CONTRACEPTION / HRT

Question 1

HRT
what HRT would you prescribe for someone with a uterus and had a period within the last 12 months?

Answer 1

• oral sequential combined oestrogen and progestogen (Elleste-duet 1mg or 2mg)
• patch sequential combined oestrogen and progestogen (evorel sequi)

DRUG NAME = ESTRADIOL WITH NORETHISTERONE

Question 2

HRT
what HRT would you prescribe for someone with a uterus who has not experienced a period within the last 12 months?

Answer 2

• oral continuous combined oestrogen and progestogen (Elleste duet conti)
• patch continuous combined oestrogen and progestogen (Evorel conti)

DRUG NAME = ESTRADIOL WITH NORETHISTERONE

Question 3

HRT
what HRT is prescribed for someone post-hysterectomy?

Answer 3

• oral or patch oestrogen (elleste solo)

DRUG NAME = ESTRADIOL

Question 4

HRT
what would you prescribe for post-menopausal osteoporosis?

Answer 4

• alendronic acid or risedronate sodium

Question 5

HRT
what would you prescribe for someone with vasomotor symptoms of menopause who are unable to have HRT?

Answer 5

clonidine (or SSRI)

Question 6

HRT
what would you prescribe for post-menopausal atrophic vaginitis?

Answer 6

topical vaginal oestrogen (pessary or ring)

Question 7

HRT
when do you use cyclical (sequential) HRT vs continuous HRT?

Answer 7

cyclical (sequential) = if still having periods
continuous = no longer having periods

Question 8

HRT
when do you use oestrogen and progestogen vs just oestrogen for HRT?

Answer 8

womb present = oestrogen + progestogen
post-hysterectomy = just oestrogen

Question 9

CONTRACEPTION
what are the options for emergency contraception?

Answer 9

• levonorgestrel
• ulipristal acetate
• IUD (copper coil)

Question 10

CONTRACEPTION
when can levonorgestrel be used as emergency contraception?

Answer 10

• if UPSI occurred <72 hrs (3 days) ago

Question 11

CONTRACEPTION
what should you do if someone vomits after taking levonorgestrel as emergency contraception?

Answer 11

if vomiting <3 hrs after taking dose, take another tablet

Question 12

CONTRACEPTION
what is the effect of BMI on dose of levonorgestrel for emergency contraception?

Answer 12

if BMI > 26 then double the dose

Question 13

CONTRACEPTION
when is ulipristal acetate used as emergency contraception?

Answer 13

if UPSI occurred <120 hrs (5 days)

Question 14

CONTRACEPTION
when is ulipristal acetate contraindicated?

Answer 14

in asthma

Question 15

CONTRACEPTION
when can the copper coil be used as emergency contraception?

Answer 15

• if UPSI occurred <120 hrs (5 days) ago
• if ovulation occurred in the last 5 days

Question 16

CONTRACEPTION
what should you prescribe for COCP?

Answer 16

DRUG NAME = ethinylestradiol with levonorgestrel (microgynon 30)

Question 17

CONTRACEPTION
what is the mechanism of action for COCP?

Answer 17

inhibits ovulation

Question 18

CONTRACEPTION
which cancers are at increased risk of developing when taking COCP?

Answer 18

increased risk of breast and cervical cancer

Question 19

CONTRACEPTION
which cancers are at decreased risk of developing when taking COCP?

Answer 19

endometrial cancer and ovarian cancer

Question 20

CONTRACEPTION
what is the most important side effect of COCP?

Answer 20

increased risk of VTE

Question 21

CONTRACEPTION
what would you prescribe for POP?

Answer 21

DRUG NAME = Desogestrel (cerazette)

Question 22

CONTRACEPTION
what is the mechanism of action for POP?

Answer 22

thickens cervical mucus (+inhibits ovulation)

Question 23

CONTRACEPTION
what is the most important side effect for POP?

Answer 23

irregular bleeding

Question 24

MISSED PILL (COCP)
what is classed as a missed pill?

Answer 24

missed pill = a pill that is >24 hours late

Question 25

MISSED PILL (COCP) what should you do if you miss 1 pill at any time during the cycle?

Answer 25

- take the last pill (even if it means taking 2 pills in one day) - continue taking pills daily, one each day - no additional contraceptive protection is required

Question 26

MISSED PILL (COCP) what should you do if you miss 2 pills during week 1 (days 1-7)?

Answer 26

- emergency contraception should be considered if she had unprotected sex during the pill-free interval or in week 1

Question 27

MISSED PILL (COCP) what should you do if you miss 2 pills during week 2 (days 8-14)?

Answer 27

- require additional contraceptive protection for 7 days

Question 28

MISSED PILL (COCP) what should you do if you miss two pills during week 3 (days 15-21)?

Answer 28

- finish the current pack - start a new pack the next day, omitting the pill free interval

Question 29

MISSED PILL (POP) what should you do if you miss 1 pill of traditional POP (micronor, noriday, nogestron, femulen)?

Answer 29

- if less than 3 hours late, take pills and continue as normal (no action required) - if more than 3 hours late, take one pill + take next pill at normal time. Continue with the rest of the pack. Use extra precautions (e.g. condoms) for 48 hours

Question 30

MISSED PILL (POP) what should you do if you miss 1 pill of desogestrel?

Answer 30

- if less than 12 hours late, continue as normal (no action required) - if more than 12 hours late, take pill and take next pill at the normal time. Continue with the rest of the pack. Use extra precautions (e.g. condoms) for 48 hours.

Question 31

MISSED PILL (POP) when would you require emergency contraception when a pill has been missed?

Answer 31

- if one or more tablets have been missed and unprotected sex has occurred before a further 2 tablets have been correctly taken