Non-LARC

Question 1

What are some forms of Non-LARC?

Answer 1

Combined hormonal contraception
Progesterone only pill
Depot Medroxyprogesterone acetate
Barrier contraception
Natural family planning
Sterilisation

Question 2

What are the 3 forms of combined hormonal contraceptive?

Answer 2

Combined oral contraceptive
Combined hormonal patch
Combined hormonal ring

Question 3

MOA of combined hormonal contraception

Answer 3

• Preventing ovulation(this is the primary mechanism of action)
• Progesterone thickens the cervical mucus
• Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
• Decreases tubal motility

Question 4

Perfect use failure rate of CHC

Answer 4

0.3%

Question 5

Typical use failure rate of CHC

Answer 5

8%

Question 6

Factors that affect effectiveness of CHC

Answer 6

• Impaired absorption (E.g. IBD)
• Increased metabolism (E.g. Liver enzyme induction)

Question 7

What examinations are required before prescribing CHC

Answer 7

• Record BP and BMI
• Check smear status if relevant
• Check UKMEC

Question 8

How should CHC be started?

Answer 8

Start on day 1 of menstrual period (Offers immediate protection)
Starting after day 5 of menstrual period, use 7 days of alternative contraception

Question 9

How to switch between different COCPs

Answer 9

Finish one pack then immediately start the new pill pack without the pill-free period

Question 10

How to switch from traditional POP to COC

Answer 10

Can switch any time but 7 days of alternative contraception is required

Question 11

How to switch from desogrestrel POP to COC

Answer 11

Can switch immediately with no alternative contraception required

Question 12

What are the 2 types of COC pill

Answer 12

Monophasic pills
Multiphasic pills

Question 13

What is monophasic COC

Answer 13

The whole pack contains the same amount of hormone in each pill

Question 14

What is multiphasic COC

Answer 14

The pills in the pack contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

Question 15

What are everyday formulations (E.g. Microgynon 30 ED)

Answer 15

Monophasic pills containing 7 inactive pills to make it easier to remember the pills

Question 16

What are some common forms of COC

Answer 16

• Microgynoncontains ethinylestradiol andlevonorgestrel
• Loestrincontains ethinylestradiol andnorethisterone
• Cilestcontains ethinylestradiol andnorgestimate
• Yasmincontains ethinylestradiol anddrospirenone
• Marveloncontains ethinylestradiol anddesogestrel

Question 17

What are the 2 options for starting COC

Answer 17

• Start in the 1st 5 days of period
• Start at any time in the cycle when not pregnancy with additional protection (E.g. condoms) for 7 days

Question 18

What are some CHC regimens

Answer 18

Either 21 days on, 7 days off

Extended use for 3 months, 7 days off

Use continuously until 4 days of breakthrough bleeding, then 4 days off

Question 19

Contraindications of COC (UKMEC 4)

Answer 19

• Uncontrolled hypertension (particularly ≥160 / ≥100)
• Migraine with aura (risk of stroke)
• History of VTE
• Aged over 35 and smoking more than 15 cigarettes per day
• Major surgery with prolonged immobility
• Vascular disease or stroke
• Ischaemic heart disease, cardiomyopathy or atrial fibrillation
• Liver cirrhosis and liver tumours
• Systemic lupus erythematosus (SLE) and antiphospholipid syndrome

Question 20

What BMI is UKMEC 3 for COC

Answer 20

> 35

Question 21

What are the main 3 risks of CHC

Answer 21

Venous thrombosis
Arterial disease
Cancer risk

Question 22

How does venous thrombosis with CHC use compare to that in pregnancy

Answer 22

Much lower in CHC use so benefit greatly outweighs risk

Question 23

Why is CHC contraindicated in migraine with aura?

Answer 23

There is an increased risk of ishcaemic stroke

Question 24

What cancer does CHC increase the risk of?

Answer 24

Breast cancer (Contraindicated in BRCA mutations)

Also small increase in cervical cancer risk

Question 25

How does stopping CHC affect breast cancer risk

Answer 25

Risk returns to normal after 10 years cessation

Question 26

Benefits of CHC

Answer 26

- 20% reduction in ovarian cancer risk for every 5 years of use up to 50% reduction after 15 years of use - 20-50% reduction in endometrial cancers - 12% reduction in all-cause mortality - CHC can be used to 40 years if no risk factors - Ethinyestradiol/Cyproterone acetate (Dianette) shows a high benefit in acne use - Rapid return of fertility after stopping - Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods) - Reduced risk of endometrial, ovarian and colon cancer - Reduced risk of benign ovarian cysts

Question 27

Side effects of CHC

Answer 27

- Nausea - Spots - Bleeding (Unscheduled) - Breast tenderness - Low mood

Question 28

Missed pill guidance for CHC

Answer 28

- Clarify how many have been taken correctly - It is usually ok to miss 1 pill anywhere in the packet, however, after this, there is the need to use condoms for 7 days

Question 29

What are some conditions that are classed as a "missed pill" day

Answer 29

Vomiting, diarrhoea and certain medications (e.g. rifampicin)

Question 30

When should CHC be stopped prior to operation

Answer 30

four weeks before a major operation (lasting more than 30 minutes) or any operation or procedure that requires the lower limb to be immobilised. This is to reduce the risk of thrombosis.

Question 31

MOA of traditional POPs

Answer 31

- Thickening the cervical mucus - Altering the endometrium and making it less accepting of implantation - Reducing ciliary action in the fallopian tubes

Question 32

What are the