Sexual Health

Question 1

What does the UKMEC stand for?
what are the levels?

Answer 1

UK Medical eligibility criteria
1-4

Question 2

What do the UKMEC levels 1-4 stand for?

Answer 2

1 - unrestricted use
2 - benefits outweigh risk
3 - risk outweigh benefits
4 - unacceptable risk - complete CI

Question 3

what are 4 categories of contraception?

Answer 3

Natural/conservative
short acting
longer acting
sterilisation

Question 4

what are natural/conservative contraceptions and % effective?

Answer 4

Family planning
condom use
75-82% effective

Question 5

What are some shorter acting contraceptions and their theoretic and actual % effectiveness?

Answer 5

COCP
POP
HRT Patch
99% theoretic
98% actual

Question 6

What are some longer acting contraceptions and their actual % effectiveness?
depot effectiveness %?

Answer 6

DEPOT provera
Nexoplanon implant
IUS
IUD
99% Actual
Depot = 94%

Question 7

Sterilisation contraception techniques?
% effectiveness?

Answer 7

vasectomy
tubal ligation

Question 8

is a vasectomy reversible or not?
why is not done by NHS?

Answer 8

reversible possible but not NHS done
High complication risk:
Unsuccessful
Bladder Sx
Malignancy
Infection

Question 9

When do all contraceptions become effective and how quickly?

Answer 9

day 1-5 of cycle = IMMEDIATE

Question 10

Which other contraceptions become effective immediately outside the day 1-5 mark?

Answer 10

IUD

Question 11

Which contraceptions become effective after a few days and how many exactly?

Answer 11

POP
After 2 days

Question 12

Which contraceptions become effective after 7 days and what extra precautions are taken?

Answer 12

COCP, Depot, Implant, IUS
7 days and extra barrier (condom)

Question 13

When can the COCP be taken postpartum?

Answer 13

don’t give COCP til >6 weeks PP

Question 14

When can the IUS/IUD be taken Postpartum?

Answer 14

<48 hours or after 4 weeks PP

Question 15

what factors fall into UKMEC 3 for COCP?

Answer 15

Immobile/wheelchair use
BMI >35
BRCA 1 or 2

Question 16

what factors fall into UKMEC 4 for COCP?

Answer 16

Migraine + aura
past Hx VTE
>35y and >15 cigs/day
liver tumours
aPL or SLE
Breast Ca

Question 17

Which hormones are used in contraceptions and are they high or low?

Answer 17

High oestrogen
High progesterone

Question 18

How is high oestrogen used for contraception?

Answer 18

high oestrogen = with progesterone , suppresses HPG axis therefore no LH surge, no follicular development

Question 19

How is high progesterone used for contraception?

Answer 19

High progesterone = maintains endometrium, thickens cervical mucus, decreased cilia flow

Question 20

What is the first line for emergency. contraception?
how many hours/days can it be done within?

Answer 20

IUD (copper coil)
within 120 hours / 5 days

Question 21

What is the 2nd line for emergency. contraception and dosage?
how many hours/days can it be done within?

Answer 21

EllaOne (Ulipristal acetate) 30mg
<120 hours / 5 days
Decreased effectiveness with time

Question 22

What is the 3rd line for emergency. contraception and dosage?
how many hours/days can it be done within?

Answer 22

Levonorgestrel 1.5mg
<72hrs / 3 days

Question 23

COCP
What does it contain?
Brand name?
Mechanism?

Answer 23

High oestrogen and prog
Microgynon
Prevents ovulation. + thickens cervical mucosa (prog) + inhibits endometrial proliferation - reduces chance of implantation

Question 24

COCP
How often do you take it?
what happens if you miss 1 pill or 2 pills?
For 2 pills, what do you do on week 1, 2 or 3?

Answer 24

Take everyday
Missed Pill:
1 = take 2
2 = Depends on week
Week 1 = emergency contraception
Week 2 = Nothing
Week 3 = Omit pill free period and use condoms for 7 days (until 7 consecutive pills taken)

Question 25

What are the Benefits/Pros and Cons/Risks of the COCP?

Answer 25

Pros: -Very effective -Decreased risk of non screened cancers (endometrial and ovarian) -Immediate fertility returned Cons: - Missed pills -Increased risk of screened cancers (breast and cervical) - VTE risk (not in patch)

Question 26

What medication decreases the efficacy of COCP and why?

Answer 26

CYP450 Inducer Carbamazepine

Question 27

What happens when you stop COCP? What happens in extended COCP use without pill free period?

Answer 27

Stopping COCP = lining of uterus sheds = withdrawal bleed Extended COCP use without pill free period = breakthrough bleed

Question 28

what is regularly checked for a patient on COCP and why?

Answer 28

Check BP as it can cause hypertension

Question 29

POP What does it contain? 2 Examples of POP and how often they are taken? Mechanism?

Answer 29

High Progesterone Levonorgestrel (3 hour window) Desogestrel (12 hour window) Take at same time everyday without pill free period Mechanism = thickens cervical mucosa

Question 30

What are the Benefits/Pros and Cons/Risks of the POP?

Answer 30

Pros: - Very effective, good were COCP in CI - Breastfeeding friendly Cons: - small window therefore missed pills - spotting

Question 31

What is UKMEC 4 in POP?

Answer 31

Breast Ca

Question 32

What medication is not good to use with POP and why?

Answer 32

CYP450 inducer Rifampicin Increases POP Metabolism (Increased preg chance) Other Abx = fine with POP

Question 33

POP What to do if you miss a pill? intercourse since missing pill?

Answer 33

Missed = take missed pill Intercourse after missing pill = emergency contraception

Question 34

What does POP increase the risk of?

Answer 34

Depression

Question 35

What is the depot, how is it administered? How often?

Answer 35

Depot provera 12 week IM Injection

Question 36

What medication is the depot? mechanism?

Answer 36

Medroxy progesterone acetate Inhibits ovulation (+ thickens cervical mucosa + endometrial thinning)

Question 37

What can Depot cause so why is it not first line in which group of people?

Answer 37

causes low BMD therefore not first Line in teenagers + young women

Question 38

What are some SE of depot?

Answer 38

Irregular bleeding, weight gain, high risk osteoporosis

Question 39

What is UKMEC 4 for depot?

Answer 39

breast Ca

Question 40

What are the Pros and Cons of depot?

Answer 40

Pros: -Long lasting -Good where COCP is CI -Won't forget to take it Cons: -Weight gain -mood change -low BMD therefore bad In older Px (>50) -Delayed fertility return (<12 months)

Question 41

What does the implant contain? What is the implant medication and what mg, ages its taken and how often is it changed?

Answer 41

Nexplanon Progesterone only 68mg Etonogestrel (18-40 y/o) every 3 years

Question 42

what is the mechanism of the implant?

Answer 42

Small flexible rod placed in upper arm beneath skin - inhibits ovulation and thickens cervical mucosa and makes endometrium less susceptible to implantation

Question 43

What is UKMEC 4 for the implant?

Answer 43

Breast ca + pregnancy

Question 44

if the implant is inserted day 1-8, is protection needed and when is protection needed?

Answer 44

Day 1-8 = immediate protection otherwise, 7 day additional protection

Question 45

When is the implant insertable straight away?

Answer 45

as soon as post partum

Question 46

What are the pros and cons of the implant?

Answer 46

Pros: -Long lasting -effective -breast feeding friendly Cons: -Mood changes -Spotting

Question 47

What is the IUS? How often is it changed? Effective after how long?

Answer 47

-Minera coil -every 5 years -every 4 years if on oestrogen only HRT -Effective after 7 days

Question 48

Mechanism of IUS?

Answer 48

Inhibiting endometrial proliferation = cervical mucus thickening = difficult for sperm to reach egg

Question 49

what is UKMEC 4 for IUS?

Answer 49

PID, Endometrial Ca, Unexplained uterine bleeding, breast Ca, pregnancy

Question 50

Pros and cons of the IUS?

Answer 50

Pros: -Long lasting -effective -breast feeding friendly -Good Tx for menorrhagia -can be used as HRT for 4 years Cons: -spotting -can move -ectopic preg risk

Question 51

What is an IUD made of? How long does it work for?

Answer 51

Copper coil 5-10 years

Question 52

What is the mechanism of the copper coil?

Answer 52

copper = spermicidal targets sperm Golgi apparatus, decreases sperm motility and survival

Question 53

What is UKMEC 4 for IUD?

Answer 53

PID, endometrial Ca, unexplained uterine bleed, Wilsons, pregnancy

Question 54

How fast does IUD provide protection?

Answer 54

Immediate protection

Question 55

What are the pros and cons of IUD?

Answer 55

Pros: -Long lasting -Very effective (good for emergencies) -good in breast ca Cons: -Menorrhagia -Can move -ectopic preg risk

Question 56

Contraception is not required for how long after birth?

Answer 56

first 21 days (3 weeks) after birth

Question 57

Contraception is needed for how long in 50+y and <50y?

Answer 57

12+ months since last period for 50+y 24+ months last period for <50