TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Contraception Goto page 1, 2  Next          TEALE FENNING Forum Index -> MRCOG Part 2: EMQs - Extended Matching Questions View previous topic :: View next topic   Author Message Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Tue Feb 20, 2007 3:23 pm    Post subject: Contraception The most appropriate contraception; A Male condom B 30 mcg COCP C Mirena IUS D Cyclical progestogens E Diaphragm with spermicides F Laparoscopic sterilisation G Progestogen only pill H T-Safe Cu380A I Ovulation detection kit J COCP with male condom K Depot provera L Norplant M Yasmin N Implanon O Vasectomy P 35mcg COCP Q Essure R GyneFix S Multiload Cu375 T 3rd generation COCP U Noristerat V Cerazette W Evra X Female condom Y Z 1. An 18 year old in a reular relationship. Fit & well. Using condoms but worried about pregnancy. 2. A 36 year old para 2 with a BMI of 34, severe PMS and a completed family. 3. A 38 year old multip with heavy periods. 4. A 26 year old nullip with heavy painful periods who wants a family next year. 5. A 21 year old epileptic with a new partner. Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Feb 20, 2007 6:12 pm    Post subject: Re: Contraception Abik wrote: The most appropriate contraception; 1. An 18 year old in a reular relationship. Fit & well. Using condoms but worried about pregnancy. B COCP _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Feb 20, 2007 6:14 pm    Post subject: Quote: 2. A 36 year old para 2 with a BMI of 34, severe PMS and a completed family. C Mirena IUS _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Feb 20, 2007 6:15 pm    Post subject: Quote: 3. A 38 year old multip with heavy periods. C Mirena IUS _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Feb 20, 2007 6:17 pm    Post subject: Quote: 4. A 26 year old nullip with heavy painful periods who wants a family next year. B COCP _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Feb 20, 2007 6:20 pm    Post subject: Quote: 5. A 21 year old epileptic with a new partner. J COCP plus condoms _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Tue Feb 20, 2007 7:42 pm    Post subject: That's a great set Abi! And quite tricky (for me at least..) 1. An 18 year old in a reular relationship. Fit & well. Using condoms but worried about pregnancy. I think the COCP would be ideal for her. She is fit, she doesn't need protection from STIs that much (you can never be sure..) the COCP works much better than condoms if she is worried. Implants would be suitable as well but are you still using the Norplant down in Poole?!.. 2. A 36 year old para 2 with a BMI of 34, severe PMS and a completed family. I disagree with Raj here. The IUS is not going to do much with her PMS. You need to give her something to stop her ovulation at best. The depo injections I was thinking if you are not very worried about osteoporosis. Oophorectomy is not one of your options... 3. A 38 year old multip with heavy periods. That's the standar mark as the easiest one. IUS, nothing else 4. A 26 year old nullip with heavy painful periods who wants a family next year. She need to go on something which is immediately (if possible) reversable. Depo? Nooooo, IUS/IUD? maybe but she is nullip. Implants? yes but they last more than a year. The COCP? maybe as they can sometime give problems resuming fertility. I would vote for the poor old POP but is probably going to get her periods worse! I think finally the COCP is the best option. 5. A 21 year old epileptic with a new partner. Is she on medications? If yes I would advise one of the coils. If not the COCP alone as she is quite young for a coil. The pill with condoms is it tested for epileptics? What's the PEARL index? I'm not sure! Iwould answer a IUCD though Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Tue Feb 20, 2007 7:58 pm    Post subject: Good thinking guys - not so easy are they I would probably go for.. 1. COCP and condoms (unless you advise her to go to GUM, she is still at risk) 2. Not for progesterones? Even the mirena can be problematic. I would give her an IUCD and some anti-depressants!! 3.Easy peasy 4. COCP 5, I agree with Wolverine, the IUCD Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Tue Feb 20, 2007 8:48 pm    Post subject: Hi guys Nice list and discussion. I've modifed the list and added a few more. Hope you do not mind Abi Suggestions for the final three?? By the way ... "The Gyne-T´® 380 (Janssen-Cilag) is not available in the UK now, however some women may still be using this device. It can be used until the licensed duration of use (10 years) is attained" ... just in case you were wondering This means the longest an IUCD can be used today is 8 years. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Wed Feb 21, 2007 10:52 am    Post subject: wolverine wrote: That's a great set Abi! And quite tricky (for me at least..) so tricky.... I was scared of answering.... after reading the LARC and HMBguidelines ... all I can think of, is to put LNG IUS in everybody.... (maybe including males...) In 21yr old epileptic with a new partner.Wouldn't DMPA be good as it'll decrease her seizure freq also.... for the rest..I really dont know .. all justifications sound good... Nick, HELP Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Wed Feb 21, 2007 11:48 am    Post subject: How bout this one An (annoyingly stubborn) 37 year old with heavy periods, following counselling refuses hormonal treatments and is booked for endometrial ablation, she requires contraception also. Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Wed Feb 21, 2007 11:59 am    Post subject: essure or sterilization Back to top drhatta Joined: 20 Feb 2007 Posts: 32 Location: Malaysia Posted: Wed Feb 21, 2007 12:05 pm    Post subject: Abi wrote: An (annoyingly stubborn) 37 year old with heavy periods, following counselling refuses hormonal treatments and is booked for endometrial ablation, she requires contraception also. I would go for sterilisation. Probably can do on the same sitting? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Wed Feb 21, 2007 3:24 pm    Post subject: agree with vangelis, essure or lap steri. reports of essure before TCRE / MEA available. good success rate. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Feb 21, 2007 6:32 pm    Post subject: I think I would favour laparoscopic sterilisation (there is some advice about this although I cannot remember if they advise to avoid or to do ) as TCRE essentially aims to induce an artifical Asherman's syndrome and it may be difficult to remove the Essure coils if so required. Not sure if they ever require removal but that's my logic. Essure is also still fairly new which would sway me away from it in most questions. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Feb 21, 2007 6:34 pm    Post subject: vani s wrote: In 21yr old epileptic with a new partner.Wouldn't DMPA be good as it'll decrease her seizure freq also.... for the rest..I really dont know .. all justifications sound good... Nick, HELP The fact you have been told she has a new partner means you have to offer barrier methods. Barrier alone is insufficient contraception for an epileptic and so the only viable option would be ... J COCP with male condom _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Last edited by Nick Raine-Fenning on Wed Feb 21, 2007 7:05 pm; edited 1 time in total Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Wed Feb 21, 2007 7:04 pm    Post subject: Re: Contraception Abik wrote: 1. An 18 year old in a regular relationship. Fit & well. Using condoms but worried about pregnancy. B 30 mcg COCP Reasoning - she is already using condoms Abik wrote: 2. A 36 year old para 2 with a BMI of 34, severe PMS and a completed family. H T-Safe Cu380A Reasoning - BMI 34 so need to avoid oestrogen and surgery / severe PMS (not just PMS) so try to avoid progestogen The other options are ... O Vasectomy & V Cerazette ... but you guys did not have these when Abi first asked the question. I would avoid the Mirena which can induce PMS symptoms but is Implanon an option? Surely the fact it induces anovulation and provides a constant level of progesterone makes it a viable choice? Abik wrote: 3. A 38 year old multip with heavy periods. C Mirena IUS Reasoning - parous / heavy periods Abik wrote: 4. A 26 year old nullip with heavy painful periods who wants a family next year. B 30 mcg COCP Reasoning - nullip so IUCD not a great idea although not contraindicated / needs fertility next year so not cost-effective for longer acting methods / heavy painful periods Abik wrote: 5. A 21 year old epileptic with a new partner. J COCP with condoms Reasoning - see above So, Abi, how did I do?? _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Abik Century Club Joined: 15 Jan 2007 Posts: 243 Location: Poole Posted: Wed Feb 21, 2007 10:28 pm    Post subject: Perfect score!! - I agree, although a little disapointed with the essure - I guess it's never an answer then? Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Wed Feb 21, 2007 11:40 pm    Post subject: Try that. One of the new generation contraception technique that is fitted hysteroscopidally! Thinking more about it it might be a bad idea as it might interfere with the ablation technique incrising the risk of perforation/thermal damage Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Thu Feb 22, 2007 10:16 am    Post subject: i know what that is will wait to give others a chance _________________ Dr Miss. 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