contraception

Question 1

general side effects of hormonal contraception

Answer 1

headache 
weight gain
bloating 
breast tenderness 
loss of libido

Question 2

side effects of progesterone contraception

Answer 2

acne 
mood changes 
hirsutism
vaginal dryness
like a moody teenager

Question 3

side effects of oestrogen contraception

Answer 3

fibroids
nausea/vomiting
hypertension
vaginal discharge

Question 4

what are the 2 broad categories of contraception

Answer 4

LARC

non-LARC

Question 5

hormones in combines oral contraceptive pill

Answer 5

oestrogen and progesterone = ethinylestradiol

Question 6

mode of action of COCP

Answer 6

inhibits ovulation

decreased endometrial thickening

Question 7

when should COCP be started? what should you do if this is not possible?

Answer 7

days 1-5 of cycle

use condoms for 7 days if unable to do so

Question 8

benefits of COCP

Answer 8

protective against ovarian and endometrial cancers

good for acne

Question 9

risks with COCP

Answer 9

thromboembolic disease

breast and cervical cancer

Question 10

when is COCP contra-indicated

Answer 10

current breast cancer 
post-partum <6 weeks and breast feeding 
migraine with aura
cardiac history
immobile 
>50 years

Question 11

when should break through bleeding stop on COCP and what should you investigate if persists

Answer 11

should stop >3months
check compliance 
rule out chronic vomiting/diarrhoea 
STI screen 
smear
pregnancy?

Question 12

mode of action of progesterone only pill

Answer 12

inhibits ovulation
slows fallopian tube transport (decreases action of cilia)
decreases endometrial thickening
thickens cervical mucous

Question 13

most common POPs

Answer 13

levongestrel, norethisterone, desogestrel

Question 14

when should POPs be started and what should you recommend if unable to do so

Answer 14

days 1-5 of cycle

use condoms for 2 days after starting

Question 15

when is POP contraindicated

Answer 15

breast cancer 
trophoblastic disease (molar pregnancy)
SLE
liver disease (interacts with liver enzyme drugs)
malabsorption

Question 16

patient is on POP and has new onset migraine with aura/MI/stroke/TIA

Answer 16

stop medication

Question 17

POP can/cannot be continued after 50 years

Answer 17

can be continued

Question 18

missed pill rules for COCP

Answer 18

1 missed - take as soon as realise. take next pill as normal
2 missed - take next one as normal. condoms until 7 days consecutive pill

Question 19

missed pill rules for POP

Answer 19

1 missed - if > 3 hours, use condoms for 48 hours (unless devogesterel - if more than 12 hours)

Question 20

what should patients be warned about timings of POPs

Answer 20

very narrow window - should be taken at same time every day

Question 21

what is depoprovera and what hormone does it use

Answer 21

injection

progesterone

Question 22

how often should depo be given vs how long does it last

Answer 22

given every 12-13 weeks

lasts 14 weeks

Question 23

when should depo be given and what should you do if unable to do so

Answer 23

days 1-5 of cycle

7 days condoms if cant

Question 24

advantages of depo

Answer 24

helps PMS and menorrhagia

Question 25

what effect does depo have on fertility

Answer 25

delay in return of fertility after stop depo

Question 26

when is depo contraindicated

Answer 26

>50 years risk of osteoporosis same risk factors for POP

Question 27

what hormone does implant use

Answer 27

progesterone

Question 28

how long does implant last

Answer 28

3 years

Question 29

implant can/cannot be continued after 50 years

Answer 29

can be continued

Question 30

why might effectiveness of implant decrease in third year

Answer 30

if obese (>35 years) - should change implant early

Question 31

when should implant be inserted and what to do if unable to do so

Answer 31

days 1-5 of cycle | 7 days condoms if cannot

Question 32

benefits of implant vs depo

Answer 32

no osteoporosis risk | immediate return of fertility

Question 33

side effect of implant

Answer 33

amenorrhoea with infrequent bleeding

Question 34

what hormone does IUS have

Answer 34

progesterone

Question 35

what are the 2 types of IUS and how long do they last

Answer 35

mirena - 5 years | jaydess - 3 years

Question 36

mode of action of IUS

Answer 36

prevents implantation prevents endometrial thickening thickens cervical mucous

Question 37

when should IUS be inserted and what to do if cant

Answer 37

days 1-5 of cycle | 7 days condoms if not

Question 38

benefits of IUS compared to IUD

Answer 38

less risk of PID and ectopic pregnancy | lighter, less painful periods

Question 39

special circumstances IUS is good for

Answer 39

``` breastfeeding obesity CVD liver enzyme drugs endometriosis ```

Question 40

SE of IUS

Answer 40

spotting for first few weeks | intermestrual bleeding

Question 41

mode of action of copper coil

Answer 41

copper is a spermicide | inflammatory response in endometrium - no implantation

Question 42

how soon are you protected after insertion of copper coil

Answer 42

immediately

Question 43

SE of IUD

Answer 43

expelled heavier, more painful periods cervical shock

Question 44

what should be checked before insertion of IUD

Answer 44

STI check

Question 45

what should be checked after each period

Answer 45

threads

Question 46

what is used for emergency contraception

Answer 46

copper coil ella-one (ullipristal acetate) levonorgestrel

Question 47

what is the most effective emergency contraception

Answer 47

copper coil

Question 48

if unable to screen for chlamydia before emergency insertion of copper coil - what should be given

Answer 48

azithromycin

Question 49

what emergency pill can be given if <120hours since sex

Answer 49

ullipristal acetate

Question 50

how long after sex can you give levonorgestrel

Answer 50

up to 72 hours

Question 51

contraindications of ullipristal acetate

Answer 51

breast feeding liver enzyme enducing drugs gastric pH lowering drugs severe asthma