Contraception

Question 1

Contraceptives: time till effective (if not the first day of period).
- IUD (1)
- POP (1)
- others (1)

Answer 1

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

Question 2

Emergency contraceptives:
When to avoid EllaOne (uliprisatal) (1)

Answer 2

asthma

Question 3

Nexplanon (estronogestrel):
where inserted?

Answer 3

subdermal

Question 4

COCP and surgery:
when to stop (1)

Answer 4

4 weeks before
Mitch to progesterone only

Question 5

COCP:
UKMEC 4 criteria

Answer 5

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

Question 6

Contraceptive side effects:
osteoporosis (1)
weight gain (1)

Answer 6

DEPO for both (and delayed return to fertility)

Question 7

Anti-epileptics and contraception:
- phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine (3)
- lamotrigine (1)

Answer 7

The pills are the problem
Coil/ Depo good for all

UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS

For lamotrigine:
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS

Question 8

POP late:
what to do? (1)
which is the exception to this rule (1)

Answer 8

Traditional’ POPs (Micronor, Noriday, Nogeston, Femulen)
-If less than 3 hours late > no action required, continue as normal.

Cerazette (desogestrel)
-If less than 12 hours late > no action required, continue as normal

Question 9

Which contraception contraindicated >50?

Answer 9

DEPO (osteoporosis)

Question 10

Mechanism of action:
- POP (other than desogestrol)
- desogestrel-only
- injectable
- IUS
- levonorgestrel
- IUD
- implant
- COCP

Answer 10

POP (EXCEPT desogestrel): thickens cervical mucus

IUS: prevents endometrial proliferation
IUD: toxic to ovum and sperm

THE REST STOP OVULATION.

Question 11

COCP and postpartum - when to avoid

Answer 11

breast feeding < 6 weeks post-partum= UKMEC 4

Question 12

stroke / IHD + COCP

Answer 12

UKMEC 4

Question 13

current breast cancer contraceptive

Answer 13

only IUD

Question 14

Cerazette (desogestrel) - why special

Answer 14

POP with 12hr window

Question 15

Fraser gudeliens_ what ages

Answer 15

<13= ILLEGAL
13-15= Fraser
16+= allowed

Question 16

when does Nexplanon work straight away

Answer 16

if inserted in first 5 days of period

Question 17

how long does neplaxon last

Answer 17

3 years

Question 18

what does neplaxon interact with

Answer 18

enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon

Question 19

when should levonorgestrel 1.5mg dose be changed (2)

Answer 19

1) BMI >26 or weight over 70kg –> DOUBLE DOSE

2) enzyme inducing drugs

Question 20

levonorgestrel - when to repeat dose

Answer 20

if vomit within 3hr

Question 21

when can you start hormonal contraceptive after: levonogestrel (1)
EllaOne (ulipristal) (1)

Answer 21

• immediately
• Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period

Question 22

What is the most common adverse effect experienced by women taking the progestogen only pill?

Answer 22

irregular bleeding

Question 23

postpartum contraceptive

Answer 23

progesterone after day 21

OR IUS/IUD within 48hr of childbirth OR after 4 weeks

NOTE:
COCP contraindicated <6 weeks postpartum if breastfeeding
UKMEC 2 6weeks-6 months

Question 24

pregnancy interval optimal

Answer 24

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies.

Question 25

oestrogen contraceptive and surgery - when to stop

Answer 25

4weeks before (offer Progesterone instead) These recommendations do not apply to minor surgery with short duration of anaesthesia, e.g. laparoscopic sterilisation or tooth extraction, or to women using oestrogen-free hormonal contraceptives.

Question 26

when can copped IUD be inserted post UPSI

Answer 26

within 5 days OR Withn 5 days of earliest ovulation date, whichever is later

Question 27

condom for latex allergy

Answer 27

polyurethane condom

Question 28

contraceptive patch: week 1 or 2 (1) week 3 (1)

Answer 28

WEEK 1 or 2: if <48hr okay if >48hr = change, 7 days contraception additional END OF WEEK 3: (i.e. delayed taking patch off at break) if removal of patch delayed then just take it off and start new on on day you ere supposed to. If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle.

Question 29

investigation if concerned about ectopic

Answer 29

Pregnancy test! if -ve no concern

Question 30

progesterone only pill - when is a late pill

Answer 30

3 hrs

Question 31

post medical termination of pregnancy: when can neplanon be inserted

Answer 31

immediately BUT ensure she is not pregnant on insertion

Question 32

Examples of contraceptives that are unaffected by EIDs are:

Answer 32

Copper intrauterine device Progesterone injection (Depo-provera) Mirena intrauterine system

Question 33

how long does POP take to be effective

Answer 33

2 days

Question 34

Progestogen only pill + antibiotics

Answer 34

no need for extra precautions