Contraception and abortion

Question 1

Which drugs contraindicate the pill

Answer 1

Anything that affects liver enzymes
Anticonvulsants, antibiotics
NB - efficacy of COCP isn’t affected by broad spectrum Abx

Question 2

How does oral contraceptive work

Answer 2

Increased O+P increase neagtice feedback on pituitary so they stop LH and FSH

Question 3

Three preparations of COCP

Answer 3

21 days on 7 off (withdrawal bleed)
24 on 4 off
monophasic - take constantly

Question 4

If woman complains of headaches and dysmenorrhea in pill free period

Answer 4

tricycle

Question 5

What to do if 1 COCP pill has been missed

Answer 5

If missed by 24 hours (up to 48) take it and the next and continue as normal even if you have to take 2 in 1 day
If you’ve missed any others in last week use emergency contraception

Question 6

If 2 or more pills missed (more than 48 hours late) in a week

Answer 6

Take last pill and current pill (2 in 1 day) and continue
USE CONDOMS until pill has been taken correctly for 7 days
if in week 1: emergency contraception
if in week 2: no need for emergency contraception
if in week 3: finish pack and then start the new one without the pill free break

Question 7

Effect of COCP on cancer incidence

Answer 7

decreased risk of colorectal, endometrial, ovarian

increased risk of breast and cervical

Question 8

Absolute contraindications for COCP

Answer 8

< 6 weeks pospartum
smoker >35
HTN (>160 SBP)
current/past hx of VTE
IHD
Hx of cerebrovascular accident
complicated valvular heart disease (pulmonary HTN etc.)
migraine w/ aura
breast cancer
diabetes w/ nephro/neuro/retinopathy
cirrhosis
liver tumour

Question 9

S/E of POP

Answer 9

Acne, irregular bleeding, persisten ovarian follicles (simple cysts)

Question 10

what to do if POP missed

Answer 10

< 3 hours late: continue as normal
3+ hours late - take missed pill, continue and use extra protection for 48 hours. If you’ve missed 2 or more, take the last missed pill, the next and use extra precaution for 48 hours, if not use emergency contraception

Question 11

Ectopic counselling for coil

Answer 11

risk of ectopic is lower than with no contraception but if you do get pregnant on contraception then your risk of ectopic is greater

Question 12

How long after sex can Cu-IUD be inserted

Answer 12

5 days after sex ALSO 5 days after ovulation

Question 13

What emergency contraceptives are available

Answer 13

Cu-iud - 5 days after sex (or if they present 5 days after sex IUD must be fitted up to 5 days after likely ovulation date)
Levonorgestrel - 3 days (inhibits ovulation) - if vom occurs within 2 hours of dose repeat
ulipristal - up to 5 days (progesterone receptor modulator - inhibits ovulation - don’t use with levonorgestrel) start using barrier contraception after 5 days.
Take caution w/ asthma
If weight >70kg or BMI >26
need different contraception

Question 14

which pre-abortion investigations should be done

Answer 14

Gestational assessment (US and clinical)
Rhesus status

Question 15

What is given in a medical abortion

Answer 15

mifepristone for sensitisation (progesterone receptor modulator) maximum activity is after 48 hours so should aim for misoprostol then
misoprostol for expulsion (prostaglandin analogue)

Question 16

Medical abortion at different stages

Answer 16

<9 weeks - mifepristone and misoprostol 24-48 hours later), can do this at home, advise that they’ll bleed for 2 weeks
Pregnancy test after 3 weeks
9-21 weeks - mifepristone then repeated doses of misoprostol every 3 hours til expulsion. Do in hospital because of pain and blood
>21 weeks - give feticide (amniotic digoxin or intracardial KCl)

Question 17

Surgical TOP

Answer 17

<14 weeks - vacuum TOP
give misoprostol if nulliparous, adolescent or previous surgery
> 14 weeks
dilation and evacuation
DILATE TO >20mm
Dilate using misoprostol 3 hours prior to surgery
USS to confirm termination

Question 18

Advice after emergency contraception

Answer 18

STI screen

take pregnancy test if next period is late

Question 19

Long vs short acting contraception

Answer 19

Long: IUD, implant, injectable
Short: pill (COCP, POP), patch, ring

Question 20

Advice for MIRENA

Answer 20

Need to use other form of contraception for first 7 days unless you insert it at the start of the cycle

Question 21

Advice for implant

Answer 21

works for 3 years
Progesterone s/e
additional contraception if not inserted in day 1-5 of cycle
antiepileptics and rifampicin can reduce effectiveness
fertility returns after you remove it

Question 22

Advice for injection

Answer 22

12-14 weeks
additional contraception for a week if not inserted in day 1-5 of cycle
s/e can cause weight gain and reduced bone density
Fertility takes 6-12 months to return after last injection

Question 23

What hormones are in COCP

Answer 23

ethinyl oestradiol + progestin

Question 24

Pros and cons of COCP

Answer 24

Pros:
effective
reversible
makes periods lighter, less painful and more regular
reduced risk of ovarian, endometrial and bowel Ca

Cons:
no protection against STI
increasedrisk of VTE, cervical, breast ca, stroke, IHD

s/e
headache, nausea, breast tenderness

Question 25

How does POP work

Answer 25

thickens cervical mucous (and desorgestrel stops ovulation)

Question 26

How to take POP

Answer 26

1 pill every day with no pill free week

if started in first 5 days of cycle don’t need any other contraception, if not you need other contraception for 2 days

Question 27

Pros and cons of POP

Answer 27

pros
doesn't have risk of oestrogen pills
cons
take everyday
irregular bleeding
osteoporosis (no oestrogen)
ovarian cysts

Question 28

How does combined hormonal transdermal patch work

Answer 28

Apply for 3 weeks and have week off

Question 29

What to do for missed patch

Answer 29

Delayed change <48 hours: change immediately w/ no further protection
delayed change >48 hours in week 1 or 2: immediate change and use barrier contraception for 7 days
delayed removal >48 hours in week 3: remove and start next patch at normal time
delayed at end of patch free week: apply and use barrier contraception for 7 days

Question 30

How does combined hormonal ring work

Answer 30

wear for 21 days, 7 days off