Larc Quiz!

Larc’s quiz 1. Copper IUD’s work primarily by preventing implantation FALSE For copper IUD main mode of action is by inhibiting fertilisation as copper is toxic to ovum and sperm. It also has effects on endometrium and cervical mucus.A copper IUD is therefore NOT an abortifacient. This is in contrast to the mode of action of the IUS whose major effect is mediated by the progestogenic effect on the endometrium. 75% women with IUS continue to ovulate. In contrast, the primary mode of action of the contraceptive implant is by inhibition of ovulation

Larc’s quiz 2. Mirena IUS fitted in a woman over 45 years can be left in situ for 7 years. TRUE For copper IUD, women who have this fitted over the age of 40 may retain it for contraceptive purposes until one year after cessation of periods stop if over 50 or for 2 years after this if under 50.

Larc’s quiz.3. Liver enzyme inducing drugs reduce the efficacy of the contraceptive implant. TRUE Women who are taking these drugs in the short term need to use additional contraceptive precautions such as condoms while on these and for 4 weeks after the drug is stopped.

Larc’s quiz 4 Prior to insertion all women having a copper IUD/Mirena IUS fitting should have screening tests for sexually transmitted infections. FALSE Only necessary if change of partner or more than one partner in the last 12 months. Testing for chlamydia alone may be sufficient and if asymptomatic urine screening rather than swab s may be appropriate.

Larc’s quiz 5 A woman changing from a copper IUD to the Mirena IUS should be advised not to have sexual intercourse in the 7 days prior to insertion. TRUE Ovulation may have occured and it takes 7 days for IUS to exert its effect on the enodmetrium so implantation could occur.

Larc’s quiz 6 A copper IUD or Mirena IUS user who is asymptomatic and has actinomyces-like organisms on her smear should have her IUS/IUD removed FALSE Need to counsel her about possible risks PID and how this may present.

Larc’s quiz 7 Combined oral contraception may be beneficial in managing problematic bleeding in women using contraceptive implant. TRUE But this may need investigating to exclude STI or other gynae pathology; particularly if it is a CHANGE in previous bleeding pattern.

Larc’s quiz 8 Women receiving liver enzyme inducing drugs should have their depo. injections at 10 weekly intervals. FALSE Depo contraception is not affected by enzyme inducing drugs

Larc’s quiz 9 A copper IUD or Mirena IUS can be fitted at any time in the menstrual cycle if the clinician can be reasonably certain that there is no risk of pregnany. TRUE But if fitting IUS later then day 7 of the cycle then additional precautions are needed for the next 7 days. The IUD is effective immediately ( hence use as emergency contraceptive method for up to 5 days after the predicted date of ovulation)

Larc’s quiz 10 Use of the Mirena IUS in a woman with previous breast cancer is UKMEC category 3 TRUE This is true for patient with a current history of breast cancer with no evidence recurrence in the last 5 years. CURRENT breast cancer is UKMEC 4 ( for all progesterone only methods)

Larc’s quiz 11 When long term users discontinue depo.contraception they do not need to use another method of contraception for 6 months due to delay in return of fertility. FALSE. Amennorhoea does not represent infertility. Users of this method should however be warned that there may be a delay of return of fertility for up to 1 year.

Larc’s quiz 12 Long term use of the contraceptive implant is associated with a clinically significant reduction in bone mineral density FALSE Studies do show a statistically significant reduction in BMD with implant use but this is not significant clinicially

Larc’s quiz 13 The Mirena IUS is not suitable for women with epilepsy on liver enzyme inducing drugs. FALSE

Larc’s quiz 14 A first line copper IUD for contraceptive use should contain 300mm of copper FALSE IUD contatining 380mm copper ( with banded arms) is now preferred as it has higher effectiveness and devices commonly used are licensed for 10 years.

Larc’s quiz 15 If a patient with intrauterine contraception presents with acute PID their device should be removed. FALSE Continuation of the method is UKMEC2; it is acceptable to leave the device in situ and treat suspected PID with antibiotics.

Larc’s quiz 16 There is no delay in return of fertility following removal of contraceptive implant TRUE. Over 90% women ovulate within 3 weeks following removal

Larc’s quiz.17 The average weight gain with depo provera after 2 years is 3kg. TRUE

Larc’s quiz 18. The use of depo is associated with a small loss in bone mineral density. TRUE.. This usually recovers after discontinuation of the method and there is no available evidence of the effect of depo contraception on long term fracture risk. Women should be assessed every 2 years to discuss the benefits and potential risks and may continue until age 50 if they wish.

Larc’s quiz 19. Depo contraception can safely be used by women who are breastfeeding TRUE. The benefits of using a progestogen-only injectable by breastfeeding women under 6 weeks postpartum outweigh any risks (UKMEC 2). Use of progestogen-only injectable contraception in breastfeeding women is unrestricted after 6 weeks postpartum (UKMEC 1).