Contraception

Question 1

Advice prior to switching IUS

Answer 1

Should abstain from sex or use barrier contraption for 7 days before fitting in case new device cannot be fitted

Question 2

How long does it take IUDs to become effective

Answer 2

Immediately for copper IUD
If IUS - immediately if in first 7 days of cycle, if not in first 7 days, women should use barrier methods for 7 days.

Question 3

Counselling for copper IUD and mirena IUS

Answer 3

Bleeding may be heavier and longer with copper. With mirena, unpredictable but usually reduce with time.
Can be fitted from 4 weeks post natal
Up to 2 in 1000 risk of perforation which increases with postnatal use and breastfeeding - will need retrieval!
1 in 20 fall out, most likely in first 3 months.
If user does get pregnant, higher chance of it being ectopic.
Risk of PID from insertion, especially if STI. But no higher infection risk after 20 days.
Contraindicated if current symptomatic STI or PID.
Hormonal side effects of Mirena- headaches, acne, breast tenderness, mood changes, tend to settle with time

Question 4

Who to do STI testing on prior to IUC insertion

Answer 4

If high risk of STI eg
Less than 25YO
Change in sexual partner or multiple partners in last Yr.
Previous STI

Do chlamydia testing and gonorrhea if high prevalence areas

Asymptomatic women at risk of STI can be swabbed and IUC fitted at same time, without waiting for the results as long as the patient is contactable in the event of a positive result.

Question 5

What is first line COCP

Answer 5

Pill with <30mcg ethinylestrdiol and levonorgestrel.
eg microgynon.