Contraception

Question 1

What is the effect of estrogen on fertility?

Answer 1

They suppressh FSH meaning a dominant follicle isn’t formed.
It also stimulates endometrial proliferation (uterus wall thickening)

Question 2

Name 3 side effects of estrogens

Answer 2

Nausea and vomiting
breast tenderness
fluid retention
change in libido
chloasma

Question 3

What happens to HDLs and LDLs with estogens? Is this good or bad?

Answer 3

HDLs increase and LDLs decrease. This is good because HDLs are a good cholesterol and LDLs are bad

Question 4

Does a patient with estrogens have blood which has lower or higher coagulability?

Answer 4

higher

Question 5

What happens to bone resorption with estrogens?

Answer 5

it decreases

Question 5

What are triglycerides? Do they increase or decrease with estrogens?

Answer 5

A type of fat, also known as lipids. They increase

Question 6

Are progestogens synthetic or natural?

Answer 6

Synthetic

Question 7

What is the difference in VTE risk between 2nd generation progestogens and a third generation progestogen such as gestodene?

Answer 7

higher generations have a higher risk of VTE

Question 8

What does progestogen do? (4)

Answer 8

Suppresses the LH surge and blocks ovulation
suppresses endometrial proliferation and thickens the uterus wall
thickens cervical mucus making it impermeable
produces secretory endometrium which prevents endometrium cancer

Question 9

When does a withdrawal bleed occur when a patient is on COCs?

Answer 9

during the 7 pill free days or placebo days

Question 10

What are 3 side effects of progestogen?

Answer 10

menstrual irregularity
nausea
bloating/weight gain
breast tenderness
acne
change in libido
mood changes

Question 11

What happens to HDLs and LDLs with progestogens? Is this good or bad?

Answer 11

decrease HDL and increase LDL This is bad because HDLs are a good cholesterol and LDLs are bad

Question 12

What is a monophasic COC?

Answer 12

same amount of estogen and progestogen for 21 days

Question 13

Who should you give progestogen only tablets to?

Answer 13

women who can’t take estrogens and people who are breast feeding

Question 14

Name an example of an emergency contraceptive?

Answer 14

Levonorgestrel and ulipristal

Question 15

How many days after unprotected sex is ulipristal effective for?

Answer 15

5

Question 16

What are two side effects of emergency contraception?

Answer 16

Nausea and vomiting

Question 17

If a patient had Levonorgestrel and then vomited 30 mins after, do they need to repeat the dose?

Answer 17

yes

Question 18

How does a vaginal ring work? (3)

Answer 18

insert in vagina for 21 days
releases estrogen and progestogen slowly
take ring out for 7 days

Question 19

How does COCs werk? (2)

Answer 19

inhibit ovulation
inhibits endometrium development and therefore corpus luteum

Question 20

How do progestogen only tablets work?

Answer 20

thickens cervical mucus so sperm penetration is unlikely

Question 21

What are three dose forms of progestogen?

Answer 21

tablet, subdermal implant, IUD and IM depot injection.

Question 22

What are 5 adverse effects for COCs?

Answer 22

breakthrough bleeding, nausea, breast enlargement, tenderness, headache, fluid retention, chloasma, VTE, allergy, hypertemsion, jaundice, pancreatitis, liver, cervical and breast cancer and stroke.

Question 23

What are 3 adverse effects for progestogen only tablets?

Answer 23

menstrual irregularities, depression and weight gain

Question 24

What are three things which COCs can prevent?

Answer 24

- ovarian and endometrial cancers - ovarian cysts - pelvic inflammatory disease

Question 25

Name 3 examples of drugs which interact with estrogen?

Answer 25

CYP3A4 inducers e.g. rifampicin, phenytoin, carbamazepine Orlistat St John’s Wort

Question 26

What should I do if i give a patient on carbamezapine a COC?

Answer 26

Increase the dose

Question 27

Name an example of a progestogen only tablet?

Answer 27

levonogestrel and norethisterone

Question 28

When do you start a progestogen only tablet?

Answer 28

first day of menstruation or 21 days postpartum

Question 29

How long do you need to use extra contraception if you have a progestogen only tablet on the 5th day of menstruation?

Answer 29

48 hours

Question 30

If I wanted to change from one COC to another, what do I do?

Answer 30

Start day after old ones

Question 31

If I wanted to change from progestogen only tablets to a COC, what do I do?

Answer 31

Start day after old ones and use extra contraception

Question 32

Do you start with a low or high dose of a COC?

Answer 32

Low

Question 33

What is trycycling and what type of COCs can you do this with?

Answer 33

taking three packets of monophasic pills without taking an inactive tablet

Question 34

If you are taking COCs, what class of drugs do you need a high dose with?

Answer 34

antiepileptics

Question 35

If you start you first active COC pill on day 4 of the menstrual cycle, do you need extra protection?

Answer 35

yes, for 7 days after

Question 36

What is the most dangerous dose of a COC to miss?

Answer 36

those at the beginning or end of the active pill cycle

Question 37

Is contraception affected if you forget a COC dose after 6 hours?

Answer 37

no

Question 38

What do you do if you missed a COC pill in the first 7 days of active pills and sexual intercourse occurred?

Answer 38

Get emergency contraception

Question 39

What do you do if you missed a COC dose for 30 hours?

Answer 39

take a pill when you remember and then take the next when it is due continue pill and use another form of contraception for the next 7 active pill doses

Question 40

If you vomit 3 hours after taking a COC, what do you do?

Answer 40

Take another ASAP and use extra contraception

Question 41

My patient took their progestogen tablet yesterday at 1400hrs, when should they have it today?

Answer 41

1400 hrs- 1700hrs at the absolute max

Question 42

How long is the maximum contraceptive effect after administration?

Answer 42

3-20 hours after

Question 43

What are 4 issues to consider when choosing contraception?

Answer 43

effectiveness, best protection against STIs, life stages, medical hx, personal/ethical/religious beliefs, risk vs benefit.