Women's Health: Contraception and infertility

Question 1

What are the benefits of the COC pill?

Answer 1

Lightens and regulates periods

Protective for endometrial and ovarian cancer

Question 2

What are the side effects of the COC pill?

Answer 2

Spotting

Clotting

Breast and cervical cancer risk

Question 3

How does breast cancer affect prescription of COC pill?

Answer 3

BRCA: relatively contraindicated

Hx: Completely contraindicated

Question 4

What neuro condition is COC pill not recommended in?

Answer 4

migraine with aura (MEC 3)

Question 5

What is the advantage of the POP pill?

Answer 5

Can take if oestrogenergic methods are not available

Question 6

What are the downsides of POP?

Answer 6

Irregular bleeding

Acne, headache

Question 7

Who cannot have the progesterone only pill?

Answer 7

Current breast cancer

Question 8

What is the advantage of injectable contraception (medroxyprogesterone acetate, Depo Provera)

Answer 8

Given every 3 months rather than daily

Question 9

What contraceptive is most associated with weight gain?

Answer 9

Injectable

Question 10

How long does restoration to normal fertlity take when stopping the injectablet?

Answer 10

12 months

Question 11

What are the advantages of the SD implant (etonestergel, nexplanon)

Answer 11

Lasts 3 years

Does not contain oestrogen

Question 12

What are the disadvantages of the implant?

Answer 12

Heavy or irregular bleeding

Question 13

Who can’t have the injectable?

Answer 13

Current of past breast cancer

Question 14

Who cant have the SD implant?

Answer 14

Current or past breast cancer

Gynae: unexplained vaginal bleeding

Systemic: IHD, liver cirrhosis/cancer

Question 15

How do the IUS and coil compare in terms of advantage, disadvantage and contraindications?

Answer 15

IUS // IUD

Both long lasting

Both can expulse within 3 months, small infection risk or perforation too

lighter/irregular periods // heavy periods

Question 16

How quickly will you get contraceptive cover with…

Copper coil

POP/desogestrel (cerazette)

COC pill

SD implant

Injectable

IUS

Answer 16

Copper: Immediate any time

POP: immediate <5 days < + 2 days barrier

COC pill, implant, injectable: Immediate < 5 days < + 7 days barrier

IUS: After 7 days

Question 17

If taking the COC pill, what timeframe do you need for switching to…

POP

Desogestrel

Answer 17

POP: 7 days barrier

Desogestrel: Immediate

Question 18

How long does it take to gain cover if switching from POP to COCP?

Answer 18

Immediate if during packet completion (day 21)

Question 19

What do with COC pill if you missed

1 pill missed

>=2 pills missed

Answer 19

1 pill

Take missed regardless of point

>=2 pills

Take missed pill, barrier/abstain for 7 days

Week 1: + emergency contraception if UPSI in wk4/1

Week 2: No emergency needed if 7 days continous pills

Week 3: + continue taking pills through the pill free interval

Question 20

For the POP and desogestrel…

What are the cut off times for each pill

What do if under the time

What do if over the time

Answer 20

3 hours for POP, 12 for deso

Under

Continue as normal for both

Over time

Take missed immediately, take next at usual time

Continue with rest of pack

Use condoms for 48 hours while pill taking re-established

Question 21

When is post-partum contraception required and what timescale can you start…

POP

IUS/IUD

Answer 21

None needed until day 21

POP: Immediate but need 48hrs barrier if >21 days

IUS/IUD: <48hrs or 4 weeks after birth

Other forms: After day 21 with 7 days barrier

Question 22

Under what conditions is the lactational amenorrheic method effective

Answer 22

Fully breast feeding

Amenorrheic

< 6 months post-partum

Question 23

What contraceptive is most associated with breastfeeding benefits?

Answer 23

Injectable

Question 24

When can breast feeding recommence if taking the COC pill?

Answer 24

After 6 weeks

Question 25

Regarding emergency contraception, how do the following compare in terms of time frame, dosage and follow up? Levonogestrel Ulipristal acetate (EllaOne) Intrauterine device

Answer 25

Levonogestrel // UA // IUD \<72hrs // \<120 hrs // \<5 days of UPSI/ovulation date 1.5mg (3mg if BMI \>26, over 70kg) // 30mg // NA Take hormonal straight after // Start COCP 5 days after if compliant + outside week 1 // Give prophylactic antibiotics

Question 26

Which emergency contraceptive is cautioned in asthmatics and disallows breastfeeding for a week?

Answer 26

Ulipristal acetate

Question 27

When can you stop the following contraceptives before and after 50? IUD COCP Depo-provera (injectable) Implant/POP/IUS

Answer 27

**Before 50** Stop non-hormal after 2 years amenorrhea Continue rest **50 and over** Stop non-hormonal after 1 year amenorrhea Swtich COCP to POP/non-hormonal Switch depo to non-hormonal then stop after 2 years amenorrhea Continue others until amenorrhea with either 55yrs or FSH \>30

Question 28

What is the beneficial side effect of POP in over 40s?

Answer 28

Can preserve bone density and perimenopausal symptoms

Question 29

For trans/non-binary folk what should be done regarding... Barrier methods Cervical screening HPV vaccinations prEP

Answer 29

Condoms and dams should be used Offered to those with a uterus vaccinate all sexually active indviduals prEP for those at risk

Question 30

What should you advise for trans patients wanting contraception regarding hormonal therapy

Answer 30

Hormonal replacement NOT contraception Avoid COC pill in testosterone takers POP/Injection/Implant thought to be fine

Question 31

For epilepsy patients, what drugs Cannot provide contraception if using lamotrigene Increase metabolism of contraceptives Reduce metabolism of contraceptives

Answer 31

COC pill P450 inducers: Phenytoin, carbamazepine, phenobarbitone (PCP) P450 inhibitors: Sodium valproate

Question 32

For infertility, what lifestyle recommendations should be made

Answer 32

BMI 20-25 smoking, alcohol cessation Sex every 2-3 days Folic acid for females

Question 33

What initial investigations should be performed for infertility in Females Males

Answer 33

LH, FSH on days 2-5 Progesterone on day 7 (repeatedly \<16 then refer) + Prolactin (inhibits ovulation) + TFTs (low increases prolactin) + AMH (rule out congenital) Males Seme analysis, refer if any low

Question 34

When can UPSI proceed following vasectomy

Answer 34

When 8 week semen analysis shows azoospermia