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TN Gyneco > 8. Contraceptions > Flashcards

8. Contraceptions Flashcards

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1
Q

Name types of contraceptive methods (6)

A
  • Physiological
  • Barrier methods
  • Hormonal
  • Copper IUD
  • Surgical
  • Emergency Postcoital Contraception (EPC)
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2
Q

Name Physiological contraceptive methods (5)

A
  • Withdrawal/coitus interruptus
  • Rhythm method/calendar/mucus/symptothermal
  • Lactational amenorrhea
  • Chance – no method used
  • Abstinence of all sexual activity
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3
Q

Name barrier contraceptive methods (6)

A
  • Condom alone
  • Spermicide alone
  • Sponge – Parous - Nulliparous
  • Diaphragm with spermicide
  • Female condom
  • Cervical cap – Parous - Nulliparous
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4
Q

Name hormonal contraceptive methods (7)

A
  • OCP
  • Nuva Ring®
  • Transdermal (Ortho Evra®)
  • Depo-Provera®
  • Progestin-only pill (Micronor®)
  • Mirena® interauterine system (IUS)
  • Jaydess® interauterine system (IUS)
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5
Q

Name surgical contraceptive methods (2)

A
  • Tubal ligation
  • Vasectomy
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6
Q

Name Emergency Postcoital Contraception (EPC) (4)

A
  • Yuzpe® method
  • “Plan B” levonorgestrel only
  • Postcoital interauterine system IUD
  • Ella
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7
Q

Name: Combined Oral Contraceptive Pills (5)

A
  • progestin
  • estrogen
  • most contain low dose ethinyl estradiol (20-35 µg) plus progestin (norethinedrone, norgestrel, levonorgestrel, desogestrel, norgestimate, drospirenone)
  • failure rate (0.3% to 8%) depending on compliance
  • monophasic or triphasic formulations (varying amount of progestin throughout cycle)
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8
Q

Describe action of progestin as Combined Oral Contraceptive Pills (5)

A
  • prevents LH surge
  • suppresses ovulation
  • thickens cervical mucus
  • decreases tubal motility
  • decidualizes endometrium
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9
Q

Describe action of estrogen as Combined Oral Contraceptive Pills (2)

A
  • suppresses FSH and follicular development
  • causes endometrial proliferation
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10
Q

Describe: Transdermal (Ortho Evra®) (6)

A
  • continuous release of 6 mg norelgestromin and 0.60 mg ethinyl estradiol into bloodstream
  • applied to lower abdomen, back, upper arm, buttocks, NOT breast
  • worn for 3 consecutive weeks (changed every wk) with 1 wk off to allow for menstruation
  • as effective as OCP in preventing pregnancy (>99% with perfect use)
  • may be less effective in women >90 kg
  • may not be covered by drug plans
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11
Q

Describe: Contraceptive Ring (Nuva Ring®) (6)

A
  • thin flexible plastic ring
  • releases etonogestrel 120 µg/d and estradiol 15 µg/d
  • works for 3 wk then removed for 1 wk to allow for menstruation
  • as effective as OCP in preventing pregnancy (98%)
  • side effects: vaginal infections/irritation, vaginal discharge
  • may have better cycle control; i.e. decreased breakthrough bleeding
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12
Q

Describe Starting Hormonal Contraceptives (4)

A
  • thorough history and physical exam, including blood pressure and breast exam
  • can start at any time during cycle but ideal if within 5 d of last menstrual period (LMP)
  • follow-up visit 6 wk after hormonal contraceptives prescribed
  • pelvic exam not required as STI screening can be done by urine and pap smear screening does not start until >21 yr
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13
Q

Name advantages: Combined Estrogen and Progestin Contraceptive Methods (10)

A
  • Highly effective
  • Reversible
  • Cycle regulation
  • Decreased dysmenorrhea and heavy menstrual bleeding (less anemia)
  • Decreased benign breast disease and ovarian cyst development
  • Decreased risk of ovarian and endometrial cancer
  • Increased cervical mucus which may lower risk of STIs
  • Decreased PMS symptoms
  • Improved acne
  • Osteoporosis protection (possibly)
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14
Q

Name estrogen-related side effects: Combined Estrogen and Progestin Contraceptive Methods (8)

A
  • Nausea
  • Breast changes (tenderness, enlargement)
  • Fluid retention/bloating/edema
  • Weight gain (rare)
  • Migraine, headaches
  • Thromboembolic events
  • Liver adenoma (rare)
  • Breakthrough bleeding (low estradiol levels)
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15
Q

Name Progestin-related side effects: Combined Estrogen and Progestin Contraceptive Methods (9)

A
  • Amenorrhea/breakthrough bleeding
  • Headaches
  • Breast tenderness
  • Increased appetite
  • Decreased libido
  • Mood changes
  • HTN
  • Acne/oily skin*
  • Hirsutism*
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16
Q

How can androgenic side effects of progestin-related contraceptive method may be minimized? (4)

A

by prescribing formulations containing

  • desogestrel
  • norgestimate
  • drospirenone
  • or cyproterone acetate
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17
Q

Name absolute contraindications: Combined Estrogen and Progestin Contraceptive Methods (9)

A
  • Known/suspected pregnancy
  • Undiagnosed abnormal vaginal bleeding
  • Prior thromboembolic events, thromboembolic disorders (Factor V Leiden mutation; protein C or S, or antithrombin III deficiency), active thrombophlebitis Cerebrovascular or coronary artery disease
  • Estrogen-dependent tumours (breast, uterus)
  • Impaired liver function associated with acute liver disease
  • Congenital hypertriglyceridemia
  • Smoker age >35 yr
  • Migraines with focal neurological symptoms (excluding aura)
  • Uncontrolled HTN
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18
Q

Name relative contraindications: Combined Estrogen and Progestin Contraceptive Methods (7)

A
  • Migraines (non-focal with aura <1 h)
  • DM complicated by vascular disease
  • SLE
  • Controlled HTN
  • Hyperlipidemia
  • Sickle cell anemia
  • Gallbladder disease
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19
Q

What can decrease efficacy of combined estrogen and progestin contraceptive method, requiring use of back-up method? (6)

A
  • Rifampin
  • phenobarbital
  • phenytoin
  • griseofulvin
  • primidone
  • St. John’s wort
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20
Q

Describe: Fetal abnormalities if conceived on OCP (1)

A

No evidence of fetal abnormalities if conceived on OCP

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21
Q

Describe use of oral contraceptive pill and nursing infant and breastfeeding (3)

A
  • No evidence that OCP is harmful to nursing infant
  • but may decrease milk production;
  • not recommended until 6 wk postpartum in breastfeeding and non-breastfeeding moms, ideally ≥3 mo postpartum if BF
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22
Q

Describe link between irregular breakthrough bleeding and OCP (2)

A
  • Irregular breakthrough bleeding often occurs in the first few months after starting OCP
  • usually resolves after three cycles
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23
Q

Name Active Compounds (estriol and progestin derivative): Alesse® (2)

A
  • 20 µg ethinyl estradiol
  • 0.5 mg levonorgestrel
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24
Q

Name advantages: Alesse® (2)

A
  • Low dose (20 µg) OCP
  • Less estrogen side effects
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25
Name disadvantages: Alesse® (2)
* Low-dose pills can often result in breakthrough bleeding * If this persists for longer than 3 mo, patient should be switched to an OCP with higher estrogen content
26
Name Active Compounds (estriol and progestin derivative): Tri-cyclen® (3)
* 35 µg ethinyl estradiol * 0.180/0.215/0.250 mg norgestimate * Triphasic oral contraceptive (graduated levels of progesterone)
27
Name advantages: Tri-cyclen® (1)
Low androgenic activity can help with acne
28
Name disadvantages: Tri-cyclen® (1)
Triphasic OCPs not ideal for continuous use \>3 wk in a row (unlike monophasic formulation)
29
Name Active Compounds (estriol and progestin derivative): Yasmin® and Yaz® (3)
* Yasmin®: 30 µg ethinyl estradiol * + 3 mg drospirenone (a new progestin) Yaz®: 20 µg ethinyl estradiol + 3 mg drospirenone – 24/4-d pill (4 d pill free interval) * Drospirenone has antimineralocorticoid activity and antiandrogenic effects
30
Name advantages: Yasmin® and Yaz® (3)
* Decreased perception of cyclic weight gain/bloating * Fewer PMS symptoms * Improved acne
31
Name disadvantages: Yasmin® and Yaz® (3)
* Hyperkalemia (rare, contraindicated in renal and adrenal insufficiency) * Check potassium if patient also on ACEI, ARB, K+-sparing diuretic, heparin * Continue use of spironolactone
32
Name indications: Progestin Only Contraceptive Methods (3)
* Suitable for postpartum women (does not affect breast milk supply) * Women with contraindications to combined OCP (e.g. thromboembolic or myocardial disease) * Women intolerant of estrogenic side effects of combined OCPs
33
Describe mechanism of action: Progestin Only Contraceptive Methods (5)
* Progestin prevents LH surge * Thickening of cervical mucus * Decrease tubal motility * Endometrial decidualization * Ovulation suppression – oral progestins (not IM) do not consistently suppress compared to combined OCPs
34
Name side effects: Progestin Only Contraceptive Methods (8)
* Irregular menstrual bleeding * Weight gain * Headache * Breast tenderness * Mood changes * Functional ovarian cysts * Acne/oily skin * Hirsutism
35
True or false ## Footnote Progestin only contraceptives must be taken at the same time every day
True
36
What to do with combined OCP if miss 1 pill in \<24h (1)
* Take 1 pill ASAP, and the next pill at the usual time
37
What to do with combined OCP if miss _\>_1 pill in a row in 1st wk (2)
* Take 1 pill ASAP, and continue taking one pill daily until the end of the pack * Use back-up contraception for 7 d; emergency postcoital contraception EPC
38
What to do with combined OCP if miss \<3 pills in 2nd or 3rd wk of cycle (4)
* Take 1 pill ASAP, and continue taking one pill daily until the end of the pack * Do not take placebo (28-d packs) or do not take a hormone free interval (21-d packs) * Start the next pack immediately after finishing the previous one * No need for back-up contraception
39
What to do with combined OCP if miss ≥3 pills during the 2nd or 3rd wk (4)
* Take 1 pill ASAP, and continue taking one pill daily until the end of the pack * Do ot take placebo (28-d packs) or do not take a hormone free interval (21-d packs) * Start the next pack immediately after finishing the previous one * Use back-up contraception for 7 d; EPC may be necessary
40
Name: SELECTED EXAMPLES OF PROGESTIN-ONLY METHODs (2)
* Progestin-Only Pill (“minipill”): Micronor® 0.35 mg norethindrone * Depo-Provera®
41
Describe: Progestin-Only Pill (“minipill”) (6)
* Micronor® 0.35 mg norethindrone * must be taken daily at same time of day to ensure reliable effect; no pill free interval * higher failure rate (1.1-13% with typical use, 0.51% with perfect use) than other hormonal methods * ovulation inhibited only in 60% of women; most have regular cycles (but may cause oligo/amenorrhea) * highly effective if also post-partum breastfeeding, or if \>35 yr * relies on the progestin effects on the cervical mucous and endometrial lining
42
Describe: Depo-Provera® (8)
* **injectable** depot **medroxyprogesterone** **acetate** * **dose 150 mg IM q12-14wk** (convenient dosing) * **initiate ideally within 5 d of beginning of normal menses**, immediately postpartum in breastfeeding and non-breastfeeding women. Can consider quick start * **irregular** **spotting** progresses to complete amenorrhea in 70% of women (after 1-2 yr of use) * highly effective 99%; failure rate 0.3% * suppresses ovulation very effectively * side effect: decreased bone density (may be reversible) and weight gain * disadvantage: restoration of fertility may take up to 9 mo
43
What to do if: Missed Progestin-Only Pills \>3 h (1)
Use back-up contraceptive method for at least 48 h; continue to take remainder of pills as prescribed
44
What to do if Missed Depo-Provera:If last injection given 13-14 wk prior (1)
give next injection immediately
45
What to do if Missed Depo-Provera: If \>14 wk prior
* do β-hCG * If β-hCG is positive, give EPC and no injection * If β-hCG is negative, give next injection right away and: * Intercourse occurred in last 5 d: give EPC, use back-up contraception for 7 d ; repeat β-hCG in 3 wk * Intercourse occurred \>5 d ago but within the last 14 d: use back-up contraception for 7 d; repeat β-hCG in 3 wk * Intercourse occurred \>14 d ago: use back- up contraception for 7 d * No evidence of fetal abnormalities if conceived on DMPA
46
Name: interauterine system (IUS)/intrauterine device (IUD) Contraceptive Methods (2)
* Copper-Containing IUD (Nova-T®) * Progesterone-Releasing IUS (MirenaV, Kyleena®, Jaydess®):
47
Describe mechanism of action: Copper-Containing IUD (Nova-T®) (2)
* mild foreign body reaction in endometrium * toxic to sperm and alters sperm motility
48
Describe mechanism of action: Progesterone-Releasing IUS (MirenaV, Kyleena®, Jaydess®) (2)
* decidualization of endometrium and thickening of cervical mucus; * minimal effect on ovulation
49
IUS/IUD Contraceptive Methods last how long? (1)
5 year
50
Name side effects of IUS/IUD Contraceptive Methods (9)
* Both Copper and Progesterone IUD * Breakthrough bleeding * Expulsion (5% in the 1st yr, greatest in 1st mo and in nulliparous women) * Uterine wall perforation (1/1000) on insertion * If pregnancy occurs with an IUD, increased risk of ectopic * Increased risk of PID (within first 10 d of insertion only) * Copper IUD: * increased blood loss and duration of menses * dysmenorrhea * Progesterone IUD: * bloating * headache
51
Name absolute contraindications: Both Copper and Progesterone IUD (4)
* Known or suspected pregnancy * Undiagnosed genital tract bleeding * Acute or chronic PID * Lifestyle risk for STIs\*
52
Name absolute contraindications: Copper IUD (2)
* Known allergy to copper * Wilson’s disease
53
Name relative contraindications: Both Copper and Progesterone IUD (6)
* Valvular heart disease * Past history of PID or ectopic pregnancy * Presence of prosthesis * Abnormalities of uterine cavity, intracavitary fibroids * Cervical stenosis * Immunosuppressed individuals (e.g. HIV)
54
Name relative contraindications: Copper IUD (1)
Severe dysmenorrhea or heavy menstrual bleeding
55
Name: Emergency Contraceptive Methods (4)
* Hormonal: * Yuzpe Method * Plan B * Ulipristal * Non-hormonal: Postcoital IUD (Copper)
56
Describe usage of Yuzpe method (5)
* Used within 72 h of unprotected intercourse; limited evidence of benefit up to 5 d * Ovral® 2 tablets then repeat in 12 h (ethinyl estradiol 100 µg/ levonorgestrel 500 µg) * Can substitute with any OCP as long as same dose of estrogen used * 2% overall risk of pregnancy * Efficacy decreased with time (e.g. less effective at 72 h than 24 h)
57
Describe mechanism of action: Yuzpe method (4)
Unknown; theories include: * Suppresses ovulation or causes * deficient luteal phase * Alters endometrium to prevent implantation * Affects sperm/ova transport
58
Name side effects: Yuzpe method (2)
* Nausea (due to estrogen; treat with Gravol®) * Irregular spotting
59
Name contraindications: Yuzpe method (2)
* Pre-existing pregnancy (although not teratogenic) * Caution in women with contraindications to OCP (although NO absolute contraindications)
60
Describe usage: Plan B (5)
* Consists of levonorgestrel 750 µg q12h for 2 doses (can also take 2 doses together); taken within 72 h of intercourse. * Can be taken up to 5 d * Greater efficacy (75-95% if used within 24 h) and better side effect profile than Yuzpe method but efficacy decreases with time; 1st line if \>24 h * No estrogen thus very few contraindications/side effects (less nausea) * Less effective in overweight individuals (\>75 kg less effective, \>80 kg not recommended)
61
Describe mechanism of action: Plan B (3)
Same as Yuzpe method -\> Unknown; theories include: * Suppresses ovulation or causes deficient luteal phase * Alters endometrium to prevent implantation * Affects sperm/ova transport
62
Name Side Effects: Plan B (2)
Same as Yuzpe method * Nausea (due to estrogen; treat with Gravol®) * Irregular spotting
63
Name Side Effects: Plan B (1)
Pre-existing pregnancy (although not teratogenic)
64
Describe dosage: Ulipristal (1)
30 mg PO within 5 d
65
Describe mechanism of action: Ulipristal (2)
* Selective Progesterone * Receptor Modulator (SPERM) with primarily antiprogestin activity: may delay ovulation by up to 5 d
66
Name side effects: Ulipristal (5)
* Headache * hot flashes * constipation * vertigo * endometrial thickening
67
Name contraindications: Ulipristal (1)
Pre-existing pregnancy (although not teratogenic)
68
Describe follow-up of emergency postcoital contraception (2)
* 3-4 wk post treatment to confirm efficacy (confirmed by spontaneous menses or pregnancy test) * contraception counselling

TN Gyneco (20 decks)

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