Contraceptives

Question 1

How quickly is an IUD effective?

Answer 1

Instantly

Question 2

How soon is the POP effective?

Answer 2

2 days

Question 3

Which 4 contraception methods are effective after 7 days?

Answer 3

1. COCP
2. IUS
3. Nexaplanon (implant)
4. Depot injection

Question 4

How does the progesterone only pill work?

Answer 4

Thickening of the cervical mucus acts as a barrier to sperm entry

Question 5

What is the mechanism of action of the COCP, injection and implant?

Answer 5

Anovulation (inhibition of ovulation)

Question 6

Side effects of the POP

Answer 6

Breast tenderness
Weight gain
Acne
Mood swings
Menstrual irregularities

Question 7

What is the mechanism of action of the copper coil, or IUD?

Answer 7

The copper acts as a spermicide to prevent entry of sperm

Question 8

At what time in the cycle does the POP provide immediate contraception?

Answer 8

If started prior to day 5 of the menstrual cycle

Question 9

What are the missed pill rules for POP?

Answer 9

1. If 3 hours or less late, continue as normal
2. If over 3 hours late, take the missed pill as soon as possible, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours

Question 10

If one COCP pill is missed, e.g. less than 72 hours since last pill was taken…

Answer 10

Take the missed pill as soon as possible (even if this means taking two pills on the same day)
No extra protection is required provided other pills before and after are taken correctly

Question 11

If more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do?

Answer 11

Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight.

Question 12

If more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are only on day 1-7 of the pack?

Answer 12

They will need emergency contraception if they have had UPSI

Question 13

if more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are only on day 8-14 of the pack?

Answer 13

If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required

Question 14

if more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are on day 15-21 of the pack?

Answer 14

If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed.

Question 15

What does the patient need to know if they are switching from a POP to a COCP?

Answer 15

1. they can switch at any time but 7 days of extra contraception (i.e. condoms) is required.
2. Ensure the woman is not already pregnant before switching (i.e. they have been using contraception reliably and consistently).

Question 16

How long after taking ulipristal acetate should a patient’s normal contraceptive be taken?

Answer 16

After taking ulipristal acetate women should wait 5 days before starting regular hormonal contraception

Question 16

When the patient switches for Desogestrel or cerazette, to the COCP, what do they need to know?

Answer 16

When switching from desogestrel, they can switch immediately, and no additional contraception is required. This differs from a traditional POP because desogestrel inhibits ovulation.

Question 17

What are the 2 types of “morning after pill”?

Answer 17

levonorgestrel (cezarette) and Ulipristal acetate

Question 18

When should Levonorgestrel be taken to be effective?

Answer 18

Within 72 h of UPSI

Question 19

When can a patient start their normal hormonal contraception after taking levornogestrel?

Answer 19

immediately

Question 20

When can an intrauterine system be implanted after childbirth?

Answer 20

Within 48 hours OR after 4 weeks

Question 21

How long does the IUD generally last for?

Answer 21

the majority of IUDs with copper on the stem only are effective for 5 years, BUT some of the IUDs that have copper on the stem and the arms of the T may be effective for up to 10 years

Question 22

How long is the IUS effective for?

Answer 22

Mirena coil, levonorgestrel 20 is effective for 5 years

Question 23

What are classed as UKMEC 3 conditions for COCP? (7)

Answer 23

1. more than 35 years old and smoking less than 15 cigarettes/day
2. BMI > 35 kg/m^2*
3. family history of thromboembolic disease in first degree relatives < 45 years
4. controlled hypertension
5. immobility e.g. wheel chair use
6. carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
7. current gallbladder disease

Question 24

What does UKMEC 3 mean?

Answer 24

Giving the medication to this person is not approved as disadvantages generally outweigh the advantages

Question 25

What are the UKMEC 4 conditions? (9)

Answer 25

1. more than 35 years old and smoking more than 15 cigarettes/day 2. migraine with aura (tingling sensation before headache and loss of vision) 3. history of thromboembolic disease or thrombogenic mutation 4. history of stroke or ischaemic heart disease 5. breast feeding < 6 weeks post-partum 6. uncontrolled hypertension 7. current breast cancer 8. major surgery with prolonged immobilisation 9. positive anti-phospholipid antibodies (e.g. in SLE)

Question 26

What is the main injectable contraceptive in the UK? What is it?

Answer 26

Depo Provera is the main injectable contraceptive used in the UK. It contains medroxyprogesterone acetate 150mg

Question 27

How often is the Depo Provera given?

Answer 27

Every 12 weeks but can be given every 14 weeks with extra precautions e.g. barrier protection

Question 28

What is the name of the only licensed contraceptive patch in the UK?

Answer 28

The Evra patch

Question 29

What is the contraceptive patch regime?

Answer 29

Wear one patch a week for three weeks and do not wear a patch on week four

Question 30

What is the criteria for Lactational amenorrhoea to work as a contraceptive?

Answer 30

Lactational amenorrhoea is a reliable method of contraception as long as mum is amenorrhoeic, baby under 6 months, and they are breastfeeding exclusively

Question 31

Give 4 examples of traditional POPs

Answer 31

Micronor Noriday Nogeston Femulen

Question 32

What is the drug name of Cerazette

Answer 32

Desogestrel

Question 33

What is the window for traditional POPs working?

Answer 33

3 hours - if pill is 3 hours late, emergency cont needed

Question 34

Cerazette window

Answer 34

12 hours - if less than 12 hours late, no action needed