to that treatment. In his guidance, Fraser stated that a doctor could provide contraception “provided he is satisfied in the following criteria:
• That the girl will understand his advice
• That he cannot persuade her to inform her parents or allow him to inform the parents
• That she is very likely to continue having sexual intercourse with or without contraception
• That unless she receives contraception, her physical or mental health or both are likely to suffer
• That her best interests require him to give her contraceptive advice, treatment or both without parental consent.
The same guidance applies to termination of pregnancy.
A 23 year old woman has been referred to the gynaecology clinic by her GP after being on the combined pill for 3 months. She has been on 20 micrograms of ethinyl oestradiol and 150mg of desogestrel. She is experiencing irregular vaginal bleeding which is interfering with her lifestyle. She has been taking the pills as prescribed and has not missed a dose. The pregnancy test in the clinic is negative. She reports no symptoms of abdominal pain. A smear was performed 5 months ago and was normal. What is the best management option?
a. Add extra progesterone cover for 5 days per month during the pill free interval
b. Advise this is normal and review in a further 3 months
c. Change to a pill containing 30mg of ethinyl oestradiol and reassess after 3 months
d. Change to a progesterone only pill and reassess after 3 months
e. Stop the pill and monitor her symptoms before trying alternative hormonal contraception
B – Advise this is normal and review in a further 3 months
A woman undergoes a forceps delivery following a prolonged second stage. She consults her GP on day 5 postnatal about contraception - she was previously using the Copper IUD and would like to have this fitted again. How long after delivery can intra-uterine contraception be fitted?
a. 7 days
b. 14 days
c. 21 days
d. 28 days
e. 42 days
D - 28 days
Intrauterine contraception may be fitted within the first 48 hours after birth though beyond this, there is deemed to be an unacceptably high risk of perforation prior to 28 days
A 34 year old woman wishes to use a cervical cap with spermicidal gel for contraception. How do you advise her this method should be used?
a. Insert immediately before and remove immediately after intercourse
b. Insert immediately before and remove 6 hours after intercourse
c. Insert an hour before and remove an hour after intercourse
d. Insert an hour before and remove 3 hours after intercourse
e. Insert an hour before and remove 6 hours after intercourse
B - Insert immediately before and remove 6 hours after intercourse
Cervical caps are associated with a pregnancy rate of 6-12%
A 34 year old wishes to use the combined pill for contraception though is anxious about the risks of venous thromboembolism. Which of the following progesterone preparations is associated with the lowest risk of VTE?
a. Desogestrel
b. Drosperinone
c. Etonorgestrel
d. Gestodene
e. Norgestimate
E - Norgestimate
Norgestimate, levonorgestrel and norethisterone carry a VTE risk of 5-7 per 10,000 women per year against a background of 2 per 10,000. Etonorgestrel and norelgestromin have a risk of 6-12 and for gestodene, desogestrel and drosperinone it is 9-12
What proportion of cases of pelvic inflammatory disease are caused by either Chlamydia or Gonorrhoea?
a. 10%
b. 25%
c. 50%
d. 75%
e. 90%
B - 25%
Which of the following is a recognised benefit of desogestrel-based progesterone only pills when compared with older generation preparations?
a. Fewer androgenic side effects
b. Permits a 7 day pill free interval
c. Lower failure rate with perfect use
d. Longer ‘missed pill’ window
e. Increases insulin sensitivity
D - Longer ‘missed pill’ window
What progesterone does the implant contain?
a. Norethisterone
b. Desogestrel
c. Etonorgestrel
d. Drospirenone
e. Norgestrel
C - Etonorgestrel
A patient has a levonorgestrel-IUS inserted at the local sexual health clinic on Day 16 of her cycle. A pregnancy test prior to insertion is negative. For how many days should she take additional contraceptive precautions?
a. No additional precautions necessary
b. 3 days
c. 7 days
d. 14 days
e. Until her next menstrual period
C - 7 days
