fsrh Flashcards

Question

Is additional contraception required after initiation of a method after abortion?

Answer 1

Women should be advised that additional contraceptive precautions (e.g. barrier methods/abstinence) are required if hormonal contraception is started 5 days or more after abortion. Additional contraceptive precaution is not required if contraception is initiated immediately or within 5 days of abortion.

Answer 2

Women should be advised that there may be a slightly higher risk of continuing pregnancy (failed abortion) if DMPA is initiated at the time of mifepristone administration.

Answer 3

Combined hormonal contraception (CHC) can be safely started immediately at any time after abortion.

Answer 4

Women who wish to conceive after miscarriage can be advised there is no need to delay as pregnancy outcomes after miscarriage are more favourable when conception occurs within 6 months of miscarriage compared with after 6 months. D Women who have been treated with methotrexate should be advised that effective contraception is recommended during and for at least 3 months after treatment in view of the teratogenic effects of this medication.  Women should be advised that effective contraception can be started on the day of methotrexate administration or surgical management of ectopic pregnancy.

Answer 5

Emergency contraception (EC) is indicated if unprotected sexual intercourse (UPSI) takes place more than 5 days after methotrexate administration or surgical treatment of ectopic pregnancy.

Answer 6

Women should be advised that additional contraceptive precautions (e.g. barrier methods/abstinence) are required if hormonal contraception is started 5 days or more after miscarriage. Additional contraceptive precaution is not required if contraception is initiated immediately or within 5 days of miscarriage.

Answer 7

Women who have had recurrent early miscarriage (REM) should be investigated for any underlying causes. However, investigations should not lead to a delay in initiation of a contraceptive method if the woman does not wish to become pregnant. D Combined hormonal contraception (CHC) should be avoided by women with REM until antiphospholipid syndrome (APS) has been excluded.

Answer 8

Women should be advised that the absolute risk of ectopic pregnancy when contraception is used is extremely small and that the risk of pregnancy is lowest with LARC. Women should be advised to seek medical advice if they suspect they may be pregnant and have symptoms suggestive of ectopic pregnancy, even while using contraception. Women who have had an ectopic pregnancy should be advised that the IUC is one of the most effective methods of contraception and so the absolute risk of any pregnancy including ectopic pregnancy is extremely low. Women should be informed that if pregnancy occurs with an IUC in situ, there is an increased risk of ectopic pregnancy and therefore the location of the pregnancy should be confirmed by ultrasound as soon as possible.

Answer 9

Clinicians should reassure women with GTD that fertility and pregnancy outcomes are favourable after GTD, including after chemotherapy for gestational trophoblastic neoplasia (GTN). However, there is an increased risk of GTD in subsequent pregnancy

Answer 10

D After complete molar pregnancy, women should be advised to avoid subsequent pregnancy for at least 6 months to allow human chorionic gonadotrophin (hCG) monitoring for ongoing GTD. D After partial molar pregnancy, women should be advised to avoid pregnancy until two consecutive monthly hCG levels are normal. D Women who have had chemotherapy for GTD should be advised to avoid pregnancy for 1 year after treatment is complete.

Answer 11

IUC should not be inserted in women with persistently elevated hCG levels or malignant disease. D IUC should not normally be inserted until hCG levels have normalised but may be considered on specialist advice with insertion in a specialist setting for women with decreasing hCG levels following discussion with a GTD centre.

Answer 12

 Emergency contraception (EC) is indicated if unprotected sexual intercourse (UPSI) takes place from 5 days after treatment for GTD. D Women should be advised that use of oral EC is safe after treatment for GTD. Insertion of copper intrauterine device (Cu-IUD) for EC may be considered in a specialist setting for women with decreasing hCG levels following discussion with a GTD centre.

Answer 13

Women should be advised that additional contraceptive precautions (e.g. barrier methods/abstinence) are required if hormonal contraception is started 5 days or more after treatment for GTD. Additional contraceptive precaution is not required if contraception is initiated immediately or within 5 days of treatment for GTD.

Answer 14

No restriction

Answer 15

Absolutely no

Answer 16

cholestasis hypertension gestational diabetes

Answer 17

Use of a Cu-IUD may be associated with a reduced risk of endometrial cancer and cervical cance

Answer 18

he 52 mg LNG-IUS may reduce pain associated with primary dysmenorrhoea, endometriosis or adenomyosis. The 52 mg LNG-IUS is effective in reducing menstrual blood loss and can be used in the management of heavy menstrual bleeding. Women considering the LNG-IUS can be informed that systemic absorption of progestogen occurs with these devices. The 13.5 and 52 mg LNG-IUS have similar sideeffect profiles (such as acne, breast tenderness/pain and headache) and hormonal side effects often settle with time. Rates of discontinuation due to side effects are not significantly different from Cu-IUD users.

Answer 19

The rate of uterine perforation associated with IUC is up to 2 per 1000 insertions and is approximately six-fold higher in breastfeeding women.

Answer 20

Insertion or reinsertion of an intrauterine method can be carried out in asymptomatic women with actinomyces-like organisms (ALOs). There is no need to remove IUC in asymptomatic women with ALOs. IUC removal is not routinely required in women with pelvic inflammatory disease but it should be removed if there is no response to treatment (approximately 72 hours).

Answer 21

Mooncups and tampons do not appear to be associated with an increased risk of IUC expulsion.

Answer 22

CHC containing ethinylestradiol (EE) can be started by medically eligible women up to and including Day 5 of a natural menstrual cycle without the need for additional contraceptive protection. CHC containing EE can be quick started by medically eligible women at any other time (with advice to use additional contraceptive precaution for 7 days) if: ► It is reasonably certain that the woman is not pregnant OR ► A high sensitivity urine pregnancy test is negative (even if there is a risk of pregnancy from unprotected sexual intercourse [UPSI] in the last 21 days). A follow up high sensitivity urine pregnancy test is required 21 days after the last UPSI.

Answer 23

Most evidence suggests no association between weight/body mass index (BMI) and effectiveness of combined oral contraceptives (COC). Limited evidence suggests a possible reduction in patch effectiveness in women ≥90 kg.

Answer 24

Women who have had bariatric surgery should be advised that the effectiveness of COC could be reduced.

Answer 25

Women taking lamotrigine should be advised that CHC may interact with lamotrigine; this could result in reduced seizure control or lamotrigine toxicity. The risks of using CHC could outweigh the benefits.

Answer 26

Additional contraceptive precautions are not required when antibiotics that do not induce enzymes are used in conjunction with CHCs.

Answer 27

Women should be advised to wait 5 days after taking ulipristal acetate for emergency contraception (UPA-EC) before starting CHC. Women should be made aware that they must use condoms reliably or abstain from sex during the 5 days waiting and then until their contraceptive method is effective.

Answer 28

ü Use of CHC for contraception may also be associated with non-contraceptive health benefits B Use of CHC can reduce heavy menstrual bleeding (HMB) and menstrual pain and improve acne. C Use of CHC may be beneficial for women with premenstrual syndrome (PMS) symptoms. A Use of CHC (particularly continuous CHC regimens) can reduce risk of recurrence of endometriosis after surgical management. B CHC can be used for management of acne, hirsutism and menstrual irregularities associated with polycystic ovary syndrome (PCOS). C CHC use is associated with a significant reduction in risk of endometrial and ovarian cancer that increases with duration of CHC use and persists for many years after stopping CHC. C Use of CHC is associated with a reduced risk of colorectal cancer.

Answer 29

VTE Breast cancer Cervical cancer C Women should be advised that current use of CHC is associated with a small increased risk of breast cancer which reduces with time after stopping CHC. Cervical cancer Clinical recommendation C Women should be advised that current use of CHC for more than 5 years is associated with a small increased risk of cervical cancer; risk reduces over time after stopping CHC and is no longer increased by about 10 years after stopping.

Answer 30

Women should be advised to stop CHC and to switch to an alternative contraceptive method at least 4 weeks prior to planned major surgery or expected period of limited mobility.

Answer 31

POP users taking enzyme-inducing drugs should be advised to switch to the progestogen-only injectable or intrauterine contraception. For short durations of enzyme-inducing treatment (<2 months) women can continue the POP providing they use additional precautions during treatment and for 28 days afterwards. Women wishing to start the POP after stopping enzyme-inducing drugs should be advised to use condoms until 28 days after the last dose of enzyme-inducing drug.

Answer 32

If a woman vomits within 2 hours of pill taking, another pill should be taken as soon as possible. If the subsequent pill is missed, additional precautions are required until 48 hours after pill taking has been resumed.

Answer 33

Evidence seems unlikely

Answer 34

55, or 50 with FSH testing

Answer 35

endometrial and ovarian seems to offer some protection. Small increased risk with breast/cervical cancer.

Answer 36

An injection of DMPA can be administered up to 7 days late (up to 14 weeks after the last injection) without the need for additional contraceptive precautions (outside the product licence for IM DMPA).

Answer 37

Women with unscheduled bleeding during use of a progestogen-only injectable contraceptive can be offered 500 mg mefenamic acid up to three times daily for 5 days.

Answer 38

Concomitant use of enzyme-inducing drugs may reduce the efficacy of the progestogen-only implant. Women should be advised to switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment.

Answer 39

Combined pill for 3 months off licence. outside of this studies are limited down to clinical judgement.

Answer 40

Women who do not wish to conceive should be offered EC after unprotected sexual intercourse (UPSI) that has taken place on any day of a natural menstrual cycle.  Women who do not wish to conceive should be offered EC after:  UPSI from Day 21 after childbirth (unless the criteria for lactational amenorrhoea are met).  UPSI from Day 5 after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease (GTD).  Women who do not wish to conceive should be offered EC after UPSI if their regular contraception has been compromised or has been used incorrectly

Answer 41

EC providers should advise women that the Cu-IUD is the most effective method of EC. EC providers should advise women that ulipristal acetate EC (UPA-EC) has been demonstrated to be effective for EC up to 120 hours after UPSI. EC providers should advise women that levonorgestrel EC (LNG-EC) is licensed for EC up to 72 hours after UPSI. The evidence suggests that LNG-EC is ineffective if taken more than 96 hours after UPSI.

Answer 42

EC providers can offer a woman UPA-EC or LNG-EC if she has had UPSI earlier in the same cycle as well as within the last 5 days, as evidence suggests that UPA-EC and LNG-EC do not disrupt an existing pregnancy and are not associated with fetal abnormality.

Answer 43

Pregnancy test - oral Emergency contraception likely to be ineffective. Quick start contraception.

Answer 44

Pregnancy cannot be excluded by an HSUP until ≥21 days after the last UPSI.

Answer 45

Combined hormonal contraception (CHC), progestogen-only pill (POP) and progestogen-only implant (IMP) can be quick started if they prefer not to delay starting contraception. Depot medroxyprogesterone acetate (DMPA) may be considered if other methods are not suitable or acceptable.  The levonorgestrel intrauterine system should not generally be quick started unless pregnancy can be reasonably excluded.  CHC containing cyproterone acetate should not be quick started unless pregnancy can be reasonably excluded.  A copper intrauterine device can be quick started only if the indications for use as EC are met.

Answer 46

After levonorgestrel EC (LNG-EC) administration, CHC, POP, IMP (and DMPA) can be quick started immediately. D After ulipristal acetate EC (UPA-EC) administration, they should wait 5 days before quick starting suitable hormonal contraception [CHC, POP, IMP (and DMPA)].

Answer 47

The guideline development group advises that women should be informed that contraceptive hormones are not thought to cause harm to the fetus and they should not be advised to terminate pregnancy on the grounds of exposure.

Answer 48

Healthcare practitioners can be reasonably certain that a woman is not currently pregnant if any one or more of the following criteria are met and there are no symptoms or signs of pregnancy: She has not had intercourse since the start of her last normal (natural) menstrual period, since childbirth, abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease. She has been correctly and consistently using a reliable method of contraception. (For the purposes of being reasonably certain that a woman is not currently pregnant, barrier methods of contraception can be considered reliable providing that they have been used consistently and correctly for every episode of intercourse.) She is within the first 5 days of the onset of a normal (natural) menstrual period. She is less than 21 days postpartum (non-breastfeeding women). She is fully breastfeeding, amenorrhoeic AND less than 6 months postpartum. She is within the first 5 days after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease. She has not had intercourse for >21 days AND has a negative high-sensitivity urinepregnancy test (able to detect hCG levels around 20 mIU/ml).

Answer 49

none (except zoely and qlaira)

Answer 50

*Day 1 is defined as the first day of natural menstrual bleeding; it does not apply to withdrawal or unscheduled bleeding in women already established on hormonal contraception.

Answer 51

Sexually active women of reproductive age with eating disorders require effective contraception despite the fact that amenorrhoea and anovulation are common in this population.

Answer 52

Amenorhea for 1 year

Answer 53

Women using sequential HRT should be advised not to rely on this for contraception. D Women may use a Mirena 52 mg LNG-IUS with estrogen for up to 5 years for endometrial protection as part of an HRT regimen. Women using Mirena for this purpose must have the device changed every 5 years.

Answer 54

Chlymidia/ghonorrhea pregnancy speculum IF greater than 3 months since starting cervical biopsy if greater than 45 u/s considered

Answer 55

Increase EE dose

Answer 56

while on depot

Answer 57

trial of coc

fsrh Flashcards

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