Contraception

Question 1

Which forms of contraception are >99% effective?

Answer 1

• IUD / IUS
• Sterility (oophorectomy) / vasectomy
• progesterone implant

Question 2

Contraceptive advice for someone at high risk of breast Ca?

Answer 2

• use barrier contraception or copper coil
• avoid any hormonal contraception

Question 3

Contraceptive advice for someone at high risk of cervical / endometrial Ca?

Answer 3

avoid Mirena coil

Question 4

Contraceptive advice for someone with Wilson’s disease?

Answer 4

avoid copper coil

Question 5

How long is contraception required for in postmenopausal women?

Answer 5

2 years if under 50 and 1 year if over 50

Question 6

When is contraception required again after childbirth?

Answer 6

after day 21

Question 6

UKMEC 4 for COCP?

Answer 6

• uncontrolled HTN
• migraine with aura
• history of VTE
• > 35 years old smoking 15+ a day
• vascular disease inc stroke and IHD
• cardiomyopathy or AF
• liver cirrhosis or liver Ca
• SLE or APS

Question 7

Can the COCP be used after childbirth?

Answer 7

Yes but should be avoided if breastfeeding (it is expressed in milk)

Question 7

When can the copper coil / Mirena be inserted after childbirth?

Answer 7

either within 48h of childbirth or after 4 weeks

Question 8

What are the options for barrier contraception?

Answer 8

• condoms (82% effective with typical use)
• diaphragms
• cervical caps (use these and diaphragms with spermicidal gel)
• dental dams

Question 8

Primary mechanism of action of COCP?

Answer 8

inhibits ovulation

Question 9

What are the 3 different cyclical ways of taking the COCP?

Answer 9

• 21 days on and 7 days off
• 63 days on and 7 days off (tricycling)
• continuous

Question 10

Which conditions does the COCP increase the risk of?

Answer 10

• VTE
• breast Ca
• cervical Ca
• MI, stroke

Question 11

When is additional protection needed alongside starting the COCP? For how long?

Answer 11

• anytime after day 5 of menstrual cycle
• use condoms for 7 days

Question 11

Which conditions does the COCP reduce the risk of?

Answer 11

• menorrhagia and dysmenorrhoea
• endometrial Ca
• ovarian Ca
• colorectal Ca
• benign ovarian cysts

Question 12

Missed pill advice less than 72 hours since it was last taken?

Answer 12

• take the missed pill asap even if it means 2 pills in a day
• no extra protection required

Question 13

Missed more than 1 pill in last 72 hours?

Answer 13

• take most recent missed pill asap even if it means 2 pills in a day
• condoms for 7 days

Question 14

Missed more than 1 pill in last 72 hours and has had unprotected sex in day 1-7 of pack?

Answer 14

Emergency contraception needed

Question 15

Missed more than 1 pill in last 72 hours and has had unprotected sex in day 8-14 of pack?

Answer 15

No emergency contraception needed

Question 16

Missed more than 1 pill in last 72 hours and has had unprotected sex in day 15-21 of pack?

Answer 16

• No emergency contraception needed
• Skip pill free period

Question 17

What is the perioperative advice for the COCP?

Answer 17

To stop 4 weeks before any major surgery

Question 18

UKMEC 4 for POP?

Answer 18

Active breast Ca

Question 19

Key difference between traditional POP and desogestrel only pill?

Answer 19

• POP cannot be taken >3 hours late
• desogestrel can be taken up to 12 hours late

Question 19

Mechanism of action of traditional POP?

Answer 19

Thickens cervical mucus

Question 20

Mechanism of action of desogestrel pill?

Answer 20

Inhibits ovulation

Question 21

When is additional protection needed after starting the POP?

Answer 21

- not needed if day 1-5 of cycle - 2 days of condoms if any other stage of cycle - you can switch between POPs without needing any extra protection

Question 21

Which conditions does POP increase the risk of?

Answer 21

- ovarian cysts - ectopic pregnancy (but not desogestrel) - breast Ca (minimal)

Question 22

Side effects of POP?

Answer 22

- irregular, prolonged or troublesome bleeding - breast tenderness - headache - acne

Question 22

Why is the depot injection less effective (94%) with typical use than perfect use (99%)?

Answer 22

many women forget to book in to get it again at 12-13 weeks

Question 23

UKMEC 4 for depot injection?

Answer 23

active breast Ca

Question 24

Mechanism of action of depot injection?

Answer 24

inhibits ovulation

Question 25

Side effects and risks of depot injection?

Answer 25

- weight gain - increased risk of osteoporosis (reduces bone mineral density) - irregular bleeding for up to 6 months - reduced libido - alopecia

Question 26

Possible benefits of depot injection?

Answer 26

- improves dysmenorrhoea - improves endometriosis - reduces ovarian and endometrial Ca risk - reduces risk of sickle cell crisis in SCA