Contraception

Question 1

Two types of hormonal contraception?

Answer 1

Combined- COCP, transdermal patch, vaginal ring, emergency pill

Progesterone only - LARC, POP, implant, Mirena IUS

Question 2

Non Hormonal contraception types?

Answer 2

Natural family planning
IUD
Barrier contraception

Question 3

Indications for contraception other than to prevent pregnancy?

Answer 3

Heavy, painful periods

Question 4

What makes the COCP less effective?

Answer 4

D+V, counts as missed pill day
Rifampicin

Question 5

Which cancers does the COCP increase the risk of?

Answer 5

Breast and cervical

Question 6

Which cancers does the COCP protect against?

Answer 6

Endometrial and ovarian

Question 7

Rules for taking COCP?

Answer 7

If possible take 1st dose on 1st day of period

If starting 1st dose after day 5, use extra protection for next 7 days as ovulation already started

3 regimes: 21 days on and 7 days off
63 days on (three packs) and 7 days off (“tricycling“)
Continuous use without a pill-free period

Question 8

Rules when switching between COCP

Answer 8

Finish previous pack then start new one without needing breaks

Question 9

Rules for switching from POP to COCP

Answer 9

If desogestrel POP → switch immediately to COCP

All other POPs→ switch immediately to COCP + use extra contraception for next 7 days

Question 10

What must you do if you miss a dose of COCP less than 72 hours ago?

Answer 10

Take missed dose immediately, no extra contraception needed

Question 11

What must you do if you miss a dose of COCP more than 72 hours ago during days 1-7?

Answer 11

Take the missed dose immediately, use extra protection until COCP taken for 7 days straight

If you had sex between days 1-7, get emergency contraception too

Question 12

What must you do if you miss a dose of COCP more than 72 hours ago during days 8-14?

Answer 12

Take the missed dose immediately, use extra protection until COCP taken for 7 days straight

No emergency contraception needed

Question 13

What must you do if you miss a dose of COCP more than 72 hours ago during days 15-21?

Answer 13

Take the missed dose immediately, use extra protection until COCP taken for 7 days straight and skip pill free interval

No emergency contraception needed

Question 14

What do you do if you missed more than one dose and the last missed dose was more than 72h ago or less than 72h ago?

Answer 14

Only treat it as if you missed the last dose, i.e. take missed dose immediately and follow advice depending on whether it was more/less than 72h ago and what day of menstrual cycle it was

Question 15

How long after unprotected sex can Levonelle (levonorgestrel) be prescribed to be the most effective?

Answer 15

Within 72h

Question 16

How long after unprotected sex can Ullipristal Acetate (Ellaone) be prescribed to be the most effective?

Answer 16

Within 120h (5 days) of unprotected sex

Question 17

How long after unprotected sex can Copper IUD be prescribed to be the most effective?

Answer 17

Within 120h (5 days) of unprotected sex
If after 120h → insert within 120h of likely ovulation date

Question 18

Which emergency contraception is contraindicated in severe asthma?

Answer 18

Ullipristal acetate (Ellaone)

Question 19

Which emergency contraception is contraindicated in STI?

Answer 19

Copper IUD

Question 20

Which emergency contraception can be used in the same menstrual cycle twice?

Answer 20

Levonorgestrel (Levonelle)

Question 21

Which emergency contraception can’t be used in the same menstrual cycle twice?

Answer 21

Ullipristal acetate (Ellaone)

Question 22

What reduces effectiveness of levonorgesterel?

Answer 22

If over 72h since unprotected sex

Women with BMI > 26 or if over 70kg (may need 2 doses)

If vomits within 2h of administering

Question 23

Indications for POP?
Benefit of POP compared to COCP?

Answer 23

If contraindications to COCP
Lower risk of VTE

Question 24

What are side effects of POPs?

Answer 24

Breast tenderness, headache

Question 25

Examples of POPs?

Answer 25

Cerazette Desogesterel

Question 26

How are POPs taken?

Answer 26

Once daily without breaks

Question 27

Advantages of LARC injections? Disadvantages?

Answer 27

Can be used during breastfeeding Good for dysmenorrhoea and endometreosis Requires regular medical visits, unpredictable bleeding, amenorrhea, weight gain, delayed return to fertility for 1-2 years

Question 28

Example of a Progesterone only implant? How long does it provide contraception for? What are the disadvantages?

Answer 28

Nexplanon 3 years Unpredictable bleeding, minor surgery, headaches and breast tenderness

Question 29

How long does an Intra-uterine system last? What is it particularly useful for?

Answer 29

3-5 years Endometriosis pain and bleeding Risk of expulsion or uterine perforation, unpredictable bleeding, cramping

Question 30

How long does an intra uterine device last? What are the disadvantages?

Answer 30

5-10 years Risk of expulsion or uterine perforation

Question 31

How long after birth can contraception be commenced?

Answer 31

After 3 weeks because before then you can not get pregnant

Question 32

Advantages of the COCP?

Answer 32

- Rapid return of fertility after stopping - Improvement in PMS sx - Improves acne - Reduces menstrual pain and heavy periods - Reduced risk of endometrial, ovarian and colon cancer - Reduced risk of benign ovarian cysts

Question 33

Side effects of combined oral contraception?

Answer 33

- unscheduled bleeding for first 3 months - breast pain - mood changes, depression - headaches - Increased risk of hypertension, MI, stroke, VTE

Question 34

First line contraception for menorrhagia?

Answer 34

IUS