Contraception

Question 1

Modes of contraceptive action:

Combined oral contraceptives

Answer 1

Inhibition of ovulation

Question 2

Antibiotics which might interfere with effect of CHC

Answer 2

Liver enzyme inducers e.g. rifampicin

Question 3

Missed pill advice for CHC:

a) one pill missed
b) two pills missed

Answer 3

a) take missed pill as soon as remembered and rest as normal

b) take last pill and continue taking as normal; EC may be needed

Question 4

When is EC needed for two missed pills with the CHC?

Answer 4

Days 1-7.

Question 5

What advice is given for two missed CHC pills in days 15-21?

Answer 5

Finish pills in current pack and omit pill-free interval

Question 6

Absolute contraindications to CHC (4)

Answer 6

Migraine with aura
Age over 35, smoking >15 a day
Current breast cancer
Stroke/TIA/VTE

Question 7

Modes of contraceptive action:

Progesterone only pill (2)

Answer 7

Thickening cervical mucus; desogestrel also inhibits ovulation

Question 8

If POP is started on a day other than days 1-5 of cycle,how many days additional precaution should be used?

Answer 8

2

Question 9

How are periods affected by the POP?

Answer 9

Irregular bleeding

Question 10

Modes of contraceptive action:

Copper IUD (2)

Answer 10

Prevents implantation; toxic to sperm

Question 11

Problems associated with IUCD (3)

Answer 11

Heavy menstrual bleeding
Uterine perforation
Expulsion risk

Question 12

Modes of contraceptive action:

Progesterone implant (2)

Answer 12

Prevents ovulation, thickens cervical mucus

Question 13

Problems with nexplanon (5)

Answer 13

Irregular/heavy bleeding
Headache
Nausea
Breast pain
Weight gain

Question 14

How long does nexplanon last?

Answer 14

3 years

Question 15

Modes of contraceptive action:

Progesterone injection/Depo Provera (3)

Answer 15

Stops ovulation
Thickens mucus
Thins endometrium

Question 16

How often is depo-provera given?

Answer 16

Every 12 weeks

Question 17

Adverse effects of depo-provera? (5)

Answer 17

Not quickly reversible
Delay in fertility return
Irregular bleeding
Weight gain
May increase osteoporosis risk

Question 18

Risks of the Mirena coil?

Answer 18

Infection, expulsion, perforation

Question 19

When is contraception required post-partum for non breastfeeding women?

Answer 19

Day 21

Question 20

Three methods of emergency contraception; when can they be used?

Answer 20

Levonellle (72hrs)
ellaOne (120 hours)
Cu-IUD- 120 hours, or 120 hours after earliest expected date of ovulation

Question 21

Factors used to assess STI risk (3)

Answer 21

Women under age 25
New sexual partner
More than one sexual partner in last year

Question 22

Important aspects of an emergency contraception consultation (4)

Answer 22

History of LSI
Menstrual and gynaeocological history
General medical history
Consider STI risk/testing
Also consider future contraceptive needs

Question 23

What is the active agent in a) levonelle and b) ellaOne?

Answer 23

a) levonergestrel

b) ulipristal acetate, a selective progesterone receptor modulator

Question 24

Why should an IUD ideally be inserted early in the menstrual cycle (i.e. soon after period begins)?

Answer 24

Procedure is easier through the soft and dilated cervix, and pregnancy is ruled out

Question 25

A history of pelvic inflammatory disease within what time period is a contraindication to insertion of an IUD?

Answer 25

3 months

Question 26

Modes of contraceptive action:

Mirena IUS (2)

Answer 26

Thickens cervical mucus

Thins endometrium