Quiz on Implanon & IUD/IUS

Quiz on Implanon & IUD/IUS Lydia Scott GP registrar

Implanon counselling True or false.... • Inhibits ovulation • Failure rate <1/1000 • Effective for 2 years • Delays return of fertility after removal • 60% have irregular bleeding • Evidence it causes weight gain

Implanon UKMEC Match the following.... UKMEC1 Taking carbamazepine UKMEC2 Current breast cancer UKMEC3 Obesity UKMEC4 Venous thromboembolism UKMEC2 Unexplained vaginal bleeding

Implanon insertion True or false.... • Can insert up to day 5 of cycle • No additional contraception needed after insertion • Can be inserted anytime postpartum • Can remove & insert at same site without additional contraception • Is inserted intra-dermally

IUD/IUS counselling True or false.... • IUS inhibits ovulation • IUD >98% effective • Risk of explusion 1 in 20 • High risk of ectopic pregnancy • IUD causes heavy painful periods • Mirena lasts for 10 years

IUD/IUS UKMEC Match the following.... UKMEC1 Previous ectopic pregnancy UKMEC2 48hrs-4weeks post partum UKMEC3 Continuation if develop PID UKMEC4 Liver enzyme inducing drugs UKMEC1 Puerperal sepsis

IUD/IUS insertion True or false.... • Copper IUD takes 7 days to be effective • Risk of uterine perforation 2:1000 • Should do first coil check in 6 weeks • Can remove & replace at any time in cycle • Do not always need to take swabs for STIs prior to insertion

Answers (no cheating!)

Implanon counselling • True – main action, also alters cervical mucus • True • False – lasts 3 years • False – need to warn them it stops working straight after being taken out • False – around 40% irregular, 40% normal periods, 20% no bleeding • False – some reports but no evidence

Implanon UKMEC UKMEC 1 = obesity UKMEC2 = taking carbamazepine (but should advise condom use) UKMEC3 = unexplained vaginal bleeding UKMEC4 = current breast cancer UKMEC2 = venous thromboembolism (current on warfarin) – this has recently been downgraded See full list of UKMEC categories on Faculty website

Implanon insertion True – can insert at any time in cycle if sure not pregnant but best to do in first 5 days so know • False – needed for 7 days after insertion • True • False – should change during period or advise to abstein/use extra contraception for 7 days prior to removing and 7 days after reinserting (but can re-insert at same site!) • False - subdermally

IUD/IUS counselling • False – prevents implantation/alters cervical mucus • True • True – higher in first 3 months • False – low risk due to low risk of pregnancy generally BUT if patient does become pregnant with coil in then more likely to be an ectopic than if no coil in situ • True – need to warn them that this could happen • False – Mirena (IUS) lasts 5 years, IUD lasts 5-10 years depending on type used

IUD/IUS UKMEC UKMEC1 = Previous ectopic pregnancy (although I would counsel very carefully if only had one tube left – see above) UKMEC2 = Continuation if develop PID (generally safer to leave in) UKMEC3 = 48hrs-4weeks post partum (due to higher risks of insertion) UKMEC4 = Puerperal sepsis UKMEC1 = Liver enzyme inducing drugs See full list of UKMEC categories on Faculty website

IUD/IUS insertion • False – effective immediately • True • True – coil check at 6/52 then check yearly (advise patient to self check after each period) • True – but try to book in just after period or abstein/use extra ceontraception following last period in case you can’t get the new one in • True – faculty suggests always do swabs if high risk (<25yrs or multiple/recent new partner) but usually offer to all patients

Quiz on Implanon & IUD/IUS