NON-LARC

Question 1

What affects choice of contraception?

Answer 1

control

Question 2

What are combined hormonal contraceptions?

Answer 2

Mix of estrogen and progesterone

• pill
• patch
• vaginal ring

Question 3

Failure rate of CHC?

Answer 3

• 0.3% if perfectly used

- 9% with typical use

Question 4

How to take COC?

Answer 4

• start in first 5 day of the cycle
• or any time when SURELY not pregnant plus condom for 7 days
• take daily for 21 days+ 7 day break

Question 5

What is meant by break-through bleed?

Answer 5

• slight spotting that occurs with use of COC (NOT period)

- if bleeding goes on for more than 4 days; stop COC for 4 more days and then continue

Question 6

What affects the effectiveness of COC?

Answer 6

• impaired ABSORPTION (GI conditions)
• increased metabolism (liver enzyme induction or drug interaction)
• forgetting

Question 7

How may risk of VTE vary with COC drugs?

Answer 7

• varies according to EE dose and progestogen types

- —-3rd gen of Progestogens has a HIGHER risk of VTE

Question 8

WHat is the VTE risk in pregnant women?

Answer 8

21-30 per 10 000

Question 9

Post-natal VTE risk ?

Answer 9

130-140 in 10 000

Question 10

When is migraine dangerous with the pill?

Answer 10

• when you have an AURA (5-20 mins prior to headache)
• –USUALLY IN THE FORM of a SCOTOMA
• OR hemiparesis/smell/taste/altered sensation

Question 11

What is the danger of having the pill if you have migraines with aura?

Answer 11

• ischemic stroke

- so CHC is C/I in people with migraine with aura

Question 12

Another risk of using the pill?

Answer 12

• age > 35 YEARS

Question 13

What is an unwanted effect of pill?

Answer 13

• increased risk of breast cancer (1.24 risk)
• cervical cancer ( use of >5 years)
• —-do regular smear and condom use

Question 14

What examination is done prior to first CHC prescription?

Answer 14

• record BP and BMI before 1st prescrip.
• smear status
• multiple risk factors?

Question 15

Best acne protection by______.

Why?

Answer 15

Dianette (Cyproterone Acetate = anti-androgen, progestagen)

Question 16

WHat are the non-contraceptive benefits of CHC?

Answer 16

• PCOS (fewer functional ovarian cysts)
• menorrhagia
• —-though regular withdrawal bleeding
• reduced PMS
• acne rx
• protec. against ovarian cancer (50% reduct. after 15 years of use) and endometrial cancer

Question 17

Best avoid COC in _______

Answer 17

bleeding disorders.

Question 18

What is as effective as COC?

Answer 18

• Cerelle
  (progesterone only pill )
  —–ensure you take it every single day

Question 19

What is a s/e of the progesterone-only pill?

Answer 19

• irregular bleeding

Question 20

What is DEPOT PROVERA?

Answer 20

• depot injection every 3 months…LOWERS estradiol, supresses FSH
• causes AMENNORHOEA (esp. nice if people want this)

Question 21

What is Sayana Press?

Answer 21

• self-administration

- LOWERS estradiol, supresses FSH

Question 22

Advantage and disadvantage of hormonal Depots?

Answer 22

• not affected by enzyme inducing drugs

- (-VE): osteopenia

Question 23

The most effective contraception ?

Answer 23

• Sub-dermal implants

Question 24

When is a diaphragm indicated?

Answer 24

• mid-30s
• no regular partner
• on cancer treatment

Question 25

What should be remembered for diaphragm?

Answer 25

- leave it for 6 HRS after sex | - more spermicide needed after 3 hrs if you have more sex

Question 26

What techniques are involved in a vasectomy?

Answer 26

- local/general anaesthetic | - NO scalpel needed

Question 27

What are complications of the vasectomy?

Answer 27

- pain - infection - bleeding - anaesthetic

Question 28

How is female sterlization done?

Answer 28

- clips over the fallopian tubes; bands; essure | - done LAPROSCOPICALLY

Question 29

What does natural planning involve?

Answer 29

- app where you insert personal information about various things to obtain fertile window

Question 30

Risks of CHC?

Answer 30

1. Venous Thrombosis 2. Arterial thrombosis 3. Adverse effects on some cancers !

Question 31

Is there a particular s.e with the use of COC on blood pressure?

Answer 31

- systemic hypertension! - ---COC use shows a SMALL increase in BP in some (so check initially at 3 months, then annually) - -->140/90

Question 32

What are some arterial pathologies that may arise from CHC use?

Answer 32

- small INCREASED risk of MI in COC users (esp. smokers) - increased risk of ISCHEMIC stroke in COC users - ----Hypertensive COC users are at a higher risk of MI and stroke then hypertensive non-COC users

Question 33

How "protective" is CHC against ovarian cancers?

Answer 33

- 5 years of use: 20% reduction in ovarian cancer | - 15 years of use: 50% reduction

Question 34

How protective is CHC against endometrial cancer?

Answer 34

- 20-50% reduction

Question 35

What are side effects of COC?

Answer 35

- nausea - spots - bleeding - breast tenderness

Question 36

How to start PO- methods (pill, patch or DMPA)?

Answer 36

- day 1-5 of period OR - anytime if certain youre not preggers + 7 days of condoms (2 for POP)