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A couple attend the clinic for contraceptive advice. The woman is currently using the LNG-IUS for contraception but it is due to be replaced and they are considering sterilisation as an alternative option. She has a body mass index of 42 kg/m2 and a history of heavy menstrual bleeding. Both partners are willing to be sterilised. What is the single most appropriate advice to offer this couple?
Due to her body mass index, she is not a candidate for sterilisation; therefore vasectomy is the best option.
Either partner could be sterilised but female sterilisation increases bleeding, therefore vasectomy is the best option.
Either partner could be sterilised but female sterilisation would be best as most women become amenorrhoeic.
Either partner could be sterilised but the LNG-IUS is also highly effective and would help with heavy menstrual bleeding.
Which of the following is true? UPA-EC may be less effective if a woman:
Has severe asthma managed with oral glucocorticoids.
Is taking truvada and raltegravir given for post-exposure HIV prophylaxis after sexual exposure (PEPSE).
Commences a hormonal contraceptive on the same day.
Takes UPA-EC between 0 and 72 hours after UPSI.
Contraindications to the insertion of a Cu-IUD for EC are the same as those for routine IUD insertion. Which of the following is a relative contraindication?
Between 48 hours and 28 days after childbirth
Risk of sexually transmitted infection
Previous ectopic pregnancy
Young age and nulliparity
How does emergency contraception (EC) work? Which of the following statements is false?
A. The primary mechanism of contraceptive action of the copper intrauterine device (Cu-IUD) is inhibition of fertilisation by its toxic effect on sperm and ova.
If fertilisation does occur, the local endometrial inflammatory reaction resulting from the presence of the Cu-IUD prevents implantation.
Given that the earliest implantation is believed to occur 6 days after ovulation, a Cu-IUD can be inserted up to 6 days after the first UPSI in a cycle.
The mechanism of contraceptive action of oral EC is to delay or inhibit ovulation for at least 5 days.
Regarding oral EC, which of the following is false?
Regular contraception should be started as soon as possible after EC because of the risk of pregnancy due to delayed ovulation in the same cycle.
Oral EC can be offered if there has been UPSI or oral EC has already been given earlier in the same cycle.
Use of LNG-EC rather than UPA-EC may be considered if the woman has taken any progestogen in the week prior to EC.
If LNG-EC is used, progestogen-containing drugs should not be restarted for 5 days afterwards.
A woman requesting EC is taking hepatic enzyme-inducing drugs. Which of the following statements is false:
single dose of 60 mg UPA-EC (double the licensed dose) can be used off-licence.
The effectiveness of UPA-EC and levonorgestrel EC (LNG-EC) could be reduced.
A Cu-IUD should be recommended if the criteria for use are met.
A single dose of 3 mg LNG (double the licensed dose) can be used off-licence.
The Cu-IUD is the most effective method of EC. A 2012 systemic review reported an overall pregnancy rate of:
During a woman’s fertile period, the pregnancy risk following a single episode of unprotected sexual intercourse (UPSI) has been estimated to be up to
Following vasectomy, the optimal time to undertake a post-vasectomy semen analysis is:
8 weeks post-procedure
12 weeks post-procedure
16 weeks post-procedure
24 weeks post-procedure
Which of these women cannot be offered the IUCD as a form of EC?
Women who have been sexually assaulted
None of the above
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