01b: Contraception

Question 1

Coitus Interruptus refers to which form of contraception? The “typical use” failure is (X)%.

Answer 1

Withdrawal/pulling out

X = 22%

Question 2

List the “female barrier” methods of contraception (equivalent to condom for males)

Answer 2

1. Diaphragm
2. Cervical cap
3. Female condom

Question 3

(X) is a surfactant used for contraception and improve efficacy of barriers if used simultaneously. Failure rates up to (Y)%.

Answer 3

X = spermicide
Y = 30

Question 4

T/F: Spermicide doesn’t prevent HIV transmission

Answer 4

True

Question 5

Sperm lifespain in F genital tract

Answer 5

1-5d

Question 6

Ovulatory window is how many days?

Answer 6

3-5d

Question 7

“Perfect use” failure of Natural Family Planning is (X)%. And “Typical use” failure is (Y)%.

Answer 7

X = 0.4-5
Y = 24

Question 8

Suppression of ovulation in hormonal contraception is the task of (X) hormone

Answer 8

X = progesterone

Question 9

List the roles of progestin in hormonal contraception

Answer 9

1. Inhibit LH surge (ovary and pituitary inhibition)
2. Thicken cervical mucus
3. Endometrial atrophy
4. Cycle control

Question 10

List the roles of estrogen in hormonal contraception

Answer 10

1. Helps inhibit LH surge
2. Thinning of and increase in cervical mucus
3. Endometrial proliferation
4. Cycle control

Question 11

List the combined hormonal contraceptive methods, aside from the “pill”.

Answer 11

The ring (NuvaRing) and the patch

Question 12

Combined hormonal contraceptive methods: Perfect use rate is (X)% and typical use rate is (Y)%.

Answer 12

X = 1-2
Y = 8-9

Question 13

List two findings in patient history that would prevent you from prescribing COC. She would be at very high risk of (X) because of (progestin/estrogen).

Answer 13

1. Smoking over 35y, more than 15/d
2. Migraine with aura
3. History of DVT, stroke, PE, valve disease (or other CV risk factors)

X = stroke, MI
Estrogen

Question 14

How long should a woman wait after birth to be put back on COC (combined oral contraceptives/the pill)?

Answer 14

3 weeks at least

Question 15

T/F: COCs should not be used in breast cancer patients.

Answer 15

True

Question 16

Progestin-only pills for contraception are taken how often?

Answer 16

Every day - at same time

Question 17

T/F: Progestin-only pills are contraindicated in women with vascular disease.

Answer 17

False - generally not

Question 18

Depot medroxyprogesterone acetate (DMPA) is administered via (X) route how often?

Answer 18

X = IM injection (at health care location)

Every 12 weeks

Question 19

Depot medroxyprogesterone acetate (DMPA) has which key adverse effects/contraindications?

Answer 19

Significant weight gain; very few medical/drug interaction contraindications

Question 20

Which contraceptive method has the best efficacy (lowest failure rate at 0.01%)?

Answer 20

Subdermal implant (Nexplanon; progestin-only)

Question 21

Perfect failure of Levonorgestrel IUD is (X)%. Typical failure is (Y)%.

Answer 21

X = Y = 0.2

Question 22

T/F: Primary mechanism of contraception by Levonorgestrel IUD is preventing LH surge.

Answer 22

False - cervical mucus thickening (via progesterone)

Question 23

Primary mechanism of contraception by Cu IUD is:

Answer 23

Cu is spermicidal and inhibits fertilization

Question 24

Perfect failure of Cu IUD is (X)%. Typical failure is (Y)%.

Answer 24

X = Y = 0.8

Question 25

T/F: Cu IUD can be used by essentially any woman since there are no hormones released.

Answer 25

True

Question 26

Plan B is a high dose of (X) with (Y)% effectiveness

Answer 26

``` X = progesterone (levonorgestrel) Y = 60-80 (depending on timing) ```

Question 27

In U.S., abortion is legal up until (X) weeks gestation

Answer 27

X = 24

Question 28

Medical abortion can be performed up until (X) weeks gestation using which medications?

Answer 28

X = 10 Mifespristone (anti-progesterone) and misoprostol (prostaglandin analogue)

Question 29

2nd trimester abortion can be carried out via:

Answer 29

1. Meds (induced labor) | 2. Dilation and evacuation

Question 30

Vaginal ring embedded with which hormones? It's labeled for (X) day use.

Answer 30

Etonogestrel (progestin) and estrogen; | X = 21

Question 31

All forms of contraception in (X) category result in menstrual disruption (amenorrhea, spotting, prolonged bleeding).

Answer 31

X = progestin-only

Question 32

Contraception: Primary reason for discontinuation of Nexplanon

Answer 32

Menstrual disruption (amenorrhea, spotting, prolonged bleeding); progestin-only implant

Question 33

T/F: Majority of women having abortions are in 20-30yo age range.

Answer 33

True

Question 34

Approximate gestational sac size at 6 weeks gestation.

Answer 34

Size of dime

Question 35

Approximate gestational sac size at 8 weeks gestation.

Answer 35

Size of quarter

Question 36

Approximate gestational sac size at 7 weeks gestation.

Answer 36

Size of nickel

Question 37

Complications of surg abortion:

Answer 37

1. Bleeding 2. Infection/Retained products (endometritis) 3. Uterine perforation

Question 38

22 yo woman presents with pelvic pain/pressure and U/S shows massive blood clot in uterus. If this is complication of a recent procedure she had, what is it and which procedure?

Answer 38

Surgical abortion Hematometra (blood collecting in uterus); Rx is to suction contents

Question 39

Laminaria is used in abortion procedures for which purpose?

Answer 39

Prep cervix for dilation (slowly expands via moisture absorption over 6+ hours)

Question 40

Dilapan is used in abortion procedures for which purpose?

Answer 40

Prep cervix for dilation (synthetic)