Contraception

Question 1

What are some examples of LARCs (long acting reversible contraception)?

Answer 1

Implantable contraception
Injectable contraceptives
Intrauterine system (IUS) - progesterone releasing coil
Intrauterine device (IUD) - copper coil

Question 2

What is the method of action of the COCP?

Answer 2

Inhibits ovulation

Question 3

What is the method of action of the POP?

Answer 3

Thickens cervical mucus

Question 4

What is the method of action of injectable contraceptives e.g., medroxyprogesterone acetate)?

Answer 4

Primarily inhibits ovulation
Also thickens cervical mucus

Question 5

How long does the medroxyprogesterone acetate injection provide contraception for?

Answer 5

12 weeks

Question 6

What is the mechanism of action of the implant?

Answer 6

Primary - inhibits ovulation
Also works to thicken the cervical mucus

Question 7

How does the IUD (copper coil) work?

Answer 7

Decreases sperm motility and survival

Question 8

How does the intrauterine system work?

Answer 8

Primarily works to prevent endometrial proliferation
Also thickens cervical mucus

Question 9

What are the 2 methods of emergency contraception that are avaliable?

Answer 9

Emergency hormonal contraception - levonorgestrel, or ulipristal
IUD - copper coil

Question 10

How long after unprotected sex is levonorgestrel effective?

Answer 10

72 hours

Question 11

What is the dose of levonorgestrel?

Answer 11

Single dose is 1.5mg
This should be doubled in those with a BMI >26, or if weigh more than 70kg

Question 12

True or False?
Hormonal contraception can be restarted straight after taking levonorgestrel as an emergency contraceptive?

Answer 12

True - hormonal contraception can be restarted immediately

Question 13

How long after unprotected sex can ulipristal be taken as an emergency contraception?

Answer 13

120 hours

Question 14

What is the dose of ulipristal?

Answer 14

30mg

Question 15

True or False?
Hormonal contraception can be restarted straight after taking ulipristal as an emergency contraceptive?

Answer 15

False - ulipristal can reduce the effectiveness of hormonal contraception
contraception via the patch, pill or ring can be started/restarted after 5 days. Barrier methods should be used in the meantime

Question 16

True or False?
It is safe to breastfeed after taking emergency contraception?

Answer 16

False
It should be stopped for one week following a dose of ulipristal
It is safe to breastfeed as normal with levonorgestrel

Question 17

What is the most effective form of emergency contraception?

Answer 17

IUD

Question 18

When can an IUD as emergency contraception be used?

Answer 18

Within 5 days of unprotected sex
OR
If presents after 5 days, the IUD can be fitted up to 5 days before the likely ovulation date

Question 19

How long after giving birth would someone require contraception?

Answer 19

After 21 days

Question 20

How long after childbirth can an IUD or IUS be inserted?

Answer 20

Within 48 hours
OR
After 4 weeks

Question 21

What method of oral contraception is contraindicated in breast-feeding people?

Answer 21

COCP

Question 22

How effective is LAM (Lactational Amenorrhea Method) as a form of contraception?

Answer 22

98% effective if fully breastfeeding, ammenorheic and <6 months post-partum

Question 23

What is the advice given for 1 missed dose of the COCP?

Answer 23

Take the pill as soon as you remember then continue taking pill as normal

Question 24

What is the advice for more than 2 missed doses of the COCP?

Answer 24

Take the last pill missed, even if this means taking 2 pills in one day. Skip any earlier missed pills
Use barrier methods or abstain from sex until the COCP has been taken for 7 consecutive days

Question 25

If 2 or more pills are missed in week 1 (days 1-7) what additional advice should be given (COCP)?

Answer 25

If the patient has had unprotected sex during the pill-free interval or during week 1, consider emergency contraception

Question 26

If 2 or more pills are missed in week 3 (days 15-21) what additional advice should be given (COCP)?

Answer 26

Finish the pills in the current pack then start the next pack straight away (on day 22) omitting the pill free interval

Question 27

What is the advice regarding a late dose of traditional POP?

Answer 27

Less than 3 hours late - take the pill as normal More than 3 hours late - take missed pill ASAP. If more than 1 is missed, just take 1. Take the next pill at usual time (even if that means taking 2 in one day - continue with the rest of the pack - extra precautions should be taken until pill taking has been re-established for 48 hours

Question 28

What is the advice regarding a late dose of Cerazette (new POP)?

Answer 28

Less than 12 hours late - take the pill as normal More than 12 hours late - take missed pill ASAP. If more than 1 is missed, just take 1. Take the next pill at usual time (even if that means taking 2 in one day - continue with the rest of the pack - extra precautions should be taken until pill taking has been re-established for 48 hours