STRAT-OG, Contraception Flashcards
1 - Evidence suggests that the highest conception rate occurs with intercourse 2 days prior to ovulation
2 - Sperm can survive within the female genital tract for 5–7 days
3 - The ovum is able to be fertilised up to 48 hours following ovulation
4 - Ovulation can be detected by a rise in luteinising hormone
5 - The average conception rate for midcycle intercourse is approximately 15% per cycle
1- True
2 - True
3 - The answer is false. It is 12 hours.
4 - The answer is true.
5 - The answer is false. It is 30%.
1 - Consent for termination of pregnancy in under-16-year-old women has to be obtained from a legal guardian
2 - Sexual activity should be discouraged in both men and women with learning difficulties because of the risk of unplanned pregnancy
3 - In England, contraception should not be prescribed to under-16-year old women unless they are deemed to be Fraser competent
4 - Termination of pregnancy always requires the signatures of two independent medical practitioners.
1 - The answer is false. This can be obtained from the patient if compliant with Fraser guidelines.
2 - The answer is false. This would contravene human rights.
3 - The answer is true.
4- The answer is false. Only one signature is required in an emergency situation.
1 - In the UK, sterilisation is the most widely used method of contraception
2 - Reversal of female sterilisation is readily available on the NHS
3 - Vasectomy has a lower failure rate than female sterilisation
4 - There is a significantly increased risk of testicular cancer following vasectomy
5 - When counselling a man regarding vasectomy, which of the following is important to stress
1 - The answer is false. Sterilisation is the most widely used form of contraception worldwide, but not in the UK. Only 10% of women 16-49 years old are sterilised in the UK.
2 - The answer is false. It is not available in most SHAs.
3 - The answer is true.
4 - The answer is false. There is no evidence of this.
5- Contraception should be used for a further 3 months with a negative semenalysis at the end of that time
- Vasectomy is reversible but usually not offered within NHS services and although reanastamosis may be successsful , this does not guarantee patency or fertility.
- Men should be advised that vasectomy is associated with a 1:2000 failure rate in comparison with 1:200 lifetime failure rate for tubal occlusion (2-3:1000 10-year failure rate for occlusion with Filshie clips) and 1:500 5-year failure rate for hysteroscopic sterilization with microinserts.
- There is no evidence of an increased testicular cancer risk after vasectomy.
Which of the following statements is the most appropriate concerning long-acting reversible contraception and intrauterine devices (IUDs)
1 - Gynefix is currently the only frameless IUD licensed in the UK
2 - IUDs available in the UK are licensed for a variable time period from 5 to 8 years
3 - The most effective IUDs contain at least 280 mm2 of copper
4 - The risk of ectopic pregnancy increases in women using IUDs
5 - Unbanded devices are the most effective IUD presently available
Gynefix is currently the only frameless IUD licensed in the UK
- Currently available IUDs in the UK are effective for 5 or 10 years.
- The most effective devices contain more than 380 mm2 of copper, and IUDs with copper bands around the arms are the most effective of all as they contain maximum copper.
- Gynefix is a device constructed of copper beads threaded onto a filament (rather than onto a plastic frame), which is secured in the fundal myometrium.
- The overall risk of ectopic pregnancy is reduced with use of an IUD compared with using no contraception; however, if a pregnancy does occur with an intrauterine method in situ, the risk of an ectopic pregnancy occurring is increased and in some studies half of the pregnancies that occurred were ectopic.
1 - Approximately 50% of women in the UK discontinue DMPA within 1 year
2 - Progestogen implants are associated with irregular vaginal bleeding
3 - The failure rate of progestogen implants is higher in women with a BMI >40
4 - The major mechanism of action of depomedroxyprogesterone acetate (DMPA) is to thicken cervical mucus
5 - DMPA does not adversely affect bone density in long-term use and, therefore, is recommended as a first-line contraceptive in young women
1 - The answer is true.
2 - The answer is true.
3 - The answer is true.
4 - The answer is false. It is to inhibit ovulation.
5 - The answer is false. See the NICE guideline. (link is external) *
CHOOSE ONE BEST
Concerning progestogen-only pills (POPs), which of the following is true?
1 - Additional contraceptive precautions should be taken during antibiotic treatment
2 - In women undergoing treatment for breast cancer, POPs increase the rate of disease recurrence
3 - They are associated with an increased risk of thromboembolic disease
4 - They are contraindicated in women with insulin-dependent diabetes
5 - They should be discontinued 4 weeks prior to major surgery
- The answer is in women undergoing treatment for breast cancer POPs increase the rate of disease recurrence. All hormonal contraception is contraindicated in women who are undergoing treatment for breast cancer as it is a hormone-dependent malignancy.
- Women with insulin-dependent diabetes may use the POP safely
- There is no evidence that POPs increases thromboembolic risk
- There is no evidence that standard antibiotic treatment reduces its contraceptive efficacy.
When counselling a woman for postcoital contraception (PCC), what should you advise
1 - Intrauterine PCC can be inserted up to Day 19 of a 28-day cycle
2 - Mifepristone can be used for PCC
3 - STI screening results should be available prior to fitting intrauterine PCC
4 - The intrauterine system is licensed for PCC
Ulipristal acetate is as effective as an IUD
Intrauterine PCC can be inserted up to Day 19 of a 28-day cycle
- Only copper IUDs are licensed for fitting for PCC.
- An IUD can be inserted up to day 19 in a 28-day cycle, before the earliest possible implantation of a blastocyst (day 20).
- IUDs are more effective up to 120 hours after unprotected intercourse (99%), in comparison with oral levenorgestrel (85% effective up to 72 hours and 64% effective up to 120 hours) and oral ulipristal acetate (85% up to 120 hours).
- Mifepristone has been used as an effective form of PCC in trials but has never been licensed for this purpose in the UK.
- An IUD can be fitted in an asymptomatic woman as long as she is willing to return for treatment in the event of a positive STI screen.
Method Failure rate (% pregnant at first year) Perfect use Typical use No method 85 85 Barrier (male) 2 15 Diaphragm 6 16 Combined oral contraceptive Progestogen-only contraception 0.3 8 Injection 0.3 3 Implant 0.05 0.05 Intrauterine device 0.6 0.8 Intrauterine system 0.1 0.1 Female sterilisation 0.5 0.5
Method Failure rate (% pregnant at first year)
Perfect use Typical use
No method: 85 85
Barrier (male) 2 15
Diaphragm 6 16
COC/POC 0.3 8
Injection 0.3 3
____________________________________
Implant 0.05 0.05
IUD 0.6 0.8
IUS 0.1 0.1
Female sterilisation 0.5 0.5
Method Failure rate (% pregnant at first year) Perfect use Typical use No method 85 85 Barrier (male) 2 15 Diaphragm 6 16 Combined oral contraceptive Progestogen-only contraception 0.3 8 Injection 0.3 3 Implant 0.05 0.05 Intrauterine device 0.6 0.8 Intrauterine system 0.1 0.1 Female sterilisation 0.5 0.5
Method Failure rate (% pregnant at first year)
Perfect use Typical use
No method: 85 85
Barrier (male) 2 15
Diaphragm 6 16
COC/POC 0.3 8
Injection 0.3 3
Implant 0.05 0.05
Intrauterine device 0.6 0.8
Intrauterine system 0.1 0.1
Female sterilisation 0.5 0.5
Which of the above statements is false? Depo-medroxy progestogen acetate should not be prescribed for women…
- Immediately sfter second trimestr abortion
- In whom COC pill is contraindicated
- In woman with Family HX of VTE
- In woman with personal HX of VTE
- under 16 years ae
- At risk of STI or HIV
- Infected with HIV/AIDS
- Breast feeding
- Takin enzyme inducin drus unless dose interval reducced.
- 2 weeks late for their injection without additional barrier contraceptipn
- BMI >35
- HX of focal mirgraine with aura
- unstable DM
Who are taking liver enzyme-inducing medication, unless the dose interval is reduced
Depo-medroxy progestogen acetate can be prescribed for women who are taking liver enzyme-inducing medication
TRUE ANSWERS ARE:Depo-medroxy progestogen acetate should not be prescribed for women…
- Immediately after second trimester abortion
- In whom COC pill is contraindicated
- In woman with Family HX of VTE
- In woman with personal HX of VTE
- under 16 years ae
- At risk of STI or HIV
- Infected with HIV/AIDS
- Breast feeding
- 2 weeks late for their injection without additional barrier contraceptipn
- BMI >35
- HX of focal mirgraine with aura
- unstable DM
Choose the statement relating to progesterone-only contraception methods that is false
- Acts by preventin ovulation
- are not contraindicated for use, by breast feedin
- Doesnot increase risk of ST acquisistion
- amenorrhea 20 %
- Irregular bleeding: 50 %
- reduced dysmenorrhea
- effective with >70 kg
- licensed in UK upto 3 years
- not associated with delay in return of fertility after removal
- not associated with reuction in BMD
- not associated with reuced efficacy in < 20 years
- not associated with weiht gain
- recomended for taking liver enzyme inducing drugs
The answer is progesterone-only contraception methods are recommended for women taking liver enzyme-inducing drugs – they are not recommended for these women.
TRUE ANSWERS ARE:progesterone-only contraception methods
- Acts by preventing ovulation
- are not contraindicated for use, by breast feeding
- Doesnot increase risk of STI acquisistion
- amenorrhea 20 %
- Irregular bleeding: 50 %
- reduced dysmenorrhea
- effective with >70 kg
- licensed in UK upto 3 years
- not associated with delay in return of fertility after removal
- not associated with reuction in BMD
- not associated with reuced efficacy in < 20 years
- not associated with weiht gain
Choose the statement relating to copper IUDs that is false
- STI screen should be performedd prior to insertion
- Antibiotic prophylaxis may be considered where risk of STI is significant
- are associated with increased dysmenorrhea
- are not associated with delay in return of fertility followin removal
- are not contraindicated for use by insulin dependant DM
- Are not contraindicated for use by nulliparous woman under age of 20 years
- Are not contraindicated for use by woman who is HIV positive
- Can be used by woman over the ae of 40 years until they no loner require contraception, even if this duration is beyond the UK markettinng authorization
- Expuslsion occurs in less than 5 %of woman in 5 years of use.
- If a woman becomes prenant with the IUD in situ the isk of ectopic prenancy is greater than 10%
- The risk of ectopic prenancy with IUD fitted is lower than when usin no contraception
- Those with 380mm2 of copper are most effective.
- The answer that is false is if a woman becomes pregnant with the IUD in situ, the risk of ectopic pregnancy is greater than 10%.
TRUE ANSWERS ARE
- STI screen should be performedd prior to insertion
- Antibiotic prophylaxis may be considered where risk of STI is significant
- are associated with increased dysmenorrhea
- are not associated with delay in return of fertility following removal
- not contraindicated for use by insulin dependant DM
- Are not contraindicated for use by nulliparous woman under age of 20 years
- not contraindicated for use by woman who is HIV positive
- Can be used by woman over the ae of 40 years until they no loner require contraception, even if this duration is beyond the UK markettinng authorization
- Expuslsion occurs in less than 5 %of woman in 5 years of use.
- The risk of ectopic prenancy with IUD fitted is lower than when using no contraception
Choose the statement relating to the Mirena® IUS that is false
- 50 % of woman becomes amenorrhoeic within the foirst year of use
- Act predominantly by preventing implantation and sometimes by inhibitin fertilization
- an STI screen should be performed prior to insertion
- Anitbitoic prophylaxis may be considered where risk of STI sinificant
- Are not contraindicated for use by nuliparous woman under 20 years age
- expulsion occurs less than 5 % of woman in 5 years use
- If woman becomes prenant with IUS in situ the risk of ectopic prenancy is about 5 %
- irreular bleedin during first 6 months is common
- Is associated with acne in some woman
- Is not contraidicated for use by HIV positive woman
- Licensed duartion is 5 years for contraception
- the risk of ectopic prenancy with IUS fitted is lower than usin no contraception
- no evidence that IUS causes weiht gain
- When fitted for woman over 45 years of ae, who are amenorrhoeic, the IUS may be used until they no loner require contraception, even if this is the duration of UK marketing authrorization
The following statement is false: 50% of women become amenorrhoeic within the first year of use.
TRUE ANSWERS ARE:the Mirena®
- Act predominantly by preventing implantation and sometimes by inhibitin fertilization
- an STI screen should be performed prior to insertion
- Anitbitoic prophylaxis may be considered where risk of STI sinificant
- Are not contraindicated for use by nuliparous woman under 20 years age
- expulsion occurs less than 5 % of woman in 5 years use
- If woman becomes prenant with IUS in situ the risk of ectopic prenancy is about 5 %
- irreular bleedin during first 6 months is common
- Is associated with acne in some woman
- Is not contraidicated for use by HIV positive woman
- Licensed duartion is 5 years for contraception
- the risk of ectopic prenancy with IUS fitted is lower than usin no contraception
- no evidence that IUS causes weiht gain
- When fitted for woman over 45 years of ae, who are amenorrhoeic, the IUS may be used until they no loner require contraception, even if this is the duration of UK marketing authrorization
An 18-year-old p1+0 (1-year-old child, normal vaginal delivery) attends her local sexual reproductive health clinic requesting contraception. Her first pregnancy was unplanned and she wants a reliable method of contraception, at the same time planning for a further pregnancy in 12–18 months.
She is in a steady relationship and has been with the same partner for 2 years. Her periods are irregular, heavy and painful, and have got worse over recent months, with a cycle of 5–7/21–38 days. She has also noted increased facial hair, requiring electrolysis. She has previously been diagnosed with PCOS. She has no relevant family history. On examination she looks well:
height: 153 cm
weight: 94 kg
BP: 120/75 mmHg.
Choose the method of contraception that is the most suitable for her
- Condoms
- Depo-Provera
- Dianette
- Mirena
- Noriday -POP
The answer is levonorgestrel IUS (Mirena®).
The Mirena® provides excellent contraceptive protection, is likely to reduce the heaviness and discomfort associated with periods, and also protects endometrium in patients with PCOS.
The Mirena provides immediately reversible contraception for medium and longer term use, enabling her to space pregnancies but without delay to return of fertility. she is in steady relationship; therefore, risk of STI is low & since she is parous fitting the IUS should be straightforward.
- Dianette® is contraindicated as BMI >40 (UKMEC Category 4).
- Noriday is less likely to control the menstrual dysfunction and has a higher failure rate if not taken reliably.
- Depo-provera® is relatively contraindicated due to concerns regarding bone loss in adolescents and delay in return to fertility in this patient who is considering further pregnancy in 12–18 months.
- Condoms are less effective for contraception and will not help with her menstrual dysfunction.
Miss Y is a 22-year-old nuliparous young woman who presents at her local sexual reproductive health clinic having had unprotected sexual intercourse on day 16 of a regular 28-day cycle. She is in a new relationship, having had intercourse last night with her 27-year-old boyfriend who she met last week at a party.
She has not had any other episodes of unprotected intercourse this cycle. She suffers from epilepsy and takes carbamazepine 400 mg twice daiy. She is otherwise well with no relevant family history. She looks well and her measurements are as follows:
height: 159 cm
weight: 58 kg
BP: 115/65 mmHg.
Choose the method of contraception that is the most suitable for her
- Inset cu-IUD as PCC and continue to use IUD as her preferred method of contraception
- Levonelle 1,5 mg Immediately as PCC, repeated after 12 hours, condoms and commence Cerazette POP at the onset of her next period
- Levonelle 1,5 mg Immediately as PCC, repeated after 12 hours, condoms and commence Depo-provera to be administered every 12 weeks at the onset of her next period
- Levonelle 1,5 mg Immediately as PCC, condoms and commence Depo-provera to be administered every 10 weeks at the onset of her next period
- Levonelle 1,5 mg Immediately as PCC, condoms and commence Microynon 30 COC at the onset of her next period
Insert a copper IUD as postcoital contraception and continue to use the IUD as her preferred method of contraception
The answer is insert a copper IUD. A copper IUD is the gold-standard of emergency contraception and should be offered to everyone. It would also make good ongoing contraception for someone taking enzyme-inducing medication (carbamazepine). If the patient refuses an IUD, then the unlicensed option of double-dose levonelle (3 mg) should be offered.
Carbamazepine is an enzyme-inducing anticonvulsant that is likely to reduce the contraceptive efficacy of the Levonelle®, which according to the CEU guidelines should be doubled (FSRH; 2012 (link is external)).
Depo-Provera® is unaffected by such agents, whereas the dose of the combined oral contraceptive pill would have to be increased to 50 microgram daily (FSRH; 2017 (link is external)).
Condoms should be advised to reduce STI risk in women in short-term relationships.
A copper IUD should be offered for postcoital contraception but if chosen, should be covered with antibiotic prophylaxis and STI screen and used with condoms in this situation. It has the advantage of not being affected by the enzyme-inducing drugs and, therefore, in this case is the preferred choice.
