Contraception

Question 1

contraceptive patch lasts how long

Answer 1

4 weeks _ evra patch - worn for first 3 weeks

Question 2

patch needs to be chnaged every week

Question 3

if patch change delayed in week 1/2

Answer 3

<48hrs just change it and no extra
>48hrs change immediate and barrier contraception for next 7 days

Question 4

patch removal delayed in week 3

Answer 4

just put on another one and no extra contraception

Question 5

If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle.

Question 6

COCP makes periods

Answer 6

light, regular and less painful

Question 7

COCP reduces risk of what cancer

Answer 7

ovarian and endometrial and colorectal

Question 8

bad things about COCP

Answer 8

VTE, increased risk of breast and cervical cancer, increased risk of stroke(especially in smokers)

Question 9

Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

Answer 9

COCP

Question 10

counselling on COCP

Answer 10

> 99% effective if taken correctly
small risk of blood clots
very small risk of heart atacks and strokes
increased risk fo breast and cervical cacner

Question 11

when dont need extra contraception when taking COCP

Answer 11

if started within 5 days of cycle.
if not then need alterantive contraception for first 7 days

Question 12

COCP should be

Answer 12

taken at same time every day

Question 13

advice that intercourse during the pill-free period is only safe if the next pack is started on time

Answer 13

referring to if do 21 days on 7 dyas off

Question 14

Discussion on situations where efficacy may be reduced*
if vomiting within 2 hours of taking COC pill
medication that induce diarrhoea or vomiting may reduce effectiveness of oral contraception (for example orlistat)
if taking liver enzyme-inducing drugs eg rifampicin

Question 15

if miss one pill

Answer 15

just take 2 rhe next day

Question 16

if 2 or more pills missed

Answer 16

take another even if it means taking 2 in one day

Question 17

the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.

Question 18

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Answer 18

*theoretically women would be protected if they took the COC in a pattern of 7 days on, 7 days off

Question 19

COCP may help if over 40 with

Answer 19

perimenopausal symptoms and maintain bone mineral density

Question 20

women should be advised there may be a delay in the return of fertility of up to 1 year for women > 40 years

Question 21

As we know hormone replacement therapy (HRT) cannot be relied upon for contraception so a separate method of contraception is needed. The FSRH advises that the POP may be be used with in conjunction with HRT as long as the HRT has a progestogen component (i.e. the POP cannot be relied upon to ‘protect’ the endometrium). In contrast the IUS is licensed to provide the progestogen component of HRT.

Question 22

barrier - condoms
daily - cocp, progesteron only pill
long acting - implant, infectable, mirena and copper coil

Question 23

Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception.

Question 24

Cervical screening should be offered to all sexually active individuals with a uterus.

Answer 24

Individuals engaging in anal sex and rimming should be advised of the risk of hepatitis A & B and offered vaccinations.

Question 25

Individuals at risk of HIV transmission should be advised of the availability of pre-exposure prophylaxis and post-exposure prophylaxis as required.

Question 26

For patients seeking permanent contraception, a fallopian tube occlusion or a vasectomy may be the most appropriate solution and neither would be affected by hormonal therapy.

Question 27

Progesterone only contraceptives are not considered to have any detrimental effect on testosterone therapy and the intrauterine system and injections may also suspend menstruation.

Question 28

age of consent dor sexual activity is

Answer 28

16 years

Question 29

however chldern under 16 are unable to consent for

Answer 29

sexual intercourse and child protection matter

Question 30

Sexual Transmitted Infections (STIs) young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)

Question 31

progesterone injection can reduce bone mineraly density so not best choic

Question 32

what is a good contraception for young people

Answer 32

progesterone only implant

Question 33

emergency pill

Answer 33

levonorgestrel

Question 34

morning after pill

Answer 34

ulipristal

Question 35

levonorgestrel

Answer 35

- should be taken asap as efficacy decreases with time - must be taken within 3 days of UPSI - if vomit within 3hrs of taking repeat dose - can be used more than once in a menstrual cycle - hormonal contrception can be started immediatly after

Question 36

Ulipristal

Answer 36

- up to 5 days after - should wait 5 dyas before contraception with pill or patch (barrier in between this) - use with caution if asthmatic - can be used more than once in the same cycle - breastfeeding should be delayed after one week

Question 37

what is the most effective method of emergency contraception

Answer 37

copper coil

Question 38

copper coil

Answer 38

- within 5 days of UPSI or 5 days after likely ovulation date - 99% effective regardless of where it is used in the cycle - can be left in but if only want for emergency contraception it should be kept in until the next period

Question 39

contraception if epileptic

Answer 39

For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine: = UKMEC 1: Depo-Provera, IUD, IUS for lamotrogine UKMEC1 = POP, implant, depo provera, IUD, IUS

Question 40

main MOA of implant

Answer 40

prevent ovualtion

Question 41

most effective form of contraception

Answer 41

implant

Question 42

doesn't contain oestrogen so can be used if past history of thromboembolism, migraine etc can be inserted immediately following a termination of pregnancy

Answer 42

implant

Question 43

disadv of implant

Answer 43

additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman's menstrual cycle

Question 44

main adverse effect of implant

Answer 44

irregular/ heavy bleeding. this is sometimes managed with co- prescription of COCP

Question 45

progestogen effects

Answer 45

headahce, nausea and breast pain

Question 46

implant

Answer 46

enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon the FSRH advises that women should be advised to switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment

Question 47

contraidnication ot implant

Answer 47

current breast cancer

Question 48

injectable

Answer 48

depo provera

Question 49

injection every

Answer 49

12 weeks however can be given up to 14 weeks after alst dose without the need for extra precasution

Question 50

how much is the delay to dertility after injection

Answer 50

12 months

Question 51

effect of injection

Answer 51

weight gain

Question 52

absolute cotnraindication to injection

Answer 52

active breast cancer

Question 53

mirena used also for

Answer 53

menorrhagia

Question 54

IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions) IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

Question 55

what can work immediately after inserrted

Answer 55

copper coil

Question 56

copper coil lasts for

Answer 56

5 or 10 years but majority are 5

Question 57

Mirena can be used after

Answer 57

7 days effective for 8 years but if >55 effective until 55

Question 58

copper coil downside

Answer 58

periods heavier,longer and more painful

Question 59

annoying thing about mirena coil

Answer 59

frequent uterine bleedi ng and spotting.Later women typically have intermittent light menses with less dysmenorrhoea and some women become amenorrhoeic

Question 60

another IUS is called the jaydess and licensed for

Answer 60

3 years

Question 61

The major clinical indicators of fertility are: changes in the cervical mucous changes in the cervix changes in basal body temperature

Answer 61

natural family planning

Question 62

after giving birth when do woemn require contraception

Answer 62

day 21

Question 63

good thing about progesterone only pill

Answer 63

can start anytime after birth. if staring after day 21 should use extra contraception for 2 dasy

Question 64

COCP breastfeeeding

Answer 64

UKMEC 4 if breastfeeding less than 6 weeks post partum

Question 65

COCP should not be used in first 21 days after birth due to increased risk of

Answer 65

VTE

Question 66

if COCP started after day 21 need additional contraception for

Answer 66

7 dyas

Question 67

mirena coil or copper coil can be

Answer 67

inserted within 48hrs of childbirth or after 4 weeks

Question 68

Lactational amenorrhoea method (LAM) is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

Question 69

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies.

Question 70

UKMEC 4 for proggesteron only pill

Answer 70

current breast cnacer or preg (diagnsoed within last 5 years or ongoing disease)

Question 71

most common problem of progesterone only pill

Answer 71

irregular vaginal bleeding

Question 72

Starting the POP if commenced up to and including day 5 of the cycle it provides immediate protection, otherwise additional contraceptive methods (e.g. condoms) should be used for the first 2 days if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)

Question 73

POP should be taken at same time every day without a pill free break

Question 74

Missed pills if < 3 hours* late: continue as normal if > 3 hours*: take the missed pill as soon as possible, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours *for Cerazette (desogestrel) a 12 hour period is allowed

Answer 74

for POP