Sex Hormones And Contraception And HRT

Question 1

Mentstual cycle

Answer 1

FSH secreted by pituitary recruits follicle and mature eff to graph Ian follicle this secretes oestrogen making endometrium thick to receive egg , ovulation, peak of fsh ans lh, grpahian rupture and release of egg and corpus luteum , now entering Luteal phase maintains healthy thick endometrium able to receive blastocyst .
If not fertilised drop in progesterone causes endometrial lining to be shed

Question 2

Contraception is broken into 4 groups
What are the hormonal oral group

Answer 2

COCP
POP

Question 3

Long acting reversible cotraceptives LARC

Answer 3

Implant
Injection
IUS
IUD

Question 4

Barrier methods are obvs and are condom and ring and diaphragm what are natural

Answer 4

Rhythm methods and withdrawal

Question 5

COCP suppress the sec reaction of LH and FSH and ovulation. Thickens the cervical mucous and thins the endometrium
It is taken for 21 days then break for 7
Pros and cons

Answer 5

Effective in treating menorrhagia nand may reduce PID good for acne and PMS too
Reduce hormonal related pathology , cystic breast disease, ovarian cysts, endometrial and ovarian cancer

Cons
Increased risk of VTE , MI and stroke with migraine aura
Breast cancer risk
Not for overweight, hypertensive, post natal older women

Question 6

Progesterone only pill taken every day without break and thickens cervical mucous and thins the endometrium and may inhibit obvulation pros and cons

Suitable for breastfeeding

Answer 6

Avoids the cardiovascular and VTE risks of oestrogen and COCP improve menstueal problems
Cons is must be taken in 3hr window, irregular bleeding, headaches breast tenderness and acne

Question 7

Implant is progesterone only sub-dermal implant inserted for 3 years on upper arm and inhibits ovulation and thickens the cervical mucous and thins the endometrium
Pros and cons

Answer 7

Lasts 3 yrs and reversible fertility , suitable for breast feeding women and reduce menstueal problems
Cons is cause irregular bleeding in first year, acne breast tender and mood changes and headaches and surgical insertion

Question 8

Injection is progesterone only depot injection last 12 weeks inhabiting ovulation thickening cervical mucous and thins endometrium
Pros and cons

Answer 8

Suitable for breast feeding and can cause amenorrhea
Cons is delay in return of fertility for up to year
Loss of bone density and menstrual irregular
Weight gain

Question 9

IUS are t shaped devices which release levonorgestrel (progesterone) over 5 years also called the miruna coil it causes endometrial atrophy and cervical mucus thickening

Answer 9

Reduces chances of menorrhgaia and dysmenorrhea
Good for heavy periods and no weight gain
Cons is unpleasant insertion, risk of PID, ectopic preg , expulsion and uterine per formation

Question 10

IUD is a t shaped coppemdevice lasting 10 years

Answer 10

Free from hormonal side effects and effective immediately after fitting
It’s unpleasant to insert, risk of PID, spotting and heavy bleeding, increased blood loss and painful periods reported, pelvic pain and ectopicmprrg

Question 11

Natural rhythm methods calendar and apps and temperature

Answer 11

Perfect use not much failure and good for religious beliefs
25% failure rate
Abstinence in fertile window
Irregular cycles

Question 12

What is the menopause

Answer 12

12 months of spontaneous amenorrhea

Question 13

Early menopause

Answer 13

Under 45

Question 14

Premature menopause

Answer 14

Under 40

Question 15

Why does the menopause occur

Answer 15

Due to depletion of ovarian follicles causing a drop in oestrogen and progesterone with a resulting spike in FSH and LH SX include menstueal irregularity etc

Question 16

Sx of menopause

Answer 16

Menstrual irregularity
Casokotor such as sweats and flushes
GI symptoms
Sleep disturbances
Mood changes
Loss of sex drive

Question 17

Types of HRT

Answer 17

Oestrogen only - only use in women without a uterus , hysterectomy to risk of endometrial cancer

combined HRT

Question 18

Combined HRT two types

Answer 18

Cyclical periods under 12 months ago
Continuous - amenorrhoeic
Form of tablets, patches gels and topical vaginal gels

Question 19

Even is asymptomatic for early menopause

Answer 19

For cardiovascular and osteoporotic protection

Question 20

HRT benefits

Answer 20

Release of Sx
Reduction in osteoporosis
Reduce cardiovascular risk
Reduce risk of colorectal cancer

Question 21

HRT cons

Answer 21

Increased VTE - oral forms
Breast cancer risk 20 per 1000 over 10yr
Endometrial cancer increase with only oestrogen forms progesterone protects against it

Question 22

HRT considerations for prescribing

Answer 22

Lowest dose for shortest time to control sx gradullay withdraw
Oestrogen only ever prescribed for women without uterus
Consider risks
HRT is not a form of contraception

Question 23

side effect of IUD

Answer 23

heavier and longer peierods

Question 24

side effects of progesterone only pill and injection

1/3 rule

Answer 24

3rd stop having periods, 3rd continue and 1/3 experience irregular bleeding in the form of irregular bleeds, light bleeding between periods to through the cycle called spotting

Question 25

A 22 year old dancer attends the sexual health clinic to discuss contraception. She is unhappy on her current contraceptive, the Nexplanon implant, as it has made her periods erratic. She also experiences spotting throughout her cycle. The irregular bleeding interferes with her work and she requests a method that will bring back regularity of her periods as soon as possible. Her past medical history includes acne, for which she uses topical Benzoyl peroxide. There is no relevant family history. She is a non-smoker and has a normal blood pressure. Which of the following is the most suitable option to offer?

Answer 25

COCP main concern is irregularity improves regualarity of cycles

Question 26

contraindication to COCP

Answer 26

less than 6 weeks postpartum breastfeeding less than 3 week postpartum with other factors like VTE cardiac function imparidee AF current breast cancer high blood pressure earn vascular disease migraine with aura

Question 27

what guidelines people under 16 years old can be prescribed contraceptives so Lon as they - demonstatre understanding - they cannot be persuaded to discuss with parents likely to have sex anyway with or without conception their physical and or mental health may suffer without it it is in their best interests

Answer 27

Fraser guiltiness

Question 28

rules for starting the pill if the patient starts the pull on the first day of her period she will be protected .....

Answer 28

immediately

Question 29

if the patient stats any time in her cycle when will the COCP become affective

Answer 29

7 dyas

Question 30

if a mother is not breastfeeding when can she begin to take the pill

Answer 30

21 days after birth

Question 31

if someone has breast cancer what is the only form of contraception they can have

Answer 31

IUD - copper coil this is a non-hormonal method so condoms could also work too

Question 32

the combined oral contraceptive pill protects against what cancer and increases what others

Answer 32

reduces risk of ovarian , endometrial and colorectal cancer and increases the risk of breast and cervical

Question 33

is the IUD suitable for someone with a current infection or someone with STI

Answer 33

no

Question 34

infertility can be causes by Cushing if this is suspected what test would you do

Answer 34

dexamethasone supresion test

Question 35

Which of the following is an advantage of HRT given through a skin patch compared to HRT given in the form of tablets?

Answer 35

reduced risk of VTE

Question 36

two types of HRT regimes

Answer 36

Combined HRT can be given either: Cyclically: for perimenopausal women who are still having menstrual periods Continuous: for postmenopausal women who are not having menstrual periods

Question 37

three risks of HRT

Answer 37

Increased risk of breast cancer Increased risk of endometrial cancer if oestrogen given alone Increased risk of venous thromboembolism

Question 38

missed pill procedure what happens if vomit in week 1 week 2 week 3

Answer 38

If vomiting within 2 hours of taking a pill, another one should be taken as soon as possible. The pill free week is the 7 days between taking packets of pills. There is occasionally a breakthrough bleed, a small bleed similar to a period, however the absence of a breakthrough bleed does not indicate pregnancy. Missed pill rules: If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week If pills are missed in week 2: no need for emergency contraception If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.

Question 39

explain monophonic regime phasic regime what happens if you start oil on first day of cycle - how long till protected what happens if you start any other day in cycle - how long protected new mothers can begin to take the pill 21 day after giving brith - providing not breastfeeding

Answer 39

Types of oral contraceptive pill instructions Guidance relating to taking the pill is dependent on the regimen that has been prescribed: Monophasic 21 day pills require 21 days of administration, followed by 7 days off Phasic 21 day pils require all 21 pills to be taken in the correct order Everyday pills require one pill to be taken each day. The packets include 21 active pills and 7 inactive pills Rules for starting the pill There is specific advice to give patients regarding starting taking the pill: If the patient starts her pill on the first day of her period (up to 5 days), she will be protected from pregnancy immediately If the patient starts at any other time in her cycle, she will need to use condoms for 7 days. New mothers can begin to take the pill 21 days after giving birth, providing they are not breastfeeding.

Question 40

woman is going for surgery and is on COCP what should she do

Answer 40

stop 4 weeks prior, start another form of contraception and then restart pill 2 weeks after as they both contribute to VTE

Question 41

advantages and disadvantages UKMEC of COCP

Answer 41

Absolute Contraindications to Contraception (UKMEC 4) Known or suspected pregnancy, smoker over the age of 35 who smokes >15 cigarettes, obesity, breast feeding <6 weeks post partum, Fx of thrombosis before 45 years old, breast cancer or cancer within last few years, BRCA genes Disadvantages of a contraceptive outweigh the advantages (UKMEC 3) Breast feeding >6weeks post partum, Previous arterial or venous clots, continued use after heart disease or stroke, migraines with aura, active disease of liver or gallbladder Advantages of a contraceptive outweigh the disadvantages (UKMEC 2) Initiation after current or past history of MI or stroke, multiple risk factors for arterial cardiovascular disease

Question 42

A 25 year old lady attends the walk-in sexual health clinic after forgetting to take her Progesterone only pill yesterday. She usually takes Cerazette (desogesterel) once a day. Her last pill was due 15 hours ago. She has not had any unprotected sexual intercourse this month. What is the most appropriate advice to give?

Answer 42

considered late over 12 hours ( microns late after 3 Horus) so take the missed pill continue the pack as usual and jus use condoms for the next 2 days

Question 43

Missed pill rules in week 1,2,3

Answer 43

Week one emergency in pill freee interval week No need in 2 In 3 take missed pills and finish pack and start next pill imemediatly

Question 44

most effective form of contraception

Answer 44

IUD

Question 45

cystocele present with anterior bulge and stress incotnicne what about rectocele and enterocele

Answer 45

uterine prolapse - abnromal cervix vaginal vault prolapse post hysterectomy rectocele - A rectocele is the prolapse of the rectum into the vagina. Instead, this would typically present with a posterior wall bulge and difficulty with defecation, tenesmus or sensation of pressure in the rectum An enterocele is the prolapse of the small bowel into the vagina. It would typically present with a posterior vaginal wall bulge and lower back pain

Question 46

if group b strep found what do you give to mother

Answer 46

given IV abx for pregnancy and labour to prevent transmission

Question 47

if group b strep found what do you give to mother

Answer 47

given IV abx for pregnancy and labour to prevent transmission

Question 48

A 33-year-old lady presents to the gynaecology clinic with dysmenorrhoea and menorrhagia. On questioning, she also reports dyspareunia and an inability to conceive for the last 3 years. A transvaginal ultrasound scan is normal and she, therefore, undergoes a diagnostic laparoscopy that reveals endometriosis. Which of the following treatment options would be most appropriate?

Answer 48

Laparoscopic diathermy and adhesiolysis This patient has infertility that is likely secondary to endometriosis. The only treatment option that has been shown to improve fertility in endometriosis is surgery. Laparoscopic diathermy and adhesiolysis is a procedure that removes the endometrial deposits and adhesions from the pelvic cavity

Question 49

fribroids tx

Answer 49

LNG IUS - not if LNG-IUS is often the 1st-line treatment; however in this case where the patient has several large pedunculated submucosal fibroids there will be uterine distortion making the insertion of an intrauterine system inappropriate COCP - This would be a 2nd-line treatment option. However, its use holds an unacceptable health risk (UK Medical Eligibility Criteria for Contraceptive Use category 4) as this lady is aged over 35 and smokes more than 15 cigarettes a day. Tranexamic acid or NSAIDs are other 2nd-line options, but are not choices here Oral norethisterone This is the correct answer. It is a 3rd line option when the above treatments are deemed unsuitable, such as in this case surgical Myomectomy involves removing the fibroid from the uterine wall, and is generally fertility-sparing. Ablation involves using a laser or radiofrequency(generates heat) to induce necrosis of the fibroid, and so the dead vessels no longer bleed. Uterine artery embolisation may provide a targeted degeneration of the fibroid. This may also preserve fertility. Hysterectomy involves removing the uterus. It is obviously extremely effective but will not preserve fertility.

Question 50

when not to do TVUS

Answer 50

if they havent had sex or are young