Contraception

Question 1

Which two forms of contraception should be stopped in women of >50 years?

Answer 1

Depo Provera

COCP (lowered dose from ages 40-50)

Question 2

Which form of contraception is associated with delayed return to fertility?

Answer 2

Depo-Provera

lasts up to twelve weeks and can take several months for the body to return to normal menstruation.

Question 3

Emergency Contraception: time limit from UPSI and MOA

Levonorgestrel
Ulipristal Acetate
Cu - ICD

Answer 3

Levonorgestrel:

• anovulatory and prevents implantation
• within 72 hours of UPSI

Ulipristal Acetate (progesterone receptor modulator):

• anovulatory
• within 120 hours

Intrauterine Device (Copper):

• inhibits fertilisation and implantation
• within 5 days

Question 4

First and second line treatment for endometriosis

Answer 4

i) COCP

ii) Progesterone only (POP, implant of injection)

Question 5

Contraception in the post partum period:

POP
COCP

Answer 5

POP: Any time after birth whether breastfeeding or not. additional contraception after day 21

Question 6

Side effects of Depo Provera

Answer 6

Depo Provera (medroxyprogesterone acetate)
- anovulatory + cervical mucous/ endometrial thickening

i) weight gain
ii) delay of 1 year to fertility
iii) osteoporosis risk
iv) irregular bleeding

Question 7

Missed pills:

COCP (cerazette)
POP (micronor, noriday, nogeston, femulen)

Answer 7

COCP

• If less than 12 hours late then just take the pill and carry on
• if more than 12 hours late then take the pill and then the next pill at the usual time. (don’t take more than one pill if more than one day was missed)

POP

• if less than 3 hours late then just take the pill and carry on
• if more than 3 hours late then take the pill and then the next pill at the usual time. (don’t take more than one pill if more than one day was missed)

In both instances condoms should be used until 48 hours of regular pill taking has been instated

Question 8

Lady says she has missed 4 days of POP/COCP pill.

“Shall i just take the 4 pills in one go? Will that be okay?”

Answer 8

No

just take one for the one you missed and then take the next at the regular time.

48 hours of condom cover from when regular pill taking has been resumed

Question 9

Mode of action:

COCP

Answer 9

Inhibits Ovulation

Question 10

Mode of action:

POP (Not desogestrel)

Answer 10

Thickens Cervical Mucus

Question 11

Mode of action:

DOP (deosgestrel)

Answer 11

Inhibits Ovulation

Thickens Cervical Mucus

Question 12

Mode of action:

Injectable Contraceptive (Medroxyprogesterone acetate)

Answer 12

Inhibits Ovulation

Thickens Cervical Mucus

Lasts for 12-14 weeks

Question 13

Mode of action:

Implantable Contraceptive (etonogestrel/Nexplanon)

Answer 13

Inhibits Ovulation

Thickens Cervical Mucus

-Lasts 3 years
-Immediate contraceptive before on the fourth day of menstrual cycle
-

Question 14

Mode of action:

IUCD (Long term and emergency)

Answer 14

Long Term Contraception:

Decreases sperm motility and survival

Emergency:

Toxicity to sperm and ovum
Inhibits implantation

Question 15

Mode of action:

IUS (levonorgestrel)

Answer 15

Prevents endometrial proliferation

Thickens cervical mucus

Question 16

Mode of action:

Oral Levonorgestrel

Answer 16

Emergency contraceptive

Inhibits Ovulation

Question 17

Mode of action:

Ulipristal Acetate

Answer 17

Emergency Contraceptive:

Inhibits Ovulation

Question 18

Contraceptives that are unaffected by enzyme inducing drugs?

Answer 18

Copper Coil is most preferred
Progesterone injection - depo provera
Mirena IUS

Question 19

Emergency contraception in patients taking EIDs?

Answer 19

Copper coil is most preferred.
If using levonorgestrel - double the dose

Ullipristal acetate should be avoided

Question 20

Precocious puberty definitions:

Males Age?

Females Age?

Answer 20

Before 9 years old in males

Before 8 years old in females

Question 21

Risk factors for ovarian cancer

Answer 21

Things which increase ovulation

• Early menarche
• Late menopause
• nulliparity
• HRT
• Obesity
• FH : BRCA1 or BRCA2