Week 2- contraception contraindications

Question 1

When can you insert an IUD?

Answer 1

At any point in the cycle.

Question 2

When can you insert an IUS?

Answer 2

Within first 7 days of the cycle.

If greater than 7 days then use a back up method for 7 days.

Question 3

What are contraindications to combined hormonal contraceptions? (this includes patches, rings and pill)?

Answer 3

Basically anything thats bad for your heart. e.g. being fat (BMI> 35), smoking more than 15 a day above the age of 35 AF, previous VTE, hypertension, thrombogenic mutations, SLE or antiphospholipid syndrome, diabetes with retinopathy, nephropathy or neuropathy
Also migraine with aura.
Also BRACA mutation or personal Hx of breast cancer

Question 4

What contraindications are there for the IUS/IUD?

Answer 4

Long QT
Unexplained vaginal bleeding
Endometrial cancer
Uterine fibroids that distort the uterine cavity
PID
Chlamydia, gonorrhoea

Question 5

What contraindications are there for progesterone only- this could be implant, pill or depot?

Answer 5

Unexplained vaginal bleeding
Current or previous breast cancer
Cirrhosis or in liver tumours.

Question 6

What do combined hormonal contraceptives defend against?

Answer 6

Ovarian and cervical cancer.

Question 7

What non-repro related disorders can combined hormonal contraceptives be used for?

Answer 7

Acne- cyproterone acetate
Premenstrual syndrome
PCOS

Question 8

A 22 year old woman attends requesting contraception
She has met a new partner and is currently using condoms
She has had no problems with these but wishes a more reliable method
Last Menstrual Period 2 weeks ago, ‘normal’
Smoker 15 cpd
Periods heavy and crampy
BMI 19, BP 115/72
Eating disorder - bulimia
Scared of putting weight on
Needle phobia
About to go abroad for 6 months

Best contraceptive option?

Answer 8

Cant give her a pill because its likely to not be absorbed.
Cant give the implant because of the needle phobia.
Going abroad for 6 months so depo won’t work, also doesn’t like injections.
Needs mirena coil.

Question 9

Periods heavy, regular
Smears up to date
New partner, previous partner vasectomy
Using condoms, STI screen negative
Worsening PMS
Otherwise well
Non-smoker
BMI 24, BP 110/75

Best contraceptive option?

Answer 9

Give her the combined pill as it will help with premenstrual symptoms. She also has no risk factors for it.