Contraception

Question 1

How do combined contraceptives work

Answer 1

• Inhibit ovulation
• Oest and prog act on HP axis = reduce LH and FSH = no ovulation
• Oest = endometrium proliferates and grows
• Prog = prevents hyperplasia

Question 2

Amenorrhoeic and starting COC

Answer 2

• Start at any time
• Additional contraception 7 days

Question 3

Postpartum and COC

Answer 3

• As long as no breastfeeding
• Start day 21 postpartum
• Contraception for 7 days
• If BF = >6 weeks as above

Question 4

Miscarriage/TOP and COC

Answer 4

• Gestation <24 weeks, start in 5 days of surg/med TOP and no additionals
• > 24w = as for postpartum

Question 5

No regular contraception and COC start

Answer 5

• Day 1 of menstrual cycle
• No additional needed
  (same if 2-5 days)
• If other time in cycle = barrier method 7 days

Question 6

Starting COC after oral emergency

Answer 6

• Levonorgestrel = immediately and 7 days
• Ulipristal acetate = 5 days after and 7 days

Question 7

Switch from POP to COC

Answer 7

• Any time in cycle and 7 days

Question 8

Vomit within 3hrs of COC

Answer 8

• Take another pill asap

Question 9

v/d more than 24hrs

Answer 9

• follow instructions
• barrier for 7 days

Question 10

starting patch

Answer 10

• day 1-5 cycle
• no additional needed

Question 11

unscheduled patch detachment for <48hrs

Answer 11

• new patch asap
• That no additional contraception is required if the patch was used correctly earlier in week 1 and the 7 days prior to the HFI.
  >48hrs
• new patch asap
• barrier for 7 days

Question 12

Inserting IUS

Answer 12

• days 1-7 cycle = no additional
• any other time in cycle = 7 days

Question 13

Postpartum IUS

Answer 13

• within 48hrs (no additional) or from 4 weeks (7 days)

Question 14

IUS after TOP

Answer 14

• Post surgical abortion, insert the LNG-IUS at the end of the procedure.
• Post medical abortion, insert the LNG-IUS any time after completion of the second part of the abortion
• If the device is fitted after day 7 post-abortion additional

Question 15

IUS emergency contraception

Answer 15

Do not insert the LNG-IUS until pregnancy can be excluded with a pregnancy test performed no sooner than 3 weeks after the last episode of unprotected sexual intercourse.

Question 16

IUD post partum

Answer 16

• 48hrs or 4 weeks
• no additional for either

Question 17

IUD post TOP

Answer 17

• no additional needed

Question 18

IUD post emergency

Answer 18

• Insert the IUD within the first 5 days (120 hours) after the first episode of UPSI or within 5 days of the earliest expected time of ovulation (for example, on day 19 of a regular, 28-day cycle), whichever is later. No additional
• Outside of the above criteria, do not insert the IUD until pregnancy can be excluded with a pregnancy test performed no sooner than 3 weeks after the last episode of UPSI.

Question 19

POP starting

Answer 19

• Day 1-5 of cycle
• No additional

Question 20

POP amennorhoea

Answer 20

• 7 days additional

Question 21

post partum

Answer 21

• up to 21 days post partum = no additional
• Can be started any time after childbirth
• After 21 days = 7 days additional

Question 22

POP after emergency

Answer 22

Levonorgestrel
- 7 days additional
Ulipristal
- 5 days after
- barrier for 7
Can start straight away

Question 23

Missed POP

Answer 23

• Take a pill as soon as possible. If more than one pill has been missed, only one should be taken.
• Take the next pill at the normal time. This may mean taking two pills in 24 hours (the missed pill and the next one at the usual time).
• Avoid sexual intercourse or use a barrier method of contraception (such as condoms) for 7 days if taking drospirenone, or 2 days for all other POPs.

Question 24

Implant insertion

Answer 24

• 1-5 cycle, no additional
• after day 5 = 7 days

Question 25

Implant postpartum

Answer 25

- Before 21 days = no additional - After 21 days = 7 barrier

Question 26

Levonorgestrel

Answer 26

- Take asap - Within 72 hrs UPSI - double dose if BMI >26/70kg - Vomit within 3hrs = repeat - hormonal contraception can be started immediately after

Question 27

ulipristal

Answer 27

- 30mg dose no later than 120 hrs after - may reduce effectiveness of hormonal - caustion if severe asthma - delay BF 1 week after taking

Question 28

Missed COC pill

Answer 28

1 pill missed - Take the alst pill even if 2 pills in 1 day 2 or more missed - take last pill - Missed in week 1 = emergency contraception if UPSI - Missed in week 2 after 7 days taking = no need emergency - Missed in week 3 = finish pack and omit pill free interval

Question 29

Method most associated with weight gain

Answer 29

Depo provera

Question 30

POP missed pill

Answer 30

- <3hrs late = no action required - >3hrs late = take missed pill, continue rest of pack, extra precautions until re-established 48hrs

Question 31

What contraception is contraindicated in trans men undergoing testosterone therapy

Answer 31

- COC or any containing oestrogen as can antagonize testosterone