EBCOG P1 3 Months May- Contraception and STIS -Day 2

1. Eight months after her implant was inserted, a woman presents at clinic concerned about persistent bleeding. After excluding risks of STIs, other pathology and pregnancy, which of the following best describes how this woman should be managed?

a. The woman should be advised that after 7 months of use her bleeding patterns are likely to remain as they are and the clinician should remove the implant
b. The woman should be advised that bleeding patterns can remain irregular with use of the progestogen-only implant and she can be offered a combined hormonal contraceptive method
c. The woman should be advised that bleeding patterns can remain irregular with use of the progestogen-only implant and as she was advised of this before insertion no action should be taken
D. The woman should be advised that the bleeding patterns will settle down over time and that no action should be taken.
E. The woman should be advised that as bleeding patterns is irregular with use of this progestogen-only implant and she can be offered a new implant.

2. A 36 year old women who has been using copper IUCD for her contraception since 2 months has now reported heavy menses.

A. Immediately change to IUS
B. Add COC for 3months
C. Add transexamic acid 1gm thrice daily
D. Counsel as mostly settles within 3 months of use.
E. Remove the device

3. A 47 year old women who has had IUCD in-situ for 4 years is come to clinic with complaints of some bleeding after few years of amenorrhoea.

A. Add coc for 3months
B. Add mefenemic acid 500 mg thrice daily
C. Achnge to IUS
D. Counsel only
E. Endometrial biopsy

4. A 43-year-old woman presents complaining about her bleeding patterns since having the LNG-IUS inserted 3 months ago. She says she was misled and that she had been told she would have no bleeding problems. What is the single most appropriate advice to give her regarding bleeding patterns associated with the LNG-IUS?

A. Irregular, light or heavy bleeding is common in the first 6 months. Thereafter women have regular monthly bleeds
B. Most women have no bleeding after 6 months of use. However, a small number of women will continue to bleed until 12 months
C. Irregular, light or heavy bleeding is common in the first 6 months. By 3 years, one half of women will have no bleeding
D. Most women have no bleeding after 3 months of use. However, a small number of women will continue to bleed until 6 months
E. Altered bleeding- usually settles in 3months. But 90 % reduction in blood loss is seen by 12 months.

5.All sexually active women presenting with problematic bleeding when using hormonal contraceptives should be:

A. Assessed for sexually transmitted infections (STIs)
B. Given a speculum and bimanual examination
C. Advised to change their method
D. Offered cervical screening
E. Haemostatic drugs given

6.A 25-year-old para 5 is due to get a LNG-IUS inserted 4 weeks post caesarean section. She defaults the appointment due to child care, but attends 3 weeks later (7 weeks postnatally). She is formula feeding her infant. She remains amenorrhoeic and had sexual intercourse with her husband 2 weeks previously, but has not since because it was too uncomfortable. A pregnancy test is negative. She is very keen for contraception, ideally with LNG-IUS, but does not want a progesterone implant. What would be the best management?

A. Advise condoms or abstinence, bring back in 1 week and insert LNG-IUS if pregnancy test negative.
B. Advise condoms or abstinence, bring back in 2 weeks and insert LNG-IUS if pregnancy test negative.
C. Give depot medroxyprogesterone acetate, bring back in 2 weeks and insert LNG-IUS.
D. Insert copper (Cu)-IUS.
E. Insert LNG-IUS.

7.A woman with sickle cell disease is seeking a long-acting reversible contraception method. She is asking if there is any method that may also help reduce her risk of sickle cell crisis and pain.What well you tell her?

A. Contraception is contraindicated in sickle cell disease patients.
B. No method will help reduce her risk.
C. She can use only barrier contraception.
D. She is best with long-acting irreversible contraception.
E. The long-acting injectable contraceptive may help reduce her crisis pain.

8. A woman with systemic lupus erythematosus comes to see you regarding safer contraception. From her notes, you see she has positive antiphospholipid antibodies.According to the UK medical eligibility criteria (UKMEC), which contraceptive would you offer?

A. Combined hormonal contraception.
B. Long-acting injectable contraception.
C. The progesterone implant.
D. The progesterone-only pill.
E. The copper intrauterine device.

9. A 33-year-old woman is on the levonorgestrel intrauterine system. She has recently suffered from a cerebral transient ischaemic attack. She is now improving. The general practitioner asks for your advice as she still requires effective contraception.What will you tell him?

A. Counsel her for sterilization.
B. Continue the same method if it was category 1 when first used.
C. Discontinue the method, as it is now a category 2.
D. Discontinue the method and offer a more suitable option.
E. She can use only barrier contraception.

10. You are counselling a 30-year-old woman with hypertrophic cardiomyopathy regarding contraception. You explain that according to UKMEC, intrauterine (IUD) contraception is her best option. What is your advice for prophylactic antibiotics?

A. A doxycycline dose for 10 days.
B. Azithromycin 1 gm stat dose.
C. A broad-spectrum antibiotic before IUD insertion and oral cephalosporin for five days.
D. A prophylactic dose for three days before IUD application.
E. There is no need to administer prophylactic antibiotics.

EBCOG P1 3 Months May- Contraception and STIS -Day 2

EBCOG P1 3 Months May- Contraception and STIS -Day 2

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