Waikato Postgraduate Medicine Inc.

Answers to Update on Contraception CME questions

Audio CD – Helen Roberts 2004
Correct answers appear in bold italics

Susan is 32 years old and wishes to use the combined pill (coc) for contraception. She is fit and well apart from mild acne, has a BMI of 29 and no family history of note. She smokes 10 cigarettes a day. Her period started four days ago. She is presently using Noriday as she has, until last week. She has been breast-feeding her third child (now 6 months old)

1. Which of the following statements is true:

1. She should not use the coc as her BMI is too high
2. She should not use the coc because she is over 30 years old and smokes
3. You can Rx the coc but she is not safe until she has taken seven pills
4. You can Rx the coc and safe if goes from pop to hormone coc
5. You can Rx the coc but should start with Estelle for her acne

Some years later, Susan, who has now given up smoking and is taking Levlen, comes back to your practice. She had her period last week and had just started her hormone pills on her next packet. However, she went away for the last two days and forgot her pills. She had intercourse two nights ago. In updating her history you learn that she has developed epilepsy and is on Epilim. She does not want to be pregnant.

2. Which of the following statements is true:

1. She does not need the ecp as she has only missed two pills
2. She is too late to take the ecp and needs postcoital IUD
3. You should prescribe two tablets of Postinor and tell her to take them stat
4. You need to tell her that she will need four tabs of Postinor because of her Epilim
5. If she takes the ecp she will then be contraceptively safe straight away

Some months later she comes back to see you again. She has always had regular periods on her Levlen but recently has started to spot in the middle of her cycle. She may have missed a few pills but that was months ago and she has had a period since. She had a smear last year, which was normal. Her baby is now three years old and she and her partner have decided that they do not want any further children.

3. Which of the following is the most appropriate first line strategy:

1. She needs a stronger pill and you suggest Brevinor 1
2. You ask her for a urine specimen for a pregnancy test
3. She should have her smear repeated now
4. You suggest tht it would be best to take STI swabs
5. You tell her that it is probably due to her Epilim

It is a few years since you have seen Susan. She has stopped her pill about 18 months ago and is using a Mirena for contraception. However, for the past year she has noticed that she has not been feeling great in the week coming up to her period. She gets really mood and feels bloated and generally just grumpy.

4. Which of the following would you do first:

1. Tell her to go back on the pill as it will help her PMS
2. Suggest that she takes an antidepressant
3. Ask her to do a symptom diary and Rx calcium
4. Put her on combined HRT as it has less progestagen than the pill
5. Suggest high dose transdermal estrogen