Contraception

Question 1

Give examples of LARCs (long-acting reversible contraceptive methods)

Answer 1

Progesterone-only subdermal implant

Copper IUD

Progestogen- only IUS

Progestogen-only injection

Question 2

What is the progrestogen-only subdermal implant?

Answer 2

flexible rod containing 68 mg of progestogen etonogestrel

Question 3

How does the progrestogen-only subdermal implant primarily work?

Answer 3

suppressing ovulation by preventing LH and FSH surge

Question 4

How does the copper IUD work?

Answer 4

preventing fertilisation as copper is toxic to sperm

inflammation on endometrium prevents inflammation

Question 5

What is in the progestogen-only IUS?

Answer 5

progestogen levonorgestrel

Question 6

How does the progestogen-only IUS work?

Answer 6

prevents pre-fertilisation by thickening cervical mucous

prevents implantation by thinning endometrial lining

Question 7

What does progestogen-only injection contain?

Answer 7

depot medroxyprogesterone acetate (DMPA) - available as Depo Provera and Sayana Press

Question 8

How often are Depo Provera and Sayana Press injections given?

Answer 8

every 13 weeks

Question 9

How do Depo Provera and Sayana Press injections work?

Answer 9

suppressed ovulation

Question 10

What is the combined oral contraceptive pill?

Answer 10

oestrogen and progestogen

Question 11

What are types of combine hormonal contraception?

Answer 11

Combined oral contraception (COC)
Combined vaginal ring (CVR)
Combined transdermal patch (CTP)

Question 12

How do combined hormonal contraceptions work?

Answer 12

inhibit ovulation, by thickening cervical mucus and impacting endometrial lining

Question 13

How do progestogen-only pills work?

Answer 13

thicken cervical mucus and inhibit sperm penetration

Question 14

What are the 3 permanent contraceptive methods?

Answer 14

Vasectomy
Tubal occlusion with clips/rings (usually via laparoscopy)
Tubal occlusion via hysteroscope

Question 15

What are the methods of emergency contraception?

Answer 15

Copper bearing intrauterine device (Cu-IUD)
Ulipristal acetate (UPA)
Levonorgestrel (LNG)

Question 16

What are the conditions for use of copper IUD as emergency contraception?

Answer 16

fit within 120hrs of UPSI or within 5 days of earliest predicted ovulation

Question 17

What are the conditions for use of UPA as emergency contraception?

Answer 17

effective up to 120hrs of UPSI

Question 18

What are the conditions for use of LNG as emergency contraception?

Answer 18

effective up to 72hrs after UPSI

Question 19

What is UKMEC for contraception?

Answer 19

recommendations which identify health conditions (e.g. hypertension) or characteristics (e.g. smoking) which may affect the safety of the method

Question 20

What is category 1 UKMEC?

Answer 20

A condition for which there is no restriction for the use of the method

Question 21

What is category 2 UKMEC?

Answer 21

A condition where the advantages of using the method generally outweigh the theoretical or proven risks

Question 22

What is category 3 UKMEC?

Answer 22

A condition where the theoretical or proven risks usually outweigh the advantages of using the method

Question 23

What is category 4 UKMEC?

Answer 23

A condition which represents an unacceptable health risk if the method is used

Question 24

When are the combined hormonal and progestogen-only contraceptive pills licensed to be initiated?

Answer 24

1-5 days of the natural menstrual cycle

Question 25

When can the IUS be fitted without requiring extra precautions?

Answer 25

days 1-7 of a menstrual cycle

Question 26

Which method is preferred for efficacy?

Answer 26

LARC

Question 27

Which method is preferred for making periods lighter?

Answer 27

combined hormonal pill or progesterone-only contraception

Question 28

Which examination is needed for those wanting to initiate a CHC?

Answer 28

BP measurement BMI

Question 29

What is monophasic CHC?

Answer 29

21 identical tablets followed by 7-pill free days (some may contain 7 placebo pills) e.g. Microgyon

Question 30

What is phasic CHC?

Answer 30

different hormone strengths in each pill - mimic fluctuating cycle e.g. Qlaira

Question 31

What are non-contraceptive benefits of CHC?

Answer 31

Reduce heavy periods Acne PMS Reduce risk of endometrial, ovarian and colorectal cancer Endometriosis PCOS

Question 32

What are risks of CHC use?

Answer 32

VTE Ischaemic stroke Migraine with aura Cervical cancer Breast cancer

Question 33

If COC is chosen, what is the typical first line formulation?

Answer 33

<30ug EE with levonorgestrel or norethisterone

Question 34

On which days of the cycle can CHC be started without additional need for contraception?

Answer 34

Day 1 to 5 of the cycle

Question 35

When is the combined transdermal patch applied?

Answer 35

New CTP applied weekly on same day for 3 consecutive weeks 4th week is patch-free (withdrawal bleed)

Question 36

Where is the combined transdermal patch applied?

Answer 36

buttock, abdomen, torso or upper-arm

Question 37

How is the combined vaginal ring inserted? How long for?

Answer 37

inserted in the vagina and retained for 3 weeks, then 7-day free interval does not need to be positioned precisely

Question 38

What are the two vaginal rings?

Answer 38

Nuvaring® and Syreniring®

Question 39

Which are the current progestogen-only pills?

Answer 39

levonorgestrel (LNG) and norethisterone (NET) desogestrel (DSG)–containing pills

Question 40

How can the progestogen only injectables be injected?

Answer 40

IM or SC

Question 41

What are contraindications to progestogen only contraception?

Answer 41

Breast cancer Severe cirrhosis

Question 42

What is the timing of NET/LNG POP for it to be effective?

Answer 42

within 3 hours of the same time each day

Question 43

What is the timing of DSG POP for it to be effective?

Answer 43

within 12 hours of the same time each day

Question 44

What are side effects of POP's?

Answer 44

Reduced libido Mood changes Altered bleeding patterns Acne Breast tenderness Weight changes Headaches

Question 45

When may POPs be started without need for additional contraception?

Answer 45

Up to day 5 of a natural cycle Up to 5 days after first or second trimester termination of pregnancy or miscarriage Up to 21 days postpartum

Question 46

What are side effects of DMPA injection?

Answer 46

Weight gain Reduction in bone density

Question 47

What are the types of subdermal implants?

Answer 47

Nexplanon and Implanon

Question 48

How does nexplanon SDI differ from implanon SDI?

Answer 48

Nexplanon contains barium sulphate to enable X-ray detection Applicator for nexplanon has been modified to reduce risk of deep insertion

Question 49

How long is an SDI licensed for?

Answer 49

3 years

Question 50

How does the SDI work?

Answer 50

Inhibition of ovulation by preventing LH surge Increased viscosity of cervical mucus inhibits sperm penetration Thinning endometrium to prevent implantation

Question 51

What are disadvantages of an SDI?

Answer 51

Change in bleeding pattern Change in weight, mood, libido Acne (improves/worsens) Headache Breast cancer risk

Question 52

When can the SDI be inserted without additional contraception?

Answer 52

Day 1-5 of cycle

Question 53

What are the licensed IUDs?

Answer 53

Mirena Lecosert Kyleena Jaydess

Question 54

Complications of IUD

Answer 54

Perforation Infection Ectopic pregnancy Expulsion