The document provides an update on contraception. It discusses various contraceptive methods including levonorgestrel emergency contraception, subcutaneous DMPA, and the lactational amenorrhea method. It addresses common misconceptions about contraceptive effectiveness and safety. The document is divided into multiple rounds testing knowledge of contraceptive guidelines through true/false and multiple choice questions.

1. Update on Contraception
Quizmasters: Dr Hariharan C
Dr Ajay SD
NO EXIT!!!

2. • “We want far better reasons for having
children than not knowing how to
prevent them.”

3. Round I
• True or False
• 8 questions
• 10 marks each
• No Bonus marks

4. • 1. Levonorgestrel Emergency Contraception
has no absolute medical contraindications

5. • TRUE!
• EC has no evidence-based absolute
contraindications, because pregnancy for women
who have concurrent medical problems (including
thromboembolic and liver disease) would pose a
greater threat than 1-day doses of estrogen or
progestin
(Medical eligibility criteria for contraceptive use. 3rd edition.
Geneva (Switzerland): World Health Organization; 2004.

6. 2. If ECPs failed to prevent pregnancy, a
woman has a greater chance of that
pregnancy being an ectopic pregnancy.

7. • False
• To date, no evidence suggests that ECPs
increase the risk of ectopic pregnancy.
Worldwide studies of progestin-only ECPs,
including a United States Food and Drug
Administration review, have not found higher
rates of ectopic pregnancy after ECPs failed
than are found among pregnancies generally.

8. • 3. Subcutaneous DMPA (DMPA-SC) is not as
effective as IM DMPA

9. • False.
• A formulation of DMPA has been developed specifically for injection into
the tissue just under the skin (subcutaneously).
• The hormonal dose of the new subcutaneous formulation (DMPA-SC) is
30% less than for DMPA formulated for injection into the muscle— 104 mg
instead of 150 mg. Thus, it may cause fewer side effects, such as weight
gain. Contraceptive effectiveness is similar.
• Like users of intramuscular DMPA, users of DMPA-SC have an injection
every
• 3 months. DMPA-SC will be available in prefilled syringes, including the
single-use Uniject system. These prefilled syringes will have special short
needles meant for subcutaneous injection. With these syringes, women
could inject DMPA themselves. DMPA-SC was approved by USFDA in
December 2004 under the name “depo-subQ provera 104.”

10. • 4. DMPA permanently decreases the bone
mineral density

11. • False
• Although DMPA use decreases bone
density, Research has not found that DMPA users
of any age are likely to have more broken bones.
• When DMPA use stops, bone density increases
again for women of reproductive age.
• Among adults who stop using DMPA, after 2 to
3years their bone density appears to be similar to
that of women who have not used DMPA.

12. 5. Efficacy of LAM method is 98% in first six
months postpartum

13. • True.
• As commonly used, there will be about 2 pregnancies per 100 women
using LAM in the first 6 months after childbirth. This means that 98 of
every 100 women relying on LAM will not become pregnant
• The lactational amenorrhea method (LAM) requires 3 conditions. All 3
must be met:
1. The mother’s monthly bleeding has not returned
2. The baby is fully or nearly fully breastfed and is fed often, day and night
3. The baby is less than 6 months old
• “Fully breastfeeding” includes both exclusive breastfeeding (the infant
receives no other liquid or food, not even water, in addition to breast milk)
and almost-exclusive breastfeeding (the infant receives
vitamins, water, juice, or other nutrients once in a while in addition to
breast milk).
• “Nearly fully breastfeeding” means that the infant receives some liquid or
food in addition to breast milk, but the majority of feedings (more than
three-fourths of all feeds) are breast milk.

14. 6. Condoms do not have any absolute
contraindications for their use

15. • False
• Know Latex allergy is an absolute
contraindication for use of condom

16. • 7. While calculating fertile period, the
woman should subtract 18 from her shortest
cycle and 11 from her longest cycle in the
last six months

17. • True
• The woman should update these calculations each
month, always using the 6 most recent cycles.
• Example:
• If the shortest of her last 6 cycles was 27 days, 27 – 18
= 9. She starts avoiding unprotected sex on day 9.
• If the longest of her last 6 cycles was 31 days, 31 – 11 =
20. She can have unprotected sex again on day 21.
• Thus, she must avoid unprotected sex from day 9
through day 20 of her cycle.

19. • 8. Spermicides increase the risk
of transmission of HIV

20. • True

21. • “It would be a service to mankind if the pill
were available in slot machines and the
cigarette were placed on prescription.”

22. Round II
• Medical disorders and contraception
• 4Questions, 10 marks each
• Bonus marks: 5

23. 1. In a woman on ATT for pulmonary
tuberculosis, the best form of contraception
would be:
• A. Second generation COC
• B. POPs
• C. Progesterone implant
• D. DMPA

24. 2. All of the following are contraindications to
COCs EXCEPT
• A. Migraine with aura
• B. varicose veins
• C. age more than 35 yrs and smoker
• D. Hypertension

25. 3. Contraceptive of choice in Ischemic heart
disease is
a. Cu-T
b. Drospirenone containing OCPs
c. Progesterone Implants
d. Depo- Provera

26. 4. Which of the following are safe in benign
breast disease
a. COCs
b. Mini-pills
c. Implants
d. All of the above.

27. • “I want to tell you a terrific story about oral
contraception. I asked this girl to sleep with
me and she said "No." ~Woody Allen”

28. Round III
Male and female sterilization
6 questions
10 marks each
5 marks bonus points

29. 1. Request for reversal of tubal sterilization is
seen in
a. 1%
b. 3%
c. 5%
d. 10%

30. 2. Which of the following is a permanently
irreversible method of sterilization?
a. Madlener’s
b. Irving’s
c. Kroner’s
d. Parkland

31. 3. In laparoscopic sterilization, which of the
following is associated with highest failure
rates
a. Hulka clips
b. Falope rings
c. Bipolar coagulation
d. Monopolar coagulation

33. 4. Which of the following methods are
associated with highest rates of ectopic
pregnancy in case of failure
a. Electrocautery
b. Silastic bands
c. Tubal resection
d. Hysteroscopic occlusion

34. • Approximately half (50%) of pregnancies that
follow a failed electrocoagulation procedure
are ectopic, compared with only 10 percent
following failure of a ring, clip, or tubal
resection method (Hatcher and
colleagues, 1990; Hendrix and
associates, 1999)

35. 5. All of the following are known complications
of male sterilization except
a. Anti sperm antibody formation
b. Wound granuloma
c. Erectile dysfunction
d. Scrotal pain.

36. 6. Typically it takes around______ ejaculations
before a man becomes azoospermic after
vasectomy
a. 10
b. 20
c. 30
d. 40

37. • “A birth control pill for men, that's fair. It
makes more sense to take the bullets out of
the gun than to wear a bulletproof vest.”

38. Round IV
• Rapid fire
• 3 min
• 10 marks per correct answer

40. 1. Efficacy of COCs on typical use is___
2. Commonest cause of failure of tubal ligation is______
3. What should be done if a woman on COCs misses 3
pills?
4. Prolonged use of COCs has been associated with
________ cancer
5. The life of Implanon is ________
6. The life of NET-EN is______
7. Commonest side effects of the Yuzpe regimen is____
8. Enlist two non contraceptive benefits of condoms
9. What is the pearl index if no contraception is used?
10. A potential problem with Drospirenone containing
OCPs is________

41. 1. Efficacy of DMPA on typical use is______
2. After male sterilization, an alternative method should always
be used for a period of____ months
3. Commonest cause of discontinuing DMPA is _____
4. Alternative method should be considered if a woman on
Cerazette delays her daily dose by____ hours
5. The life of Cu T 380A is________ years
6. The life of Jadelle is_______
7. Commonest side effect of LNG for EC is______
8. Enlist two non contraceptive benefits of Mirena apart from
AUB.
9. The efficacy of the cervical diaphragm on typical use is_____
10. Most important problem with use of progestasert is_______

43. Life of contraceptives
• Norplant- 5 years
• Jadelle- 5 years
• Implanon- 3 years
• CuT 380A- 10 years
• Nova T- 5 years
• Multiload 375- 5 years
• Multiload 250- 3 years

44. • “We all worry about the population
explosion, but we don't worry about it at the
right time.”

46. Thank You.