Incomplete - 206 - Use of Hormonal Contraception in Women with Coexisting Medical Conditions

Question 1

MEC categories and meaning

Answer 1

1 - no restrictions
2 - benefits > risks
3 - risks > benefits
4 - unnaceptable

Question 2

Which coagulation factors does estrogen increase?

Answer 2

VII, X and fibrinogen

Question 3

Risk of estrogen contraception in causing VTE compared to pregnancy

Answer 3

1/2 the risk

Question 4

What is the MEC for estrogen contraception if previous provoked DVT

Answer 4

3

could also use if risk of recurrence but for example on anticoagulation and getting hemorrhagic cysts

Question 5

How long does it take to reverse the hypercoaguable state induced by combined contraception?

Answer 5

4-6 weeks.

It is category 4 if there is a major surgery planned with prolonged immobilization

Question 6

What is the amount of ethinyl estradiol in patch compared to pills?

Answer 6

More total in patch but lower peaks

Question 7

Factors making COC category 3 or 4

Answer 7

• smoking over 35yo
• <21 PP or 21-42d PP with other RF (>35yo, thrombophilia, prior VTE, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI >30, PPH, post-cesarean, PEC, smoking
• major surgery of prolonged immobilization
• hx DVT/PE
• IBD with active or extensive disease, surgery, immobilization, steroids, vitamin deficiencies, or fluid depletion
• SLE with positive of unknown antiphospholopid antibodies
• superficial venous thrombosis (now or hx)

Question 8

At what level of ethinyl estradiol does VTE risk decrease?

Answer 8

50mcg

Question 9

What is the difference between old progestins (levonorgestrel, norethindrone) and new progestins (desogestrel, drospirenone) on VTE risk?

Answer 9

Same

Question 10

Which progestin only method is category 3 for hx of IHD or stroke and why?

Answer 10

DMPA due to hypoestrogenic effects and increased total cholesterol levels

Question 11

MEC of progestin only for hx VTE?

Answer 11

2 for initiating

3 for continuing if VTE, ischemic cardiac event, or stroke occur while on them

Question 12

MEC for COC and P-only contraception with inherited thrombobphilias

Answer 12

COC - 4

P only - 2

Question 13

For breast-feeding exclusive mothers, how long can lactational amenorrhea be considered a method of contraception?

Answer 13

6 months

Question 14

How soon after birth can non-breastfeeding mothers ovulate?

Answer 14

3 weeks (usually 6+)

Question 15

MEC for COC use in SLE by risk factors:

Answer 15

• Antibody positive = 4

- plt <50k or immunosuppression = 2 (unless CV risk factors)

Question 16

Risk of MI in SLE patients?

Answer 16

50x baseline

Question 17

MEC for progestin contraception in SLE by risk factors:

Answer 17

• antibody positive = 3

- Plt <50k or immunosuppression = 2 ***(except INITIATION of DMPA = 3 for low plt due to risk of irregular bleeding)

Question 18

What should you do for SLE pts before initiating contraception?

Answer 18

Check antibodies