contraception

Question 1

what are the links between the COCP and cancer?

Answer 1

slightly increases risk of cervical and breast cancer but decreases risk of endometrial and ovarian cancer

Question 2

what virus is linked to cervical cancer

Answer 2

HPV

Question 3

absolute contraindications to COCP (4)

Answer 3

migraine with aura
history of VTE
breast cancer
over 35 and 15+ cigarettes per day

also.. bp over 160/95
history of stroke or IHD

Question 4

advice for patient on protection when starting the COCP

Answer 4

if started in first 5 days of period then no other contraception needed. if started later then use additional protection

Question 5

advice for patient on COCP about missed pills

Answer 5

if one missed pill then take as soon as possible and continue as normal.

if two or more missed then continue pack and use additional contraception for 7 days

Question 6

what is the definition of infertility

Answer 6

inability to conceive after 12 months+ of regular unprotected sex.

next step is to refer for infertility investigations

Question 7

when is a person fertile again after giving birth

Answer 7

21 days postpartum

Question 8

what to do if a patient with a Nexplanon (implant) has a non-palpable implant

Answer 8

SIGNIFICANT event

1. condoms
2. pregnancy test
3. ultrasound of the arm to find the implant - if fails then x ray
4. refer for specialist removal

Question 9

potential adverse effects of Nexplanon

Answer 9

changes in menstrual bleeding
amenorrhea
headache
mood and weight changes
breast pain
nausea

Question 10

when can a copper IUD be inserted

Answer 10

anytime during menstrual cycle, after first or second trimester abortion and 4 weeks post partum
effective immediately after insertion

Question 11

what is the biggest risk with an IUD

Answer 11

ectopic pregnancy - doesnt alter risk of fertilisation in fallopian tube

Question 12

emergency contraception options

Answer 12

before ovulation (day 14 ish) = levonorgestrel, if within 72 hours of intercourse. it inhibits ovulation for 5 days.

if after 72 hours then ulipristal acetate can be taken within 5 days - better for people with higher BMI also

after ovulation = copper IUD

Question 13

what contraception is NOT ok postpartum

Answer 13

COCP

Question 14

what is the first line investigations for infertility

Answer 14

F = serum progesterone at day 21 (mid-luteal phase)
M = semen analysis

Question 15

why is effective contraception so important in a woman with controlled epilepsy

Answer 15

if shes taking sodium valproate for epilepsy, this is a known teratogenic (can cause serious congenital malformations if taken during pregnancy)

a single method may not be effective enough so another reliable barrier method should be considered.

Question 16

advice for patient on protection when starting the progesterone only pill

Answer 16

use contraception for 2 days after starting the pill.

Question 17

when is each hormone tested for in regards to infertility

Answer 17

FSH = day 3 of cycle
Oestrogen = 1 week after ovulation (~19-22 days)
progesterone = day 14 ish
LH = day before ovulation (~13/14)

Question 18

why should FSH be tested

Answer 18

to find abnormalities with fertility, ovarian function, menstrual cycle and menopause

Question 19

why should GnRH be tested

Answer 19

to diagnose hypothalamic-pituitary disease in precocious and delayed puberty in children.

GnRH = anytime of cycle

Question 20

describe the stages of a regular cycle

Answer 20

Menstrual phase: day 1-5 shedding of the endometrium, decrease in oestrogen and progesterone

Follicular phase: FSH triggers follicule development and a dominant follicule forms. oestrogen rises which causes a positive FB loop to increase LH
FSH and LH are produced in the anterior pituitary

ovulation: LH surge triggers ovulation, around day 14, following ovulation, FSH causes the dominant follicle to transform into the corpus luteum. the corpus luteum produces a surge of progesterone which peaks around day 21.

if no fertilisation then corpus luteum regresses and progesterone drops = triggers menstruation

Question 21

what are common causes of infertility

Answer 21

PCOS
hypothalamic amenorrhea
endometriosis
fibroids

low sperm count
poor motility
abnormal morphology
congenital absence of vas deferens

Question 22

explain these progesterone results

<16 nmol/L
16-30 nmol/L
30 nmol/L

Answer 22

<16 nmol/L = repeat and consider referral
16-30 nmol/L = repeat test
30 nmol/L = ovulation occured

Question 23

what is the first line treatments for infertility (F)

Answer 23

lifestyle modifications - clomiphene citrate (1)
letrozole (2)
metformin (for PCOS with insulin resistance)

Question 24

when should IVF be considered

Answer 24

after 2 years of infertility or with specific indications