Contraception

Question 1

COCP MOA

Answer 1

Prevents ovulation

Acts on hypothalamus-pituitary-ovarian axis

⬇️FSH + LH

Also:
Cervical mucus ⬇️sperm penetration
Endometrium ⬇️blastocyst implantation

Question 2

COCP Risks

Answer 2

⬆️BP
⬆️R of VTE
⬆️R of MI/stroke (v small)
⬆️R of breast and cervical Ca

⬇️R of EChO
E - endometrial Ca
C- colorectal Ca
O - ovarian Ca + cysts

Question 3

Starting COCP

Answer 3

D1-5 of cycle - no extra protection needed

D5-28- extra protection for 7 d

After oral EC extra protection required:
Levonorgestrel = for 7d
Ulipristal acetate = 14d

Question 4

COCP interactions

Answer 4

Rifampicin
St John’s wart
Anticonvulsants
Antiretrovirals

Orlistat (D+V)

Question 5

Missed COCP

Answer 5

Missed pill = >24h

1 missed pill - take missed pill now and resume as normal

2 or more:
Take missed pill now
Resume normal pill taking
Extra precautions for 7d

2 or more from D1-7 + UPSI:
Emergency contraception required

2 or more from D15-21:
Start next packet after current packet (omit pill free period)

Question 6

COCP and surgery

Answer 6

Major elective surgery/leg surgery/prolonged immobilisation of lower limb:
Stop COCP 4 weeks before

Restart at the first period that happens after 2 weeks of full mobilisation

Question 7

POP MOA

Answer 7

Traditional (LNG + NET)
⬆️viscosity of cervical mucus
🚫sperm penetration

Newer (DSG +DRSP)
Inhibition of ovulation

Question 8

POP Risks

Answer 8

Irregular bleeding or no bleeding
Breast tenderness
Skin changes
Headaches

⬆️R of Breast Ca + Ovarian cysts 👻

Drisoeridone - ⬆️K+

Active Breast Ca is only UKMEC4

Can be used by breastfeeding mums

Question 9

Starting POP

Answer 9

No extra precautions:
LNG/NET/DSG - D1-5
DRSP - D1 only

After Childbirth:
Less than 21d = no extra precautions
>21d = extra precautions for 48h (DRSP - 7d)

COCP➡️POP:
Finish last active pill then start POP

After oral Emrg Contraception:
Extra precautions for 48h

Question 10

Missed POP

Answer 10

Missed pill:
NET/LNG = >3h late
DSG = >12h late
DRSP = >24h late

Action:
Take missed pill now
Resume normal pill taken
Extra precautions for:
- 48h for LNG/NET/DSG
- 7d for DRSP

UPSI between missed pill to normal pill taking resumed for 48h/7d

For DRSP
Missed pill in d1-7 and UPSI during HFI and d1-7