1)P No Sharing or Copying Allowed by any means Compensations and ersion 4.6 Penalties Worldwide System is Active [Corrected], Updated), Lighter, om (Constantly updated for online subscribers) Plabikeys.com LA ncaa, * (OBS/GYNE Strict Copyrights! KEYS PLAB KEYS ith the Most Recent Recalls and the UK Guideline: This file will be updated online on our website frequently!| (exampl more recent than Aku) Key Contraception More details on each of the following is explained in the coming keys. You will need to go over this entire Key several times to absorb it. Notes and Scenarios Collections on Medroxyprogesterone acetate). lf < 20 YO| > Don’t prescribe IUS (Mirena®) or Depo-Provera (IM Copyrights @ Plabikeys.com2| Page [08S/GYN] ©Copyright w 1kevs.com (Constantly updated for online subscribers) Depo-Provera — Risk for osteoporosis in such a young age. * Many females who recently started on Depo-Provera (Progesterone-only- injections) or Mirena tend to initially have bleeding more days than usual and vaginal spotting between cycles. Most females become amenorrheic after 1 year of use. Therefore > Reassure and advice the patient to come back if these! unscheduled bleedings become problematic. What if bleeding becomes problematic? > COCP for 3 months (While still on Depo-Provera) Or: Mefenamic acid or Tranexamic acid for 5 days. * IUS (Mirena®) and Depo-Provera are not recommended if 2 20 YO * Nexplanon® “Etonogestrel implant” is safe k 20 YO). * COCP and POP are also safe |< 20 YO). ¢ In females with some learning difficulties > Do not prescribe Pills (COCP, POP) as they may forget taking the pills. Copyrights @ PlabiKeys.com3| Page [08S/GYN] ©Copyright www.plabtkevs.com (Constantly updated for online subscribers) @ Some important contraindications for the use of COCP: V Smoking. V Obesity (BMI > 30 Kg/m’). v Hx of thromboembolism. ¥ Learning difficulties (as they may forget to take the pills). Vv Post-partum (if breastfeeding: CI for 6 months) (If not: CI for 6 weeks). Vv Migraine with aura. v HTN (even if well-controlled HTN). * Intrauterine contraceptive systems (IUS) (eg, Merina) and Progesterone- only implants (eg, Nexplanon) are used for long-term contraception and thus should be avoided if a woman has intentions and plans to get pregnant in the near future (eg, within 6 months). After giving a birth, COCP is contraindicated in breastfeeding 2 (for 6 months) and in non-breastfeeding 2 (for 6 weeks). After Delivery: - Abreastfeeding 9 can start taking COCP after 6 months of delivery. - Ahon-breastfeeding 9 can start COCP after 6 weeks of delivery. © Progesterone only pills (POP) are orally; and they are s feeding, they are given birth-control methods. Copyrights @ PlabiKeys.come [085/GYN] ©Copyright w ab ikevs.com (Constantly updated for online subscribers) © No contraceptive method is required post-partum for 21 days after delivery. * Depo-Provera (Medroxyprogesterone acetate) is IM injection given once every 3 months. It is contraindicated in females < 20 YO. However, it is first-line in females with SCA and Menorrhagia. V Menorrhagia = Heavy menstruation [|v Dysmenorrhea = Painful menstruation | V Metrorrhagia = Irregular menses wn young 2, Not sexually active (i.e., she doesn't require any, contraception as she is sexually inactive @ Menorrhagia only (Heavy menstruation) > First line is |Mirena}, unless if pregnancy is wished soon or she is < 20 YO, then > [Tranexamic acid}. @ Menorrhagia + Dysmenorrhea > |Mefenamic acid, @ Menorrhagia + Irregular menses + Does not want to get pregnant > kcocrs) @ Metrorrhagia (irregular menses) + Menorrhagia/ Dysmenorrhea > {coces, V Once there is dysmenorrhea (painful menstruation) > Mefenamic acid V Once there are N 2s) > COCPs agia (inn > Mirena (first-line) unless if she is < 20 YO or she wishes to be pregnant in the near future, then > Tranexamic acid > Depo-Provera (IM progesterone). a in a female with Copyrights @ PlabiKeys.com© Copyright com (Constantly updated for online subscribers) In a sexually active 9 (she requires contraception) + Menorrhagia/ + Dysmenorrhea/ or Fibroids NOT distorting the| > > ¢ The first-line > Levonelle pill. (Mirena (IUS) = Levonorgestrel Intrauterine System| ¢ If there is uterine cavity distortion by fibroids > IUD “Copper” | or EllaOne pill}. Q) What if Mirena is Contraindicated (e.g., the 9 < 20 YO or no long contraception is wished)? If No contraindications to COCP (e.g. smoking, obesity, Hx of thromboembolism) ~|cocr| (or POP or implants). implants (e.g. INexplanon| ) * If 2 with SCD “Sickle cell disease” and Menorrhagia > Depo-Provera IM. v Presented within 120 hours (5 days) of the unprotected sex S eet Rela oes ten) (had unprotected sex and wants contraception now) V presented within 72 hours (within 3 days) of the unprotected sex Copyrights @ PlabiKeys.comN] ©Copyright w 1kevs.com (Constantly updated for online subscribers) © The contraception that reduces the risk of Cervical Cancer > [Condoms Using condoms reduces the risk of HPV infections > thus, reduces the risk of cervical cancer. Scenavios and Examples on Contraceptio Example ( 1) 25 YO female is now 22 days after delivery and wishes a contraceptive method that does not include needles. She would like to get pregnant after 6 months. > Progesterone-only pills. v IUS and Implants are for long-term contraception. v COCPs are contraindicated after delivery for 6 months in breastfeeding 2. Vv Depo-Provera is IM injection (and she doesn’t want injections). Example (2), 18 YO with some learning difficulties using condoms and want an alternative contraceptive method. Copyrights @ PlabiKeys.com7|Page [08S/GYN] ©Copyright www.plabtkevs.com (Constantly updated for online subscribers) > |Nexplanon] (implants) v COCP is safe < 20 YO if no contraindications. However, she has learning difficulties and thus may forget to take the pills. V< 20 YO: IUS (Mirena) and Depo-Provera are better avoided (UKIMEC2). Example (: 3) A40 YO smoker and overweight female presents with heavy periods (Menorrhagia). She would like a long-term contraceptive method. > |lUs (e.g. Mirena = levonorgestrel intrauterine system).| * Remember, ina sexually active $ (requires contraception) with menorrhagia/ dysmenorrhea/ or fibroids not distorting the uterine cavity The first line — Mirena (IUS) = Levonorgestrel Intrauterine System © Furthermore, this lady has contraindications to COCP (Obesity, Smoking). Example (4) After initiating Depo-Provera 2 months ago, a female presents complaining of unscheduled bleeding. Copyrights @ PlabiKeys.com8|P2ge [08S/GYN] ©Copyright www.plabikeys.com (Constantly updated for online subscribers) > |Reassure and advice to return if bleeding become problematic. The majority of females who start Depo-Provera (Progesterone-only IM injections taken once every 3 months “12 weeks”) tend to have intermenstrual spotting. This usually settles after a year of Depo-Provera use. Example (5), A. 16 YO female who is not sexually active presents complaining of menorrhagia (heavy bleeding), Dysmenorrhea (Painful cycles) and Irregular cycles. > col Pl Gin young $, Not sexually active (doesn’t requires contraception) *M hagia only (Heavy menstruation) — Tranexamic acid @ Menorrhagia + Dysmenorrhea — Mefenamic acid ¢ Metrorrhagia (irregular menses) + Menorrhagia/ Dysmenorrhea > COCP. Example (ey A31 YO lady, known case of sickle cell disease, presents complaining of heavy menstrual bleeding (menorrhagia). She is not sexually active and has no plans for children in the near future. The most appropriate Rx: Copyrights @ PlabiKeys.com