Contraception

Question 1

What is the UK medical eligibility guidelines ?

Answer 1

Used to categorise the risks of starting different methods of contraception in different individuals

Question 2

What are the 4 levels of UK medical eligibility ?

Answer 2

UKMEC1-no restriction
UKMEC2 - benefits outweigh the risks
UKMEC3 - risks generally outweigh the benefits
UKMEC4 - unacceptable risk

Question 3

What contraception should be avoided in breast cancer ?

Answer 3

Avoid any hormonal contraception
Advise copper coil and barrier methods

Question 4

What contraception should be avoided in cervical or endometrial cancer ?

Answer 4

Intrauterine system - Mirena coil

Question 5

What contraception should be avoided in Wilson’s disease ?

Answer 5

Copper coil

Question 6

What are some specific risks that should make you avoid the COCP ?

Answer 6

Uncontrolled HTN
Migraine with aura
History of VTE
Aged over 35 smoking more than 15 cigarettes
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease
Liver cirrhosis
SLE or antiphospholipid syndrome

Question 7

Which is the only method of contraception that protects against STI’s ?

Answer 7

Barrier methods

Question 8

What are some barrier methods ?

Answer 8

Condoms
Diaphragms and cervical caps
Dental dams

Question 9

What infections can be spread through oral sex ?

Answer 9

Chlamydia
Gonorrhoea
Herpes simplex 1 and 2
HPV
Ecoli
Pubic lice
Syphilis
HIV

Question 10

How does the COCP work as a contraception ?

Answer 10

Preventing ovulation
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of the endometrium

Question 11

What are some side effects and risks of the COCP ?

Answer 11

Unscheduled bleeding
Breast pain
Mood changes and depression
Headaches
HTN
VTE
Small increased risk of breast and cervical cancer
Small increased risk of MI or stroke

Question 12

What are the benefits of using the COCP ?

Answer 12

Effective contraception
Rapid return of fertility after stopping
Improvement of premenstrual symptoms, Menorrhagia and dysmenorrhoea
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts

Question 13

What is classed as missing a pill in contraception ?

Answer 13

When the pill is more than 24 hours late ( 48 hours since the last pill was taken )

Question 14

What advice is given if a contraceptive pill is missed ( less than 72 hours since last pill was taken )?

Answer 14

Take the extra pill as soon as possible
No extra protection is required if other pills were taken correctly and less than 72 hours since last pill was taken

Question 15

What advice is given if a contraceptive pill is missed ( more than 72 hours since last pill was taken )?

Answer 15

Take most recent pill as soon as possible
Additional contraception is needed until they have taken the pill regularly for 7 days straight

Question 16

When should the COCP be stopped before a major operation ?

Answer 16

4 weeks before the operation

Question 17

What is the only UKMEC4 criteria for the POP ?

Answer 17

Active breast cancer

Question 18

How do traditional progestogen only pills work ?

Answer 18

Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation
Reducing ciliary action in the fallopian tubes

Question 19

How does Desogestrel POP work ?

Answer 19

Inhibits ovulation
Thickens the cervical mucus
Alters the endometrium
Reduces ciliary action in the Fallopian tubes

Question 20

What are some side effects of the POP ?

Answer 20

Amenorrhoea
Regular bleeding
Irregular, prolonged or troublesome bleeding
Breast tenderness
Headaches
Acne

Question 21

What are some potential risks of the POP ?

Answer 21

Ovarian cysts
Small risk of ectopic pregnancy
Minimal risk of breast cancer

Question 22

What is classed as a missed pill for a traditional POP ?

Answer 22

More than 3 hours late ( more than 26 hours after the last pill )

Question 23

What is classed as a missed pill for the Desogestrel POP ?

Answer 23

More than 12 hours late ( more than 36 hours after the last pill )

Question 24

At what intervals is the progestogen-only injection given ?

Answer 24

12-13 weeks

Question 25

How long does it take for fertility to return after the progestogen-only infection ?

Answer 25

12 months

Question 26

What are the UKMEC4 contraindications for the progestogen-only injection ?

Answer 26

Active breast cancer

Question 27

What are some UKMEC3 contraindications for the progestogen - only injection ?

Answer 27

Ischaemic heart disease Unexplained vaginal bleeding Severe liver cirrhosis Liver cancer

Question 28

What is the mechanism of action of the progestogen only injection ?

Answer 28

Inhibition of ovulation by inhibiting FSH secretion Thickens cervical mucus Alters the endometrium

Question 29

What are some side effects of the progestogen only infection ?

Answer 29

Changes to bleeding schedule Weight gain Reduced libido Mood changes Headaches Flushes Hair loss Skin reactions Osteoporosis

Question 30

What are some potential benefits of the progestogen only injection ?

Answer 30

Improves dysmenorrhoea Improves endometriosis related symptoms Reduces the risk of ovarian and endometrial cancer

Question 31

What is the progestogen only implant ?

Answer 31

A small flexible plastic rod that is placed in the upper arm beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the systemic circulation.

Question 32

What UKMEC4 contraindications are there for the progestogen only implant ?

Answer 32

Active breast cancer

Question 33

What is the mechanism of action for the implant ?

Answer 33

Inhibition of ovulation Thickens cervical mucus Alters endometrium

Question 34

How long is the implant effective for ?

Answer 34

3 years

Question 35

What are the benefits of the implant ?

Answer 35

Effective and reliable contraception Improves dysmenorrhoea Make periods lighter or stop altogether Does not cause weight gain No effect on bone density No increase in thrombosis risk No restrictions in obese patients

Question 36

What are the negatives of the implant ?

Answer 36

Requires a minor operation Can lead to worsening of acne No protection against STI’s Can cause problematic breast feeding Can be bent or fractured

Question 37

What are the 2 types of intrauterine devices ?

Answer 37

Copper coil Levonorgestrel intrauterine system

Question 38

What are some contraindications of the coil ?

Answer 38

Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion - fibroids

Question 39

What are some risks relating to the insertion of the coil ?

Answer 39

Bleeding Pain on insertion Vasovagal reactions Uterine perforation Pelvic inflammatory disease

Question 40

If the coil threads are not visible or palpated what should be excluded ?

Answer 40

Expulsion Pregnancy Uterine perforation

Question 41

If the threads aren’t visible what investigations should be performed ?

Answer 41

USS Abdo and pelvic x ray can be used if there has been a uterine perforation Hysteroscopy or laparoscopic surgery may be required depending on the location of the coil

Question 42

What is the copper coil ?

Answer 42

A long acting reversible contraception licensed for 5-10 years after insertion. Can be used as an emergency contraception if inserted up to 5 days after sexual intercourse

Question 43

What is the mechanism of action of the copper coil ?

Answer 43

Copper is toxic to the ovum and sperm.

Question 44

What are the benefits of using the copper coil ?

Answer 44

Reliable contraception Can be inserted at any time in the menstrual cycle and is effective immediately Contains no hormones May reduce the risk of endometrial and cervical cancer

Question 45

What are the negatives of the copper coil ?

Answer 45

A procedure is required Can cause heavy bleeding Some women experience pelvic pain Does no protect against sexually transmitted infections Increased risk of ectopic pregnancy

Question 46

How does the

Question 47

How does the Levonorgestrel intrauterine system work ?

Answer 47

Thickens cervical mucus Alters endometrium Inhibits ovulation

Question 48

What are the benefits of the Levonorgestrel intrauterine system ?

Answer 48

Can make periods lighter Improves dysmenorrhoea or pelvic pain No effect on bone density No increase in thrombosis risk No restrictions in obese patients

Question 49

What are the negatives of the Levonorgestrel intrauterine system ?

Answer 49

A procedure is required Can cause spotting or irregular bleeding Pelvic pain Do protection against STI’s Increased risk of ectopic pregnancy Increased incidence of ovarian cysts Falling out

Question 50

What are the 3 types of emergency contraception and their timeframes ?

Answer 50

Levonorgestrel - taken in 72 hours Ulipristal - taken in 120 hours Copper coil - inserted within 5 days

Question 51

What are some side effects of using levonorgestrel as an emergency contraception ?

Answer 51

Nausea and vomiting Spotting and changes to the next menstrual period Diarrhoea Breast tenderness Dizziness Depresses mood

Question 52

What is Ulipristal ?

Answer 52

A selective progesterone receptor modulator that works by delaying ovulation.

Question 53

What are some side effects of Ulipristal ?

Answer 53

Nausea and vomiting Spotting and changes to the next menstrual period Back pain Mood changes Headache Dizziness Breast tenderness

Question 54

What is the method for female sterilisation ?

Answer 54

Tubal occlusion using filshie clips preventing the ovum travelling from the ovary to the uterus.

Question 55

What is the male sterilisation method ?

Answer 55

Vasectomy which involves cutting the vas deferens preventing sperm travelling from the testes to join the ejaculated fluid.

Question 56

For how long should alternative contraception be used for after a vasectomy ?

Answer 56

2 months

Question 57

What is gillick competence ?

Answer 57

Refers to a judgment about whether the understanding and intelligence of the child is sufficient to consent to treatment. Needs to be made on a decision by decision basis.