Contraception

Question 1

When does the risk from cervical cancer and CHC stop

Answer 1

10 years after stopping

Question 2

What cancers is CHC associates with

Answer 2

Breast and cervical

Question 3

What cancers are CHC protective for

Answer 3

Ovarian, endometrial (bowel)

Question 4

First line CHC?

Answer 4

</= 30mcg ethinylestradiol +
Levonorgestrel/northisterone

Question 5

Perfect use CHC

Answer 5

<1%

Question 6

Typical use CHC

Answer 6

9% failure

Question 7

What is the theoretical weight limit risk with CHC patch

Answer 7

> 90kg

Question 8

Lowest risk CHC for VTE

Answer 8

COC with levonorgestrel, northisterone, norgestimate

Question 9

First generation progestogen?

Answer 9

Northisterone (NET)

Question 10

Second generation progestogen

Answer 10

Levonorgestrel (LNG)

Question 11

Third generation progestogen

Answer 11

Desogestrel, gestodene, norgestimate*
LNG is an active metabolite

Question 12

Newer progestogens?

Answer 12

Drospirinone, dienogest, nomegestrol acetate

Question 13

What is etonogestrel an active metabolite of?

Answer 13

Desogestrel

Question 14

Do women using co-cyprindiol for acne and hirsutism management need additional contraception?

Answer 14

No

Question 15

What is in the patch

Answer 15

EE and norelgestromin

Question 16

What is in the vaginal ring

Answer 16

EE and etonogestrel

Question 17

Is the first line COC multiphasic or monophasic

Answer 17

Monophasic

Question 18

How does CHC work

Answer 18

Acts on the HPO to supress LH and FSH thus inhibiting ovulation

Question 19

Can multiphasic COC be used in tailored regiemes

Answer 19

No

Question 20

What symptoms are more common during the HFI?

Answer 20

Headache, pelvic pain, bloating, breast tenderness

Question 21

How many women have menstrual cycles shorter than 20 days

Answer 21

<5% (<2% in the 20-39 group)

Question 22

Is condoms needed when switching traditional POP to CHC

Answer 22

Yes

Question 23

Is 7 days of condoms needed when switching to CHC from desogestrel/implant/depo

Answer 23

No (if in licence/time frame!)

Question 24

What happens if CHC/POP taken in the the 5 days after taking UPA-EC?

Answer 24

UPA effectiveness decreased, no effect on the CHC/pop

Question 25

Yearly VTE risk for someone on CHC Vs normal

Answer 25

5-12 in 10,000 Vs 2 in 10,000

Question 26

Fatality of VTE in CHC users

Answer 26

1%

Question 27

CHC containing which progesterones are at highest risk of vte

Answer 27

Desogestrel, drospirinone, gestodene (9-12 in 10,000)

Question 28

What route of administration has best bioavailability

Answer 28

Vaginally

Question 29

What is the implant etonogestrel dose per day?

Answer 29

Week 5-6 60-70mcg End of year 1 35-45mcg End of year 3 25-30mcg

Question 30

Rates of deep inplants

Answer 30

0.4% of insertions

Question 31

Most likely nerve injury from insertion

Answer 31

Ulnar nerve (roots C8-T1)

Question 32

When should implant removal be discussed with other team(s)?

Answer 32

If plts below 50. Warfarin use not an issue however

Question 33

What concentration of etonogestrel is required to inhibit ovulation with the implant?

Answer 33

90pg/ml = achieved by day 2

Question 34

Women with meningioma should avoid what contraception

Answer 34

Cyproterone acetate

Question 35

Why does EE not convert to E2?

Answer 35

The ethinyl group on carbon 17 does not get removed during metabolism

Question 36

What estrogen is in Qlaira

Answer 36

E2V (estradiol valerate)

Question 37

What estrogen is in zoely

Answer 37

E2 (estradiol)

Question 38

EE effect on clotting

Answer 38

Increase procoagulatory factors Decrease anticoagulation mechanisms

Question 39

CHC levonorgestrel VTE risk

Answer 39

5-7

Question 40

CHC norgestimate VTE risk

Answer 40

5-7

Question 41

CHC northisterone VTE risk

Answer 41

5-7

Question 42

CHC etonogestrel VTE risk

Answer 42

6-12

Question 43

CHC norelgestromin VTE risk

Answer 43

6-12

Question 44

CHC gestodene VTE risk

Answer 44

9-12

Question 45

CHC desogestrel VTE risk

Answer 45

9-12

Question 46

CHC drospirinone VTE risk

Answer 46

9-12

Question 47

CHC dienogest VTE risk

Answer 47

Unknown

Question 48

CHC nomegestrol VTE risk

Answer 48

Unknown

Question 49

52mg IUS dose release after insertion

Answer 49

20mcg a day

Question 50

19.5mg IUS dose release after insertion

Answer 50

17.5mcg a day

Question 51

13.5mg IUS dose release after insertion

Answer 51

15mcg a day

Question 52

52mg IUS dose release at end of licence

Answer 52

9mcg a day

Question 53

19.5mg IUS dose release at end of licence

Answer 53

7.4mcg a day

Question 54

13.5mg IUS dose release at end of licence

Answer 54

5mcg a day

Question 55

Which IUS have silver ring for USS visibility

Answer 55

Jaydess and kyleena

Question 56

What to do in regards to IUD fits in patients with adrenal insufficiency

Answer 56

Double glucocorticoid 1hr before and for 24 hours after Fit early morning. No adjustments if mineralocorticoid

Question 57

Which HIV meds classes interact with hormonal contraception

Answer 57

Protease inhibitors and some NNRTIs

Question 58

What is the rule for COC and atazanavir?

Answer 58

At least 35mcg EE required (high dose!)

Question 59

Definitely contraception safe hiv drugs?

Answer 59

Rilpivirine, maraviroc, raltegravir, dolutegravir

Question 60

Downsides of DMPA and art treatments

Answer 60

No efficacy affected but BMD worries

Question 61

EC on HAART?

Answer 61

IUD Double dose levonorgestrel ? UPA

Question 62

Teratogenic hiv meds

Answer 62

Stavudine, didanosine Efavirenz

Question 63

When should missed pill rules be followed in a women on CHC with severe diarrhea

Answer 63

24 hours

Question 64

VTE risk with CHC patch and ring

Answer 64

6-12 in 10,000

Question 65

CHC VTE risk with dienogest, nomegestrol, mestranol

Answer 65

Unknown

Question 66

What CHC contains estradiol

Answer 66

Estradiol/nomegestrol acetate (zoely) Estradiol valerate/dienogest (Qlaira)

Question 67

Signs of lamotrogeine toxicity

Answer 67

Diplopia 👀 Ataxia 🍂 Dizziness 🌪️