contraception - general

Question 1

when is breastfeeding a reliable form of contraception (3 criteria)

Answer 1

all must be present

• baby is exclusively breastfed
• amenorrhoeic since delivery
• baby is under 6 months of age

Question 2

rank progesterone formulations in order of reducing androgenicity

Answer 2

levonorgestrel
norethisterone
cyproterone, etonorgestrel, drospirenone, normogestrel

Question 3

if you are epileptic, on enzyme inducing drugs - what contraceptive options can you still use

Answer 3

• depo-provera
• mirena IUD
• copper IUD

Question 4

what is the difference between withdrawal bleeding and breakthrough bleeding

Answer 4

withdrawal bleed - the bleed that happens when you go from taking contraceptive pills, to stopping them. hormone is withdrawn -> bleed
breakthrough bleeding - when you get bleeding while you are on active pills

Question 5

copper IUD - what time period do you expect irregular bleeding

Answer 5

usually in first 6 months after insertion

Question 6

copper IUD - managing problematic bleeding

Answer 6

ponstan 500mg PO BD for 5 days

tranexamic acid 500mg TDS for 5 days

Question 7

suitable contraceptive options in perimenopausal period

Answer 7

LNG-IUD
copper IUD
implanon
progesterone only pill
all emergency contraceptives

Question 8

contraceptives to be avoided in perimenopause, and why

Answer 8

DMPA
* ?bone density and lipid effects
CHC
* risk of MI and VTE

Question 9

when can a perimenopausal women on no hormones stop using contraception

Answer 9

> = 50 - after 12 months of amenorrhoea

< 50 - after 24 months of amenorrhoea

Question 10

how do you manage contraception in a woman >= 50, on DMPA or CHC

Answer 10

change to a different contraceptive

Question 11

perimenopausal women on hormonal contraception - when can it be ceased

Answer 11

test FSH after 12 months of amenorrhoea
if its > 30 IU/L, repeat in 6 weeks
if 2 raised FSH -> stop contraception after 12 months