Contraception\

Question 1

How do you begin taking the COCP?

Answer 1

• Best to start on day 1- first day of period as offers protection straight away
• if started after day 5, requires condoms for first 7 days before protection

Question 2

Advice if one pill missed - less than 72 hours since the last (COCP)

Answer 2

• Take the missed pill as soon as possible
• No extra protection required

Question 3

Advice if more than one pill missed- more than 72 hours since last? (cocp)

Answer 3

• Take most recent missed pill
• Condoms until taken pill regularly for 7 days straight
• If missed between days 1-7 of the packet, emergency contraception required if have had unprotected sex
• If day 8-14, and day 1-7 was fully compliant, no emergency contraception required
• If day 15-21, no emergency contraception but start next pack and skip pill free period

Question 4

what is the progesterone only injection known as and what are the 2 versions given?

Answer 4

• depo medroxyprogesterone acetate (DMPA)
• depo provera (IM)
• sayana press (SC)

Question 5

how long does it take for fertility to return with the injection?

Answer 5

12 months

Question 6

contraindications to the progesterone injection?

Answer 6

breast cancer (active and past)
- IHD or stroke
- severe liver cirrhosis
- liver cancer
- unexplained vaginal bleeding

Question 7

how long does the progesterone only implant last?

Answer 7

3 years, slow releasing progesterone

Question 8

benefits of the progesterone implant?

Answer 8

• improves dysmenorrhoea and menorrhagia
• no need to remember taking pills
• no weight gain, osteoporosis or VTE risk

Question 9

what is sterilisation?

Answer 9

permanent surgical intervention to prevent conception

Question 10

what is tubal occlusion and vasectomy?

Answer 10

• tubal ligation = occlusion of the fallopian tubes using ‘flishie clips’, done by laparoscopy under GA (can also tie or cut the tubes in an elective surgery or during CS)
• vasectomy = where the vas deferens is cut to the sperm can’t be released in the semen

Question 11

how long do you need alternative contraception after a vasectomy?

Answer 11

2 months and you have to test the semen to confirm the absence of sperm, this is carried out after 12 weeks
- a second semen sample may be needed for confirmation

Question 12

what are the types of POP?

Answer 12

• traditional POP (can’t delay more than 3 hours)
• desogestrel POP (can’t delay more than 12 hours)

Question 13

What are the rules for day 3-7 of pill free period and days 1-7 of taking COCP if they have not had unprotected sex since day 3 of hormone free period? (with regards to switching to POP)

Answer 13

Can start POP immediately but require additional contraception for first 48 hours

Question 14

What are the rules for day 3-7 of pill free period and days 1-7 of taking COCP if they HAVE had unprotected sex since day 3 of hormone free period? (POP)

Answer 14

they should take COCP until they’ve taken it for 7 days consecutively and then switch to POP (without needed any additional contraception)

Question 15

what are the 3 options for emergency contraception?

Answer 15

• Levonorgestrel - upto 72 hours
• Ulipristal - 120 hours
• Copper coil - 5 days

Question 16

Why is the copper coil the most effective form of emergency contraception?

Answer 16

• it’s not affected by BMI, enzyme inducing drugs or malabsorption
• it’s toxic to ovum and sperm and inhibits implantation

Question 17

how long after taking levonorgestrel can COCP or POP be started

Answer 17

Immediately but must use extra contraception for 7 days for COCP and 2 days for POP

Question 18

After how long can you take the COCP or POP after having Ulipristal?

Answer 18

5 days

Question 19

restrictions to ulipristal?

Answer 19

• avoid breastfeeding for 1 week after taking it
• avoided in patients with severe asthma