Contraception

Question 1

What is the primary mode of action of the COCP?

Answer 1

Inhibits ovulation (does this by reducing production of FSH and LH)

Question 2

What is a secondary mode of action of the COCP?

Answer 2

Thickening of cervical mucus

Question 3

What should a patients blood pressure be below to start the COCP?

Answer 3

140/90

Question 4

You have just started a 29 year old women on the COCP for the first time. When do you need to check her blood pressure?

Answer 4

At three months

Anually after that

Question 5

What COCP is useful if a patients has acne and/or hirsutism?

Answer 5

Co cyprindiol (Dianette)

Question 6

Is the risk of cervical cancer increased or decreased with COCP use?

Answer 6

Increased

Question 7

What two measurments are important to record before the first prescription of the COCP?

Answer 7

Blood pressure

BMI

Question 8

What two cancers is use of the COCP protective from?

Answer 8

Ovarian

Endometrial

Question 9

When can the COCP be started that means no other means of contraception needed from day 1?

Answer 9

Up to day 5 of the cycle

Question 10

If the COCP is started on day 10 of the cycle, how many days will it be until the women has contraceptive cover?

Answer 10

7

Question 11

How long after taking levonelle 1500 should you use a barrier contraception/abstain for?

Answer 11

7 days

Question 12

How long after taking ellaOne how long should you wait before starting contraception?

Answer 12

5 days

Question 13

What should you do if you miss one COCP?

Answer 13

Take the missed pill as soon as remembered and take the remaining pills at the normal time. Emergency contraception not required

Question 14

What should you do if you miss 2 COCP pills?

Answer 14

Take the most recent missed pill
Take the remaining pills at the correct time
Use condoms/abstain until 7 pills have been taken consecutively

Question 15

If you miss more that 2 pills in the last week of a pack what should you do to minimise risk of pregnancy?

Answer 15

Omit the next pill free interval

Question 16

Which week is pregnancy most likely if you have missed two pills and you have had sex?

Answer 16

1st week of a pack

Question 17

How long can a contraceptive patch stay off for before its efficacy is reduced?

Answer 17

48 hours

Question 18

How many days can a patch be worn for before its efficacy is reduced?

Answer 18

9 days (7 days + 48hrs)

Question 19

Describe how you use a contraceptive patch

Answer 19

1 patch is applied and worn for 1 week to suppress ovulation. Thereafter the patch is reapplied weekly for a further 2 weeks. The fourth week is patch free to allow a withdrawal bleed.

Question 20

Describe how you use a vaginal ring?

Answer 20

Ring placed in the vagina and left for 21 days. After this there is a ring free interval for 7 days when there will be withdrawal bleed and then a new ring should be inserted

Question 21

How long can a vaginal ring be out of the vagina for before its efficacy is reduced?

Answer 21

48 hours

Question 22

How long can a vaginal ring be worn for before its efficacy is reduced?

Answer 22

4 weeks

Question 23

Which progesterone out of these 3 is the longest acting:

• Levonorgestrel
• Norethisterone
• Etonorgestrel

Answer 23

Etonorgestrel

Question 24

What the primary mechanism of the progesterone only pill?

Answer 24

Thickening cervical mucus

Question 25

What is the primary mechanism of the etonorgestrel progesterone pill?

Answer 25

Thickening of cervical mucus and suppression of ovulatuon in 97% of cycles

Question 26

What are the secondary mechanisms of the progesterone only pills?

Answer 26

Suppression of ovulation Reduced endometrial receptivity to blastocyst Reduction in cilia activity in fallopian tube

Question 27

Which progesterone out of these 3 is used in newer progesterone only pills: - Levonorgestrel - Norethisterone - Etonorgestrel

Answer 27

Etonorgestrel. Due to it being longer acting

Question 28

Describe how you take the progesterone only pill?

Answer 28

Daily at the same time with no break

Question 29

With the older progesterone pills (levonorgestrel & norethisterone) how may hours have should there be between doses?

Answer 29

Between 24 - 27 hours

Question 30

With the newer progesterone pills (etonorgestrel) how many hours should there be between doses?

Answer 30

24 - 36. Longer window than older POPs

Question 31

How many progesterone only pills do you have to miss to require emergency contraception?

Answer 31

1

Question 32

List 5 methods of natural family planning

Answer 32

1. Basal body temperature 2. Cervical mucous thickness 3. Cervical position 4. Calculating fertile days 5. Breastfeeding

Question 33

What is the position of the cervix when you are fertile?

Answer 33

High in the vagina, soft and open

Question 34

What is the position of the cervix when you are less fertile?

Answer 34

Low in vagina; firm and closed

Question 35

In a 28 day cycle what days are you most fertile?

Answer 35

Days 8 - 18

Question 36

What are the three criteria that you need to fulfil to make breastfeeding a reliable contraceptive?

Answer 36

1. Only breast feeding 2. Less that 6 months post natal 3. Amenorrhoeic

Question 37

What does it mean if a contraception is in category MEC 1?

Answer 37

No restriction for use of this contraceptive method

Question 38

What does it mean if a contraception is in category MEC 2?

Answer 38

Advantages of using this method generally outweigh the risks

Question 39

What does it mean if a contraception is in category MEC 3?

Answer 39

Risks of using this contraceptive generally outweigh the advantages (expert clinical judgement required)

Question 40

What does it mean if a contraception is in category MEC 4?

Answer 40

A condition which represents unacceptable risk if the contraceptive method is used.

Question 41

What calculation is used to work out the pearl index for contraception reliability?

Answer 41

Number of accidental pregnancies x 1200/ Total months of exposure

Question 42

What is the primary action of the depo provera injection?

Answer 42

Inhibits ovulation

Question 43

What condition do you need to consider the risk off before prescribing depo provera?

Answer 43

Osteoporosis

Question 44

When can the depo provera injection be given so it will be effective straight away?

Answer 44

Up to an including day 5 of the cycle

Question 45

How long do you have to use another method of contraception for if you start the depo provera on day 9?

Answer 45

7 days

Question 46

What are the main side effects of the depoprovera injection?

Answer 46

Weight gain Delay in return of fertility Irregular bleeding Risk of osteoporosis

Question 47

What is the main mode of action of the IUD?

Answer 47

Prevents fertilisation | Inflammatory response in endometrium

Question 48

What is the main mode of action of the IUS?

Answer 48

Effect on implantation - endometrium rendered unfavourable for implantation

Question 49

How many days after UPSI can the IUD be fitted for emergency contraception?

Answer 49

5 days

Question 50

How many days after a TOP can the IUD be fitted?

Answer 50

Immediately (of products of conception seen)

Question 51

How many days after childbirth can the IUD be fitted for emergency contraception?

Answer 51

Either within 48 hrs or after 4 weeks

Question 52

How many days after childbirth can the IUS be fitted for emergency contraception?

Answer 52

Either within 48 hrs or after 4 weeks

Question 53

How many days after a TOP can the IUS be fitted?

Answer 53

Immediately (if products of conception seen)

Question 54

How long is the contraceptive implant licenced for?

Answer 54

3 years

Question 55

What is the primary mode of action of the implant?

Answer 55

Preventing ovulation