O&G Written - Contraception

Question 1

Emergency contraception - options

Answer 1

Levonorgestrel (Levonelle)

Ulipristal acetate (EllaOne)

Copper IUD

Question 2

Logistics of Levonorgestrel (Levonelle)

Answer 2

Within 72 hours of UPSI
1.5mg - double dose if BMI >26 or weight >70kg
Repeat if vomiting within 2 hours.

Can be used more than once in same cycle.
Hormonal contraception can be started ASAP.

Question 3

Logistics of Ulipristal Acetate (EllaOne)

Answer 3

Within 120 Hours of UPSI
30mg
CAUTION: severe asthma (using steroids)
Repeat dose if vomiting within 3 hours.

Previously not used more than once in same cycle but now can.
Wait 5 days (using barrier methods) before (re)starting any hormonal contraception.

Question 4

Copper IUD as emergency contraceptive

Answer 4

Most effective

+ also give Abx if high risk STI

Question 5

MOA contraceptive methods

Answer 5

COCP = inhibit ovulation
POP = thicken cervical mucus (desogestrel inhibits ovulation)
Injectable progesterone = inhibit ovulation
Implant progesterone = inhibit ovulation

IUS = inhibit endometrial proliferation

IUD = spermicidal + thins endometrium/prevents implantation?

Question 6

Absolute contradictions to COCP

Answer 6

<6 weeks Postpartum + breastfeeding
Migraine with aura
Major surgery with prolonged immobility
>35yo smoking >15 a day
Current breast ca.

VTE, TIA, stroke.
Thrombogenic mutation - Factor V Leiden, protein C deficiency, antiphospholipid Ab
Ischaemic or valvular heart disease
Severe cirrhosis, liver tumout
Uncontrolled HTN (>160/110)
Complicated diabetes

Question 7

Rules for missed COCP

Answer 7

1 missed pill -> take last pill ASAP + current pill when scheduled

2 missed pills –> take last pill ASAP + current pill when sheduled + condoms for 7 days

• during week 1 = consider emergency contraception
• during week 2 = nothing extra
• during week 3 = skip pill-free interval

Question 8

Rules for COCP with surgery

Answer 8

Stop 4 weeks before

Restart 2 weeks after (switch to POP)

Question 9

Rules for switching between POP/COP

Answer 9

From POP –> COCP - 7 days barrier needed

From COCP –> POP - immediate protection if started directly after end of COCP (day 21)

Question 10

Rules for missed POP

Answer 10

Traditional POP
< 3 hours = nothing
3+ hours = take missed pill ASAP + continue with pack + extra protection for 48 hours
2 missed pills = as above + emergency contraception if UPSI

Desogestrel
Same but 12 hours

Question 11

Hormonal contraception safe when taking enzyme inducers e.g. rifampicin?

Answer 11

Depot injection

Question 12

Post-partum contraceptive options

Answer 12

POP - anytime, if started after day 21 use additional measured for 48 hours

Progesterone implant - anytime

COCP - NOT in first 21 days, NOT in first 6 weeks if breastfeeding, from 6 weeks - 6 months UKMEC2

IUD/IUS - within 48 hours or after 4 weeks

Question 13

Criteria for lactational amenorrhoea method to work properly

Answer 13

Exclusively breastfeeding - no top up formula feeds
Amenorrheic
<6 months post-partum

Question 14

Risks of getting pregnant too soon after delivery

Answer 14

Pregnancy interval <12 months increases risk of:

• pre term birth
• LBW
• SGA baby

Question 15

Contraception for Transgender females

Answer 15

Hysterectomy and/or bilateral oophorectomy = no risk of pregnancy

Testosterone therapy NOT protective + is a teratogen

Progesterone only = ok with testosterone therapy

• POP
• Implant
• Depot injection
• IUS

Copper IUD also ok with testosterone but may be unacceptable due to heavy bleeding

Question 16

Emergency contraception in transgender female

Answer 16

All 3 methods are fine with testosterone therapy

BUT Copper IUD may be unacceptable due to heavy bleeding

Question 17

Contraception for Transgender male

Answer 17

Bilateral orchiectomy = no risk

Hormonal Tx may reduce sperm production but not reliable so Condoms recommended!