Contraception LARC

Question 1

What is the world’s most widely used contraceptive method

Answer 1

withdrawal

Question 2

What are the ascects of ‘natural’ family planning

Answer 2

Body temp
cervical mucous
cervical position
'standard days'
Breast feeding

Question 3

What happens to body temperature when a woman is ovulating

Answer 3

it increased by more than 0.2 degrees celcius

sustained for three days after at least six days of lower temp

Question 4

What happens to cervical mucous around ovulation

Answer 4

thick and stick post ovulation

occurs for at least three days after a thinner, watery mucous

Question 5

What is the cervical position when fertile

Answer 5

high in vagina, soft and open

Question 6

When are the most fertile days in a standard 28 day cycle

Answer 6

8 to 18

Question 7

how effective is breast feeding as a contraceptive

Answer 7

if three criteria are me it is 98 percent effective

1. exclusively breast feeding
2. less than 6/12 post natal
3. amenorrhoeic

Question 8

What is the pearl index

Answer 8

represents no of contraceptive failures per 100 women users/year-
(no of accidental pregnancies x 1200)divided by total months of exposure

Question 9

What are the options for LARC or VLARC?

Answer 9

LARC- injectable contraception ie depo provera

VLARC- IUD, IUS, implant

Question 10

What is the primary mode of action of depo provera

Answer 10

inhibits ovulation

progesterone only

Question 11

What other effects does depo provera have?

Answer 11

effects cervical mucus and endometrium

Question 12

What is the peal index of depo provera

Answer 12

0.3 percent

Question 13

What are the side effects of depo provera

Answer 13

weight gain
delay in return of fertility
irregular bleeding
risk osteoporosis

Question 14

What are the risk factors for osteoporosis

Answer 14

anorexia/underweight
steroid use 
xs alcohol
immobile
FHx
Smoking
Low trauma fracture
Chronic condition eg hypothyroid, coeliac, RA, hyperparathyroid, IBD, renal disease

Question 15

When can depo be started

Answer 15

Up to and including day 5 of a cycle without need for additional protection
Beyond day 5 a woman con start depo providing she is reasonably certain she is not pregnant and uses condoms/abstains for 7 days

Question 16

What is ‘reasonably certain’ a woman isn’t pregnant

Answer 16

no sex since last period
consistant with contraception
- less than seven days of a normal period
- less than than four weeks post partum
breast feeding with criteria met
negative pregnancy test more than 3 weeks since UPSI

Question 17

when can depo be given post partum

Answer 17

up to day 21

Question 18

when can depo be given after TOP

Answer 18

up to day five

Question 19

What is the IUD

Answer 19

t shaped non hormonal device containing copper and plastic (some silver etc is used to prevent corrosion)
gold standard - 380mm2 copper

Question 20

what is the primary mode of action of the IUD

Answer 20

prevents fertilisation

creates inflammatory response in endometrium

Question 21

How long is the IUD licenced to be kept in for

Answer 21

5-10 years

Question 22

What is the pearl index of the IUD

Answer 22

0.5 percent (1 in 200)

Question 23

What is the IUS?

Answer 23

Two types- 52mg LNG-IUS (20mcg levonorgestrel daily, decreasing to 10ug per day at 5 years) liscenced for 5 yrs
- 13.5mg LNG-IUS (14ug per day for first 24 days, decreasing to 5ug per day at 5 years) liscenced for 3 years
progesterone only device

Question 24

what is the primary mode of action of the IUS

Answer 24

effects implantation

endometrium is rendered unfavourable for implantation

Question 25

what is the pearl index of the IUS

Answer 25

0.2 percent (1 in 500)

Question 26

What are the contraindication to IUD/IUS

Answer 26

``` current pelvic infection abnormal uterine anatomy pregnancy sensitive to constituents gestational trophoblastic disease where bhcg levels abnormal endometrial cancer cervical cancer awaiting treatment ```

Question 27

When can an IUD be fitted

Answer 27

Within in the first 7 days of a period Any time provide reasonably certain not pregnant Up to 5 days after UPSI ( for EC) OR Up to 5 days after predicted date of ovulation Either within 48 hrs or > 4 weeks post partum Immediately post TOP ( if products of conception seen)

Question 28

When can an IUS be fitted?

Answer 28

Within the first 7 day of a period Any time provide reasonably certain not pregnant NOT used for EC If fitted out with first 7/7- use condoms for first 7/7 Either with in 48 hrs or > 4 weeks post partum Immediately post TOP ( if products conception seen)

Question 29

What are the side effects of the IUD

Answer 29

``` heavy prolonged menses pain, infection PID risk increased in first 20 days Perforation Expulsion Ectopic pregnancy risk ```

Question 30

What are the side effects of IUS

Answer 30

``` Lighter, less frequent bleeding Pain, infection PID increased in first 20 days Perforation 1-2/1000 Expulsion- same as IUD Ectopic risk?? …….Overall 0.01 to 0.1 per 100 women yrs Maybe higher with lower does version?? failure ```

Question 31

What is the implant

Answer 31

single, non biodegradable subdermal rod can be used for 3 yrs contains 68mg of eng- releases 60/70ug per day in weeks 5-6 25-30ug per day end of 3rd year use

Question 32

what is the primary mode of action of the implant

Answer 32

inhibition of ovulation | other - effects endometrium and cervical mucous

Question 33

what is the pearl index of the implant

Answer 33

0 to 0.1 percent

Question 34

when can an implant be fitted

Answer 34

No need for additional precautions: Within first 5 days of cycle Up to day 5 post first/second trimester abortion On or before day 21 postpartum Need for additional precautions first 7 days If it is reasonably certain she is not pregnant “quick start” after emergency contraception Off licence

Question 35

When can you switch to the implant from another form of contraception

Answer 35

immediately effective if fitted after last active pill pack taken or depo still within 14 weeks if weeks 2-3 of coc, patch or ring need additional contraception if - change from POP or IUS -switching from non hormonal method (IUD)

Question 36

what are the side effects of the implant

Answer 36

``` irregular bleeding wt gain acne nerve damage deep insertion ```