Contraception

Question 1

Contraceptive used for acne

Answer 1

COCP:

Co-cyprindiol (contains cyproterone, which is anti androgenic)

Question 2

Problem with co-cyprindiol

Answer 2

has a high clot risk

needs to be stopped after 2-3 mo post acne resolution

Question 3

Mech of action of COCP

Answer 3

• inhibit ovulation via hypothalamo-pituitary-ovarian axis

- prevent fertilisation and implantation by altering mucus in cervix and endometrium

Question 4

How does risk of clots on COCP compares to healthy controls/pregnant

Answer 4

20 in 100 000 on COCP
5-10 healthy
60 pregnant

Question 5

SE of COCP

Answer 5

• increased BP
• Hormonal SEs: nausea, breast tenderness, mood changes, change in libido
• headaches

Question 6

Monitoring whilst on COCP

Answer 6

BP annually

Question 7

CI to COCP

Answer 7

1. VTE or condition that increases its risk (SLE, phospholipid syndrome)
2. arterial thrombosis or TIA
3. Migraine with aura
4. cholestatic jaundice or liver disease
5. known pregnancy
6. hormone dependent cancer, eg breast
7. undiagnosed vaginal bleed

Question 8

How to take COCP

Answer 8

• Take for 21 days, starting on day 1-5 of period

- 7 day break, expect bleed

Question 9

Can COCP be taken back to back

Answer 9

yes, but need to have at least 4 periods per year

Question 10

Which abx cant be taken with COCP

Answer 10

enzyme induced ones eg rifampicin

Question 11

Drugs that may interact with COCP

Answer 11

Herbal prep eg St Johns wort

antiepileptics

Question 12

SEs of POP

Answer 12

irregular or infrequent bleeding

amenorrhoea

Question 13

2 different IM progesterone only contraceptives and how often given

Answer 13

Depot Provera 12wkly

Noristerat 8wkly

Question 14

How often does progesterone only implant need to change

Answer 14

every 3 yrs

Question 15

How often doe mirena coil IUS need to change

Answer 15

5 yrly

Question 16

how often does copper coil IUD need to change

Answer 16

10 yrly

Question 17

Effect of mirena coil on periods

Answer 17

reduces heavy painful periods

Question 18

Effect of copper coil on period

Answer 18

makes them heavier and more painful

Question 19

Risk with pregnancy in presence of coil

Answer 19

ectopic

Question 20

Post coital contraception options

Answer 20

Levonorgestrel (Levonelle-1)
Ulipristal Acetate (ellaOne)
IUD copper coil

Question 21

How long after intercourse is levonogestrel effective

Answer 21

72hrs

Question 22

How long after intercourse is ulipristal acetate effective

Answer 22

120hrs (5dys)

Question 23

How long after intercourse is IUD copper coil effective

Answer 23

120 hrs or up to 5 dys after estimated earliest date of ovulation

Question 24

Mech of action of levonogestrel

Answer 24

unknown, maybe prevents ovulation/implantation

Question 25

Mech of action of ulipristal acetate

Answer 25

SPRM (selective progesterone receptor modulator) ; inhibits/delays ovulation

Question 26

What happens if vomiting after taking the emergency contraceptive pill

Answer 26

take a second dose with domperidone 10 mg (antiemtic)

Question 27

When can someone have sex after levonelle

Answer 27

until contraceptive cover is resumed (7 days of COCP or 2 days of POP)

Question 28

When can someone have sex after ellaOne

Answer 28

use barrier methods or completely avoid until next period (as reduces the efficacy of hormonal contraceptives)

Question 29

How long does it take for cocp contraceptive cover to start

Answer 29

7 days post start (shouldnt have sex)

Question 30

How long does it take for pop contraceptive cover to start

Answer 30

2 days post start

Question 31

CIs to copper coil

Answer 31

suspected pregnancy
PID
Cervical abnormality
Cervical or endometrial cancer
Trophoblastic disease

Question 32

Mech of action of copper coil

Answer 32

prevents fertilisation

Question 33

Missed POP pill

Answer 33

<3 hrs, take it, no action (unless cerazette 12hrs)
>3hrs actions:
- take the pill
- condoms more 2days