Q65: Women's health: PLAB/UK(MLA)/AKT Exam style question
Today, we will discuss another Q65 Women’s Health PLAB 1/ UKMLA exam-style question.
A 33-year-old woman has given birth to her second child 3 weeks ago and is now seeking contraception advice. She is exclusively breastfeeding and her husband is scheduled to undergo a vasectomy in three months.
What is the most suitable form of contraception for her to use in the meantime?
A. Combined oral contraceptive pill
B. Progesterone-only pill
C. Intra-uterine coil
D. Intra-uterine progesterone-only system (Mirena)
E. Progesterone implant (Nexplanon) Explanation
Explanation
The correct answer is B.
The progestogen-only pill (POP) is a suitable option for women who are breastfeeding, as it is considered safe for the infant and does not affect breast milk production. The POP can be started at any time after giving birth, but additional contraception should be used for the first 2 days if taking drospirenone or any other POP unless the lactational amenorrhea method (LAM) criteria are met. The LAM criteria are that the woman is fully breastfeeding, amenorrhoeic, and less than 6 months postpartum. However, this method requires strict adherence to the criteria and may not be reliable if any of them are not met.
The combined oral contraceptive pill (COCP) is not suitable for women who are breastfeeding within 6 weeks postpartum and is not recommended for women who are breastfeeding between 6 weeks and 6 months postpartum. The COCP may reduce breast milk production in lactating mothers and should not be used in the first 21 days after giving birth due to the increased risk of venous thromboembolism.
The intrauterine device (IUD) or intrauterine system (IUS) are long-acting reversible contraceptives that can be inserted after 48 hours of giving birth or 4 weeks postpartum. However, these methods may not be a sensible choice for a woman whose partner will undergo a vasectomy in three months, as they require a procedure to insert and remove them.
The progestogen implant (Nexplanon) is another long-acting reversible contraceptive that can be inserted at any time after giving birth if the woman is not breastfeeding or from day 21 postpartum if she is breastfeeding. However, this method also requires a procedure to insert and remove it and may not be a sensible choice for a woman whose partner will undergo a vasectomy in three months.
Women should be advised that an interpregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birthweight, and small for gestational age babies. Therefore, contraception should be started immediately after childbirth if desired and the woman is medically eligible.
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Reference:
The NICE guidance on contraception covers a range of topics, such as contraceptive information and methods, emergency contraception, contraception after an abortion, and contraceptive services for under 25s. Here are some of the reference links that you can use to access the guidance:
Contraception | Topic | NICE: This is the main page for all NICE products on contraception, including guidance, advice and quality standards. You can find the published products on this topic and the guidance by programme sections.
Contraception - NICE: This is the quality standard for contraception, which sets out priority areas for quality improvement in health and social care. You can find the quality statements, rationale, measures, source guidance, and definitions of terms used in this document.
Contraceptive Services for Under 25s - NICE: This is the public health guideline for contraceptive services for under 25s, which aims to ensure that young people have access to a range of contraceptive methods and are supported to make informed choices. You can find the recommendations, evidence review, economic analysis, and implementation tools in this document.
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