Women's health
Practice questions with explanations

C. Arthralgia and accelerated bone loss are common, so bone density is monitored and exercise, calcium and vitamin D are addressed

Joint pain and stiffness are the leading reason for stopping and should be raised proactively, since many women assume they are unrelated. Bone loss is faster than natural postmenopausal decline, so density is monitored and antiresorptive therapy considered. The drugs are ineffective in premenopausal women unless ovarian function is suppressed.

D. Migraine with aura

Migraine with aura carries an increased baseline risk of ischaemic stroke, and combined hormonal contraception multiplies it, so it is a category 4 condition. Other absolute contraindications include previous venous thromboembolism, known thrombophilia, current breast cancer, severe liver disease, smoking over 35 at 15 or more cigarettes a day, and the first weeks postpartum in a breastfeeding woman.

B. Enzyme-inducing drugs such as rifampicin, carbamazepine, phenytoin and St John's wort

Induction of CYP3A4 accelerates clearance of contraceptive steroids enough to cause failure, and the effect persists for weeks after the inducer stops. Additional or alternative contraception is required, and for long-term inducers a method not dependent on hepatic metabolism, such as an intrauterine device or depot injection, is preferred. The general antibiotic interaction was withdrawn for lack of evidence.