Contraception

Question 1

When can you provide hormonal contraceptives to under 16s?

Answer 1

She understands the doctors advice
She cannot he persuaded to inform her parents
She is very likely to continue having sex
Unless she receives contraception her mental and physical health will suffer
In her best interests to provide treatment

Question 2

What are the combined oral contraceptives oestrogens?

Answer 2

Ethinylestradiol
Mestranol
Estradiol - zoely with normegestrol, qlaira with diemogest

Question 3

What are the oral contraceptives progestogen?

Answer 3

Norgestimate
Desogestrel
Drosperinone
Gestodene
Norethisterone
Dienogest
Nomegestrel
Levonorgestrel

Question 4

Which progestogens are best used for acne, depression, headaches, breast symptoms, breakthrough bleeding?

Answer 4

Norgesitmate
Desogestrel
Drosperinone

Question 5

What are the transdermal contraceptive patches?

Answer 5

Evra - norelgestromin with ethinylestradiol

Question 6

What are the progesterone only pills?

Answer 6

Desogestrel - cerelle, cerazette
Norethisterone - micronor, noriday
Levonorgestrel - norgeston

Question 7

What are the parenteral progestogen contraceptives?

Answer 7

Medroxyprogesterone (injection)
Northisterone (injection)
Etonorgestrel (implant)

Question 8

What hormone is in the IUD?

Answer 8

Levonorgestrel

Question 9

What are the hormones in the NuvaRing?

Answer 9

Etonogestrel with ethinylestradiol

Question 10

How do you take the combined oral contraceptives?

Answer 10

One tablet daily for 3 weeks + 1 week pill free interval for withdrawal bleeding

Start any time in menstrual cycle; if started on day 6 or later use protection for 7 days

Not for women above 50 years

Question 11

What is a monophasic preparation?

Answer 11

Fixed amount of oestrogen and progestogen

Question 12

What is a phasic preparation?

Answer 12

Varying amount of oestrogen and progestogen

For women who do not have withdrawal bleeding

Or have breakthrough bleeding with monophasic preparations

Question 13

What is an every day preparation?

Answer 13

Pill free interval replaced with inactive pills

Question 14

What are the low strength oestrogen preparation?

Answer 14

Risk factor for circulatory disease - 20mg ethinylestradiol

Question 15

What do you need to be careful of with oestrogens?

Answer 15

Increased risk of VTE

Increased risk of arterial thromboembolism

Question 16

When do you stop taking contraceptives that contain oestrogen before surgery?

Answer 16

4 weeks before for major surgery and all surgery to the legs or surgery that results in prolonged immobilisation of a lower limb

Question 17

When should you stop oestrogen containing preparations?

Answer 17

VTE
Stroke
Liver dysfunction
Blood pressure
Prolonged immobility after surgery or leg injury
Detection of a risk factor which contraindicates treatment

Question 18

How do the progestogen only pills work?

Answer 18

Prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg

Alternative when oestrogens contraindicated

Question 19

How do you take POPs?

Answer 19

Take one daily on a continuous basis, starting on day 1 of cycle and taken at the same time each day

If started after day 5 of menstrual cycle, additional precaution is required for 2 days

Question 20

What are the other side effects of hormonal contraceptives?

Answer 20

Combined - increase risk of cervical and breast cancer

Progestogen - increase risk of breast cancer

Question 21

What are the benefits of combined oral contraceptives?

Answer 21

Reduces risk of ovarian and endometrial cancer

Reduces dysmenorrhea and menorrhagia, premenstrual tension, reduced risk of PID

Question 22

When is a COC considered missed?

Answer 22

> 24 hours

Zoely/qlaira > 12 hours

Question 23

What do you do if you miss a COC?

Answer 23

1 missed pill - take one ASAP and one at normal time even if it means taking two together

2+ missed pills - take one pill ASAP + condom for 7 days (9 days if zoely/qlaira)

Omit pill free interval if missed in last 7 days

EHC - if missed in first 7 days and unprotected sex occurs

Question 24

How many hours is a POP considered missed?

Answer 24

3 hours (desogestrel > 12 hours)

Question 25

What do you do if you miss a POP?

Answer 25

Take ASAP + condom for 2 days EHC - unprotected sex occurs before 2 pills are taken correctly

Question 26

What do you do if you have vomiting/diarrhoea while taking a COC?

Answer 26

Vomiting < 2 hours of taking - take one ASAP >24 hours - protection until 7 days after recovery and pill is resumed (9 days if Qlaira) If it occurs in last 7 days - omit pill free interval

Question 27

What do you do if vomiting/diarrhoea and taking a POP?

Answer 27

Vomiting < 2 hours of taking = take another ASAP Severe of if pill not taken within 3 hours of normal time (12 hours if desogestrel) = protection until 2 days after recovery and pill is resumed

Question 28

What do you do if a transdermal patch is detached for >24 hours or delayed application at beginning of cycle?

Answer 28

Apply new patch ASAP | Start a new day 1 cycle + condom for 7 days

Question 29

What do you do if a transdermal patch has delayed application in the middle of cycle?

Answer 29

< 48 hours apply new patch and continue as normal > 48 hours start a new day 1 cycle + condom for 7 days

Question 30

What are the enzyme inducers that affect hormonal contraception by reducing their effectiveness?

Answer 30

``` Carbamazepine Phenytoin Phenobarbital St. John’s wort Rifampicin Rifabutin ```

Question 31

What reduces the efficacy of ulipristal?

Answer 31

Antacids H2 receptor antagonists PPI

Question 32

How long after sex can the copper IUD be used as EHC?

Answer 32

120 hours (5 days) after unprotected intercourse or up to 5 days after the earliest calculated ovulation

Question 33

Which EHC do you use if patients BMI > 26 kg/m2

Answer 33

Ulipristal or double dose of levonorgestrel

Question 34

How does levonorgestrel work?

Answer 34

Prevents ovulation and fertilisation

Question 35

What is the dose of levonorgestrel for EHC?

Answer 35

1500mg < 72 hours after unprotected sex If vomiting < 3 hours of taking dose, give replacement dose

Question 36

What are the cautions with levonorgestrel?

Answer 36

Crohn’s Past ectopic pregnancy Ciclosporin

Question 37

What is the mechani of action of ulipristal?

Answer 37

Progestogen receptor modulator inhibits or delays ovulation More effective than levonorgestrel

Question 38

When do you use ulipristal?

Answer 38

30 mg 96-120 hours after unprotected sex

Question 39

What are the cautions for ulipristal?

Answer 39

Severe asthma treated by oral corticosteroids Avoid in severe liver impairment

Question 40

What are the contraindications of ulipristal?

Answer 40

Repeated use within the same menstrual cycle

Question 41

What are the counselling points for ulipristal?

Answer 41

Reduces effectiveness of regular contraceptives Wait 5 days before starting regular hormonal contraception

Question 42

What are the hormonal contraception side effects?

Answer 42

Menstrual irregularities

Question 43

What are the counselling points for hormonal contraception?

Answer 43

Next periods may be early or late Use barrier protection until next period If lower abdominal pain see gp to rule out ectopic pregnancy If periods are abnormal take a pregnancy test

Question 44

Why should an IUD not be used in under 25s?

Answer 44

Increased risk of PID

Question 45

What are the side effects of IUD?

Answer 45

Pain on insertion and bleeding Uterine perforation Risk of infection

Question 46

What is the MHRA warnings for IUDs?

Answer 46

Uterine perforation | Report severe pelvic pain, sudden changes in periods pain during sex, unable to feel threads

Question 47

When do you remove IUD?

Answer 47

Do not remove mid cycle unless additional contraceptive used for 7 days If removal is essential and unprotected sex occurs give EHC If pregnant remove in 1 st trimester

Question 48

What are the counselling points for medroxyprogesterone injection?

Answer 48

Lasts 2 years Delay in return to fertility and menstrual irregularities Osteoporosis risk

Question 49

How often do you need norethisterone injection?

Answer 49

8 weeks

Question 50

What is the MHRA warning for etonogestrel implant?

Answer 50

Nexplanon contaceptive implants - reports of device in vasculature and lung

Question 51

When should spermicidal contraceptives not be used?

Answer 51

At high risk of STIs, high use associated with genital lesions and increased risk of acquiring infections