contraception - methods

Question 1

mechanism COCP prevents pregnancy

Answer 1

inhibits ovulation

Question 2

when should you start taking COCP

Answer 2

if started within 1st 5 days of cycle no additional contraception needed // if started any later use condoms for 7 days

Question 3

how should you take COCP

Answer 3

same time every day // no need for withdrawal bleed (take continuously, take 3 packs then a break)

Question 4

which medications may reduced efficiency of the COCP

Answer 4

liver enzyme inducing eg rifampicin

Question 5

advantages of COCP (esp cancer)

Answer 5

lighter periods // reduced ovarian, endometrial and colorectal cancer!!!

Question 6

increased risks with COCP

Answer 6

VTE // breast and cervical cancer // stroke and IHD (esp smokers)

Question 7

SE COCP

Answer 7

headache, nausea, breast tenderness

Question 8

what to do with 1 missed pill COCP

Answer 8

take pill at any time you remember, even if that means taking 2 in a day

Question 9

advice if 2 COCP pills are missed in week 1 of cycle

Answer 9

consider emergency contraception

Question 10

advice if 2 COCP pills are missed in week 2 of cycle

Answer 10

if she has taken pill for 7 consecutive days there is no need for emergency contraception

Question 11

advice if 2 COCP pills are missed in week 3 of cycle

Answer 11

finish pills in her back and start new pack (miss pill free interval)

Question 12

UKMEC 3 COCP

Answer 12

35 + smoke <15 // BMI >35 // FH VTE <45 // hypertension // immobile eg wheel chair // BRCA // gallbladder disease

Question 13

UKMEC 4 COCP

Answer 13

35+ smoke >15 // migraine with aura // PMH VTE (or mutation) // stroke or IHD // breastfeeding <6weeks // uncontrolled hypertension // breast cancer // surgery + immobile // antiphospholipid antibodies eg SLE or APS // diabetes >20 years ago

Question 14

UKMEC 4 COCP

Answer 14

35+ smoke >15 // migraine with aura // PMH VTE (or mutation) // stroke or IHD // breastfeeding <6weeks // uncontrolled hypertension // breast cancer // surgery + immobile // antiphospholipid antibodies eg SLE or APS

Question 15

how should the combined patch be used

Answer 15

wear a patch for 3 weeks (change each week), 4th week no patch

Question 16

advice if there is a delay in changing combined patch for in week 1 or 2

Answer 16

if <48 hours change immediately // if >48 hours then change immediately and use condoms for 7 days (or emergency contraception is needed)

Question 17

advice if there is a delay in changing combined patch for in week 3

Answer 17

remove ASAP and apply patch on usual start day for next cycle (ie have withdrawal bleed, no need for condoms)

Question 18

advice if there is a delay in applying new combined patch at end of week 4 (patch free week)

Answer 18

condoms for 7 days

Question 19

mechanism POP (not desogesterol)

Answer 19

thickens cervical mucus

Question 20

mechanism POP desogesterol

Answer 20

inhibits ovulation (and thickens mucous)

Question 21

most common SE POP

Answer 21

irregular vaginal bleeding

Question 22

advise about starting POP

Answer 22

if started up to day 5 of period safe to start // if after use condoms for 2 days

Question 23

what to do if missed pill with POP

Answer 23

<3 hours take as normal // >3 hours use condoms for 48 hours // if deosgestrel (cerazette) a 12 hour window

Question 24

mechanism implant

Answer 24

inhibits ovulation + thickens mucous (progesterone)

Question 25

how long does implant last

Answer 25

3 years (most effective form of contraception)

Question 26

when should implant be inserted

Answer 26

if applied on day 1-5 no extra needed // if outwith that then 7 days needed

Question 27

biggest SE implant

Answer 27

irregular or heavy bleeding // progesterone side effects eg headache, nausea, breast pain

Question 28

how can irregular bleeding be controlled with implant

Answer 28

COCP

Question 29

what medications can reduce effectiveness of implant

Answer 29

some anti-epileptics and rifampicin

Question 30

UKMEC 3 implant

Answer 30

IHD, stroke, vaginal bleeding, past breast cancer, liver cirrhosis or cancer

Question 31

UKMEC 4 implant

Answer 31

current breast cancer

Question 32

mode of action IUD

Answer 32

copper - decreases sperm motility and survival

Question 33

how long to IUDs last + when should they be inserter

Answer 33

effective as soon as inserted // last 5-10 years

Question 34

mechanism IUS

Answer 34

(mirena) - thickens mucous and prevents endometrial proliferation

Question 35

how long does IUS last and when is it effective

Answer 35

after 7 days // up to 5 years

Question 36

SE IUD

Answer 36

heavy, painful period

Question 37

SE IUS

Answer 37

initial frequent bleeding and spotting which decreases over time

Question 38

risks of intrauterine implants

Answer 38

perforation, PID, expulsion

Question 39

methods of emergency contraception

Answer 39

levonorgestrel (levonelle), ulipristal (ellaone), IUD

Question 40

mechanism Levonorgestrel (levonelle)

Answer 40

inhibit ovulation + implantation (progesterone)

Question 41

window for Levonorgestrel

Answer 41

72 hours

Question 42

dose Levonorgestrel

Answer 42

1.5mg (double if BMI >26 or weight >70kg)

Question 43

what to do if vomiting after Levonorgestrel

Answer 43

if within 3 hours repeat dose

Question 44

how many times can Levonorgestrel be used in a cycle + when can contraception be started

Answer 44

more than once of indicated - start contraception straight away

Question 45

when can ellaone be taken + dose

Answer 45

30mg within 120 hours

Question 46

other contraception + ellaone

Answer 46

reduced effectiveness of pill, patch, and ring for 5 days // use condoms for that time

Question 47

what condition needs caution with ellaone

Answer 47

asthma

Question 48

how many times can emergency contraception be given in a cycle

Answer 48

more than once

Question 49

most effective emergency contraception

Answer 49

copper IUD - 99% effective at any time in cycle

Question 50

when can copper coil be inserted for emergencies

Answer 50

up to 5 days after ovvulation date

Question 51

clinical indication family planning

Answer 51

temperature, changes in mucous, changes in cervix