Contraception — SAQ

Stem

A candidate is asked to manage a classic presentation of Contraception in an exam setting. Use precise definitions, scores, doses, and decision thresholds.

Core knowledge (model answer backbone)

Contraception methods span hormonal (combined oral contraceptive pill, progestogen-only pill, implant, injectable, hormonal intrauterine system), intrauterine (copper IUD), barrier (condom, diaphragm), natural (fertility awareness, lactational amenorrhoea), emergency contraception, and permanent sterilisation. Choice depends on efficacy, safety, side effects, reversibility, coital independence, age, comorbidities, and patient preference. Long-acting reversible contraception (LARC) — copper IUD, LNG-IUS, implant — is most effective and offered first-line. UK Medical Eligibility Criteria (UKMEC) categorise every method from 1 (no restriction) to 4 (unacceptable risk) across medical conditions.

Red flags

• Chest pain, dyspnoea, calf pain or swelling, severe headache, visual disturbance, focal deficit or jaundice in a woman on combined hormonal contraception — thromboembolism (VTE, PE, ischaemic stroke) until proven otherwise; stop CHC, urgent imaging (D-dimer, CTPA, MRI brain)
• Severe abdominal pain in an IUD/IUS user — uterine perforation (about 1 in 1000), pregnancy (intrauterine or ectopic) or pelvic infection; urgent ultrasound and surgical review
• Pregnancy with an IUD in situ — locate device; if not seen on ultrasound suspect ectopic; remove if threads accessible; counsel regarding miscarriage and sepsis risk
• Unscheduled heavy or persistent bleeding on IUS, implant or DMPA — exclude infection, expulsion, perforation, pregnancy and gynaecological pathology before attributing to the method

High-yield structure examiners expect

Cover: Overview & Definition, Classification, Epidemiology & Risk Factors, Pathophysiology, Clinical Presentation, Differential Diagnosis.

Key doses / thresholds (from topic teaching)

• ethinylestradiol 20 to 35 mcg plus a progestogen) is UKMEC 4 in VTE,
• ulipristal 30 mg within 120 hours or levonorgestrel 1
• Levonorgestrel IUS 52 mg (Mirena) — 8 years contraception (5 yea
• Jaydess 13.5 mg 3 years", "DMPA injection 150 mg IM q12
• ethinylestradiol 20 to 35 mcg plus progestogen; typical-use 9 percent
• desogestrel 75 mcg or norethisterone 350 mcg or levonorges

Questions

a) Define the condition and give the most important classification or severity framework used in exams. (3 marks)

• Clear one-line definition matching standard teaching.
• Named classification / stages / types with discriminating features.
• One sentence on why classification changes management.

b) Outline pathophysiology in a mechanism chain that explains the main clinical features. (3 marks)

• Initiating insult → intermediate pathway → end-organ effect.
• Link at least two symptoms/signs to mechanism.
• Mention one complication pathway (e.g. shock, perforation, herniation, arrhythmia).

c) List discriminating clinical features and bedside assessment. (3 marks)

• Classic presentation plus one atypical group (elderly, pregnancy, child, immunocompromised).
• Named signs/manoeuvres if relevant.
• What must never be missed on exam/bedside (pregnancy test, airway, glucose, etc.).

d) Investigations with thresholds and one named score if applicable. (3 marks)

• First-line tests and what positive findings mean.
• Gold-standard or definitive investigation when needed.
• Score components reproduced exactly if a named score is standard for this topic.

e) Immediate resuscitation and definitive management with doses where standard. (3 marks)

• ABC / time-critical steps first.
• First-line drug(s) with agent + dose + route (or procedure steps).
• Escalation triggers (theatre, ICU, thrombolysis window, antidote, etc.).
• Disposition and safety-netting.

Marking tips

Full marks require specificity (numbers, names, doses) not generic "give antibiotics/fluids." Regional practice (ICMR / NICE / AHA) may be cited as alternative where relevant.