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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

Methods that prevent ovulation

A

Combined hormonal contraceptives, contraceptive implant, contraceptive injection

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2
Q

Methods that prevent fertilization

A

Abstinence, fertility awareness methods, intrauterine device, progestin only pill, barrier methods, spermicides, withdraw, sterilization

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3
Q

Methods that prevent implantation

A

Secondary mechanism for hormonal contraception and IUDs

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4
Q

Combined hormonal methods (CHC)

A

Estrogen plus progestin –> prevent ovulation and thicken cervical mucous

Three formations: the pill, transdermal patch, vaginal ring

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5
Q

How does CHC prevent ovulation?

A

Progestin in the dominant hormone –> diminishes frequency of hypothalamic GnRH pulse frequency and inhibits the estrogen induced LH surge at mid-cycle

Estrogen suppresses FSH preventing selection and emergence of dominant follicle

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6
Q

Progestin pill formulations

A

Norethindrone (1st generation)
Norgestimate, desogestrel (3rd gen)
Norgestrel, levonorgestrel (2nd gen)
Drospirenone (4th gen)

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7
Q

How does the combined contraceptive vaginal ring prevent ovulation?

A

Ethylene vinyl acetate ring
Deliveres 15 mcg ethinyl estradiol and 120 mcg etonogestrel
Single ring, vaginally 3 weeks, removed for one week to allow withdrawal bleed

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8
Q

How does the combined transdermal patch prevent ovulation?

A

20cm^2 patch delivers 20 mug of ethanol estradiol and norelgestromin
One patch per week for 3 weeks then one patch free week
Less effective in women >90 kg/m^2
May have higher rate of VTE

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9
Q

How do combined hormonal contraceptives increase the risk of VTE?

A

Increases levels of pro-coagulant factors II, VII, VIII, X and fibrinogen
Decrease anticoagulants protein S, anti-thrombin, and tissue factor pathway inhibitor
Induce resistance to the natural anticoagulant activated protein C

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10
Q

CI to CHC

A 
History of VTE, inherited or acquired thrombophilia
Postpartum - initial 3-6 weeks 
History of MI or CAD
History of cerebrovascular accident
Cigarette smokers > age 35
Complicated diabetes, vascular disease
Severe htn BP > 160/100
Migraine with aura
Severe active liver disease, cirrhosis, history of hepatic adenoma 
Personal history of breast or endometrial cancer
Undiagnosed abnormal uterine bleeding
Pregnancy
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11
Q

Progestin only methods

A

Pills
Injection
Subdermal implant

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12
Q

How do progestin only pills work?

A

Ovulation suppressed in 50% of cycles
Prevent fertilization from thickening of cervical mucus and slowing ovum transport through decreased tubal motility
Possibly prevent implantation from thinning of endometrium
Effects are time dependent – for maximal efficacy needs to be taken at the same time every day
Unscheduled bleeding can occur

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13
Q

How does Depot medroxyprogesterone acetate injections work?

A

Profound ovulation inhibition – slow return to baseline fertility – 7-10 months
Given every 12 weeks
High efficacy
Unscheduled bleeding with trend toward amenorrhea
Reversible decrease in bone density, no evidence of fracture risk
Unaffected by hepatic enzyme inducing drugs
Decreases frequency of seizures and sickle cell crises

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14
Q

How does the contraceptive implant work?

A

Inhibits ovulation
Single rod – contains progestin etonogestrel
Effective for 3 years
Most effective reversible method
Irregular bleeding is most common adverse effect

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15
Q

How are estrogens and progestin metabolized?

A

Hepatic cytochrome p450 3A4

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16
Q

What are some cytochrome p450 3A4 inducing medications?

A 
Rifampin (antibiotic) 
Griseofulvin (antifungal) 
St. Johns Wort
Modafinil 
Some HIV protease inhibitors 
Nevirapine - non-nucleoside reverse transcriptase inhibitor
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17
Q

What are some cytochrome p450 3A4 inducing anti-epileptics?

A

Pheytoin
Carbamazepine
Phenobarbital

Primodone
Topiramate
Felbamat
Vigabatron

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18
Q

What are some anti-epileptics that have no effect on cytochrome p450 3A4?

A

Valproate
Gabapentin
Lamotrigine
Tiagabine

19
Q

How do IUDs work?

A

Highly effective
Two types = Copper and progestin levonorgestrel (5 year and 3 year)
Placed quickly and easily in the office without anesthesia
DO NOT increase risk for infertility
Safe in nulliparous women and teens

20
Q

Mechanism of Copper T IUD

A

Prevents normal fertilization
Cu+ ions reduce motility and viability of sperm, toxic to oocytes

Also inhibits implantation, especially if used for emergency contraception

21
Q

5 year levonorgestrel IUD

A

Prevents fertilization
Thick impenetrable cervical mucus
Sterile inflammatory reaction within uterus
Impaired sperm migration
Highly effective
FDA approved to treat abnormal uterine bleeding

22
Q

3 year levonorgestrel IUD

A 
Mechanism same as 5 year
Smaller size of device and inserter
Contains lower dose of levonorgestrel 
Designed for teens and nulliparous women 
Lower rates of amenorrhea
23
Q

Contraindications to IUD/IUS use

A

Pregnancy
Pelvic inflammatory disease (current or w/i past 3 months)
Current STI
Puerperal or postabortion sepsis current or within the past 3 months
Purulent cervicitis
Undiagnosed abnormal genital bleeding
malignancy of the genital tract
Known uterine anomalies or fibroids distorting the cavity in a way incompatible with IUD insertion
Allergy to any component of the IUD or Wilson’s disease (for copper)

24
Q

How does a male condom work?

A

Prevents fertilization
Reduces risk of STI transmission
Typical use failure rate first year 18%
Perfect use failure rate first year 3%
Latex, polyurethane and natural membrane
3-5% breakage or slippage rate – consider use of emergency contraception as back up
Use only water based lubricants with latex

25
Q

How does a female condom work?

A 
Nitrile sheath with 2 flexible polyurethane rings lined with silicone
Protects against STI 
Single use only 
Do NOT use with male condom
Typical first year failure rate 21%
26
Q

Spermicide

A

Available as creams, gels, film, foam and suppositories containing nonoxynol-9
Used alone or ideally with a barrier method
Typical one year failure rate 28%

27
Q

Sponge

A

Nonoxynol-9 impregnante polyurethane sponge
Should be removed after 24-30 hours due to increased risk of irritation and TSS
Typical failure rate 24% for multiparous and 12% for nulliparous women

28
Q

Diaphragm

A 
Prevents fertilization
Used with spermicide
Multiple sizes
Typical 1 year failure rate 12%
New silicone diaphragm
29
Q

Cervical cap

A 
Silicone cap with outward flared rim
One year typical failure rate 15%
Use with spermicide
Leave in at least 8 hours after intercourse
Do not leave in longer than 48 hours
30
Q

Fertility awareness methods

A

Calendar method
Standard days method
Cervical mucus ovulation detection method
Two day method
Symptom-Thermal method
Sympto-hormonal method (Marquette method)

31
Q

Calendar method

A

Subtract 18 days from shortest cycle and 11 days from longest cycle to calculate fertile window

32
Q

Standard days method

A

Must have regular 26-32 days cycle (80% of women); days 8-19 are fertile days; cumulative probability was 4.75% over 13 cycles with correct use and 12% probability under typical use

33
Q

Cervical mucus method

A

Abstinence or use barrier with onset of cervical secretions until 4th day after last day of peak ovulatory secretions (clear, stretchy, egg white) consistency

34
Q

Two day method

A

Abstain or use barrier if detect cervical secretions of any type TODAY and YESTERDAY

35
Q

Sympto-Thermal method

A

Fertile interval begins with cervical secretions and ends with sustained increased in basal body temp of at least 0.4 degrees for 3 consecutive days following 6 days of lower temperatures

36
Q

Sympto-hormonal method

A

Combines cervical secretion check and detection of urine LH with ovulation predictor device. Fertile period onset of cervical secretions until 3 days after PEAK LH reading

37
Q

Emergency contraception

A

Levonorgestral 1.5 mg tab

Ulipristal acetate 30 mg tab

38
Q

Levonorgestral – emergency contraceptive

A

Used up to 72 hours after unprotected intercourse (Up to 120 hours)
Less effective in women with BMI >30
Effective if taken 2-3 days before LH peak

39
Q

Ulipristal acetate – emergency contraceptive

A

Selective progesterone receptor modulator
Approved for use up to 120 hours after unprotected intercourse
Prevents follicular rupture 100% if taken just prior to LH surge
Prevents follicular rupture or 24-48 hours if taken on day of LH peak

40
Q

What else can be used as emergency contraception?

A

Copper IUD
If placed within 5 days after unprotected intercourse
Copper ions toxic effect on sperm as well as negative effects on oocyte, zygote-morula-blastocyst and endometrium

41
Q

Female sterilization methods

A

Laparoscopy
Mini-laparotomy post partum
Hysteroscopy

42
Q

Male sterilization methods

A

Outpatient office procedure

43
Q

Female sterilization – 10 year failure rates

A 
Postpartum partial salpingectomy 0.8%
Interval laparoscopy with general anesthesia 
--Filshie clips 0.9%
--Silastic ring 1.8%
--Bipolar cautery 2.5%
--Hulka clip 3.7%
44
Q

Hysteroscopic sterilization

A

Expandable outer coil (alloy of nickel, titanium, polyester fibers)
Stainless steel inner coil
Expands to fit contour of tube
Over 3 months tissue grows into the device occluding the tube
0.3% failure rate at 5 years

Repro (20 decks)

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