Contraception

Question 1

Methods` of Contraception

Answer 1

1. Daily pill(s)
2. IUS/D/vaginal ring
3. Injection
4. Patch
5. Implant

Question 2

COCP Hormones

Answer 2

ethinyl oestradio + progestin (desogestrel/levongestrel)

Question 3

COCP MoA

Answer 3

prevents ovulation

Question 4

COCP regimen

Answer 4

1/day for 3 wks then 1 wk off (withdrawal bleed)
Can tricycle to reduce withdrawal freq.
- preference
- reduces chance of unexpected bleed
If started on first 5 days of cycle (28 day cycle) confers immediate protection (caution shorter cycle length)
Stop >4 wks prior to surgery

Question 5

COCP Adv+Dis

Answer 5

Adv:

• > 99% effective
• Reversible upon stopping
• Regular less painful periods
• reduced risk of ovarian, endom. bowel ca.

Dis:

• Adherance
• No STI protection
• risk of VTE, breast ca, cervical ca., stroke, IHD

Question 6

COCP SE profile

Answer 6

Headache, N+V, breast tenderness, choice of ABx my be altered (inform GP)

Question 7

COCP vomiting?

Answer 7

If within 2 hours take another

Question 8

COCP absolute CI

Answer 8

1. <6 weeks post partum and breastfeeding
2. smoker >35 (>15/day)
3. HTN (systolic >160 or diastolic >100)
4. Current or past Hx VTE
5. IHD
6. Hx CVA
7. Complicated valve dx (pHTN, AF, IE)
8. Migraine w/aura
9. Breast ca (current)
10. DM w/retin/nephropathy
11. Severe cirrhosis
12. Liver tumer (adenoma or hepatoma)

Question 9

COCP Missed Pill

Answer 9

1 miss: take last and current, no other contraception needed
2 missed: take last and current and continue taking:
Use condoms until 7d correct pill usage
2 missed in wk 1 consider EC
2 missed in wk 2 no need for EC
2 missed in wk 3 finish pills and start new with no break

Question 10

POP Hormone and MoA

Answer 10

Desogestrel (cerazette 12hr), levonogestrel or norethistrone
Thicken cervical mucous
NB. desogestrel also stops ovulation

Question 11

POP how to take?

Answer 11

1 Pill same time every day

NO pill free week

Question 12

POP protection window

Answer 12

Immediate if in first 5 days
If at any other time use additional methods for 2 days
NB. If switching from COCP immediate protection

Question 13

POP benefits

Answer 13

Doesn’t have risks of oestrogen pills

Question 14

POP disadvantages

Answer 14

Adherence daily
Irregular bleeding
osteoporosis
ovarian cysts

Question 15

POP Missed Pill (3+12hr versions)

Answer 15

<3 hrs late: continue as normal
>3hrs take missed pill ASAP, continue, condom until 48 restablished pill taking
EC if UPSI in 48 hr window
2 or more missed pills: take last and next, condoms for 48 hrs

Question 16

POP SE profile

Answer 16

Irregular vaginal bleeding
acne
breast tenderness
mood changes 
headache

Question 17

Combined hormonal transdermal patch: Hormones and regime, brand name, risk of clot?

Answer 17

Norelgestromin + ethinyl oesteadiol
Applied for 3 wks (new patch per wk), then withdrawal bleed - tricycling possible
Evrapatch
No increased risk of clot

Question 18

CHTP missed patch

Answer 18

<48 hr: change with no precautions
>48 in wk 1 or 2: change and use barrier for 7d (if UPSI within 5d prev. or during patch free consider EC)
>48hr in wk 3: remove and apply next patch on normal date
Delayed at end of withdrawal: barrier for 7d

Question 19

Combined hormonal ring

Answer 19

inserted PV
Novaring
Worn 21d then 7d break

Question 20

Mirena (LNG-IUS): Hormone? MoA? Duration?

Answer 20

Levonorgestrel
Thins endometrium and prevents implantation
3-5 years

Question 21

Menses using LNG-IUS

Answer 21

tend to be less painful and lighter

however initially bleeding my be heavier

Question 22

Additional contraception after LNG-IUS insertion?

Answer 22

Needed for 7d unless inserted within first 7d of cycle

Question 23

SE profile of LNG-IUS

Answer 23

Acne
Breast tenderness
Mood disturbance
Headache

Question 24

Indications for LNG-IUS

Answer 24

Emergency contraception
HMB
Part of HRT

Question 25

What is Jaydess?

Answer 25

Smaller LNG-IUS effective for contraception only (not HMB) | Smaller so easier to fit esp. if nullip

Question 26

Progesterone implant: Hormone? MoA? Application/Duration? Brand name?

Answer 26

Etonogestrel Prevents ovulation Inserted into non-dom arm, works for 3 years

Question 27

Fertility after implant removal?

Answer 27

Restored immediately

Question 28

Side effects of progesterone implant?

Answer 28

Irregular bleeding mood changes breast tenderness nausea

Question 29

What can alter effectiveness of implant?

Answer 29

Anti-epileptic drugs | Rifampicin

Question 30

Progesterone depot injection: Hormone? Duration? Brand?

Answer 30

Medroxyprogesterone acetate 12-14 wks Depo-provera

Question 31

Depo-provera: additional contraception requirements

Answer 31

Contraception for first 7d unless injection given in first 5d of cycle

Question 32

Depo-provera: side effects:

Answer 32

Weight gain reduced bone density Irregular periods

Question 33

Fertility after depoprovera?

Answer 33

May take 6-12 mon. to return

Question 34

Copper coil MoA, Duration

Answer 34

Sterile inflammation prevents implantation Spermicide 5or 10 year options

Question 35

Cu IUD effective window?

Answer 35

IMMEDIATE

Question 36

Cu-IUD insertion?

Answer 36

Any time during cycle provided not pregnant

Question 37

SE of Cu-IUD`

Answer 37

Heavy painful periods Risk of expulsion Infection Perforation

Question 38

LARCs Effective window?`

Answer 38

All take 1 week to start except Copper IUD

Question 39

PACES Counselling Contraception: | History

Answer 39

``` Hx: - Personal/family VTE, migraine, cancer, stroke, HTN - Menstrual problems? ```

Question 40

PACES Counselling Contraception: | Options

Answer 40

Long acting: - IUS/D - Injection - Implant Short acting: - Pills (PoP/COCP) - Patches - Rings

Question 41

Female Sterilisation Method

Answer 41

Laparoscopic sterilisation: occlude tube using Filshie clips | PERMANENT loss of fertility

Question 42

Female sterilisation Need for contraception?

Answer 42

Use until next period (3mo if hysteroscopic)

Question 43

Advise re stertilisation

Answer 43

IRREVERSIBLE Vasectomy safer, quicker, less morbidity No protection against STI Pregnancy afterwards vv rare but higher risk ectopic

Question 44

Hysteroscopic sterilisatition

Answer 44

Outpt. w/o GA Expanding rings inserted into tubal ostia Induce fibrosis Takes 3 mo so req. contraception until then

Question 45

Vasectomy

Answer 45

Interrupt Vas deferens Small risk of scrotal haematomaand infection 12w post op ejacualate analysis for 0 sperm