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Revision Questions: Obstetric & Gynaecological (Preview)

Sample Questions

  1. There are two types of combined oral contraceptives (COCs): monophasic and triphasic. Explain the differences.
  2. A patient wants to know what alternative products are available to her as she always forgets to take her oral contraceptive. She wants something long term.
  3. What contraceptive methods can a breastfeeding mother use?
  4. What are the common side effects of COCs?
  5. Provide some counselling points for a patient using COCs for the first time.

Sample Answers

  1. Monophasic: oestrogen and progestogen doses are the same. It is taken for 21 days of the cycle followed by 7 days of inactive pills. Triphasic: the dose of oestrogen and progestogen varies during the 21 days of active pills.
  2. As daily tablets are not suitable for this patient, there are several options the patient can take:
    • Medroxyprogesterone IM depot (Depo-Ralovera; Depo-Provera): injection every 12 weeks
    • Etonogestrel Implant (Implanon): long term contraception 3 years
    • Levonorgestrel IUD (Mirena): long term contraception 5 years
    • Copper IUD (Multiload): long term contraception 5-8 years
  3. Progesterone-only contraceptives, barrier methods (condoms, diaphragms) and IUDs can be used. Avoid using COCs in breastfeeding as oestrogens can decrease milk supply. COCS should also be delayed at least 21 days postpartum due to increased risk of thrombosis during this period.
  4. Breakthrough bleeding, nausea, vomiting, changes in weight, breast enlargement and tenderness, headache, mood changes (eg depression), changes in libido, fluid retention, chloasma, acne, thrush
  5. Start in the first week of active tablets on day 1-5 of period to be protected immediately. If start active pills after this time, use additional contraception or avoid intercourse until 7 active pills have been taken.
    • Missing pills: <12 hours take it asap and take the next pill at usual time
    • Missing pills: >12 hours take it asap and next pill at usual time but need to wait 7 days for protection. But if the 7 days extend into inactive pills, then skip the inactive pills and go straight to a new pack of active pills (so no periods for this month)
    • If you missed active pills and need to take emergency contraceptive tablets, you should start taking your pill again within 12 hours of taking the emergency contraceptive tablets. You will need to use additional contraception, eg condoms, or avoid intercourse until you have taken active pills for 7 days.
    • Stop taking and see the doctor if the following occurs: severe and sudden pain in the chest, severe headache, blurred vision or loss of sight, unexplained tenderness or pain and swelling in the leg.

The full version has many more questions with answers included.

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