LARC Contraception

Question 1

How many babies are born every 2 seconds on the planet?

Answer 1

9

Question 2

How many people die every 2 seconds on the planet?

Answer 2

3

Question 3

What are the ideal features of a perfect contraception?

Answer 3

Effective
Availability
Easy to use
Safe, free from side effects
Cheap
Reversible
Not memory reliant

Question 4

What is the most common method of contraception?

Answer 4

Withdrawl

Question 5

What 5 things are part of natural family planning?

Answer 5

Basal body temperature
Cervical mucous
Cervical position
"Standard" days
Breast feeding

Question 6

Describe the cervical mucous post ovulation

Answer 6

Thick and sticky

Question 7

Describe how the cervical mucous is during ovulation

Answer 7

Thinner, watery and stretchy

Question 8

What is the cervical position when fertile?

Answer 8

High in the vagina, soft and open

Question 9

What is the cervical position when less fertile?

Answer 9

Low in vagina, firm and closed

Question 10

What days in the cycle are the most fertile?

Answer 10

In a 28 day cycle… day 8-18

Question 11

What is the criteria of breast feeding as a contraception?

Answer 11

Exclusively breast feeding
Less than 6/12 post natal
Amenorrhoeic

Question 12

How effective is breast feeding as a contraception?

Answer 12

98%

Question 13

What do you use to assess the patient before prescribing contraception?

Answer 13

UKMEC 2016 - UK Medical Eligibility Criteria

Question 14

What are the 4 categories of the UKMEC?

Answer 14

1. No restriction for use of contraception method
2. Where advantages outweigh negatives
3. A condition where use gives more disadvantage
4. A condition that presents as an unacceptable risk if contraception used

Question 15

What drugs can be used as the contraceptive pill?

Answer 15

Medroxyprogesterone acetate
(Depo Provera)
Sayana

Question 16

How does the contraceptive pill work?

Answer 16

Inhibits ovulation
Given every 13 weeks
Will last 14 days
Thickens cervical mucous
Effects the endometirum

Question 17

What examinations are done prior to contraception prescribing?

Answer 17

Record BP and BMI
Check smear test status
Consider osteoporosis risk factors

Question 18

When do you start Depo?

Answer 18

Up to and including day 5 of the cycle without need for additional contraception

Question 19

What points are important to remember?

Answer 19

Conception most likely if UPSI on day ovulation OR preceding 24hrs
Fertile period is highly variable

Question 20

What happens when Depo is started beyond day 5?

Answer 20

Needs to use condoms or abstain for 7 days

Question 21

What criteria is taken into account when deciding if the person is really ‘reasonably certain’?

Answer 21

No sex since last period
Consistently using reliable contraception
<7 days since last normal period
< 4 wks post partum (not breast feeding)
Fully breastfeeding, amenorrhoeic and <6m post partum
Negative pregnancy test and >3 wks since UPSI

Question 22

What do you do if pregnancy can’t be excluded?

Answer 22

Pregnancy test after 3 weeks and give depo thereafter

Question 23

What are side effects of depo?

Answer 23

Weight gain
Delay in return to fertility
Irregular bleeding
Osteoporosis risk

Question 24

Is VLARC good?

Answer 24

Most cost effective

Question 25

Describe the LARC - IUD?

Answer 25

T-shaped Non-hormonal Contain copper and plastic but can contain silver

Question 26

What is the gold standard of a copper coil?

Answer 26

380mm2 copper

Question 27

How does the coil work?

Answer 27

Prevents fertilisation | Inflammatory response in endometrium

Question 28

What is IUS?

Answer 28

T shaped device with elastomere core 52mg LNG-IUS ALso, 13.5mg

Question 29

What drug is present with IUS?

Answer 29

Levanorgestrel

Question 30

How does IUS work?

Answer 30

Effects implantation Endometrium rendered unfavourable for implantation Also effects cervical mucous and pre-fertilisation

Question 31

What are the contraindications of the IUD and IUS?

Answer 31

``` Current pelvic infection Abnormal uterine anatomy Pregnancy Sensitivity to any of constituents Gestational trophoblastic disease when b-HCG levels are high/abnormal Endometrial/cervical cancer ```

Question 32

What examinations are performed?

Answer 32

PV to check uterine size and position | BP and pulse

Question 33

When can an IUD be fitted?

Answer 33

Within first 7 days of period Up to 5 days after UPSI for emergency contraception Up to 5 days after predicted ovulation date

Question 34

When can an IUS be fitted?

Answer 34

Within first 7 days of a period | Not used for emergency contraception

Question 35

What are side effects of IUD?

Answer 35

``` Heavy, prolonged menses Pain/infection PD within first 20 days Perforation Expulsion Higher post 2nd trimester abortion, post natal Ectopic risk ```

Question 36

What are side effects of IUS?

Answer 36

``` Lighter, less frequent bleeding Pain/infection in first 20 days Perforation Expulsion Ectopic risk Failure ```

Question 37

What is the implant?

Answer 37

Single, non biodegradable | Subdermal rod

Question 38

What does the implant contain?

Answer 38

68mg ENG releases 60/70ug per day in weeks 5-6 25-30ug per day at end of 3rd year use

Question 39

How does the implant work?

Answer 39

Inhibition of ovulation | Effects endometrium and cervical mucous

Question 40

When can the implant be fitted?

Answer 40

Within first 5 days Up to day 5 post 1st/2nd trimester abortion On or before day 21 post partum

Question 41

What are side effects of the implant?

Answer 41

``` Irregular bleeding Weight gain Acne Nerve damage/vascular injury Deep insertion ```

Question 42

What are health concerns regarding the implant?

Answer 42

``` No know risk on: Bone mineral density CV risk VTE risk MI risk ```

Question 43

What drug interactions may the implant have?

Answer 43

Enzyme inducers | !Always check BNF!