B8-012 Contraception Flashcards by Felicia Jones

progestin inhibits ovulation by […] suppression

How well did you know this?

Not at all

Perfectly

[…] thickens the cervical mucus, preventing sperm transport

progestin

How well did you know this?

Not at all

Perfectly

what type of contraception is contraindicated in patients who experience migraine with aura?

combined hormonal contraception (CHC)

(vision changes, numbness, parasthesias)

How well did you know this?

Not at all

Perfectly

what schedule of combined oral contraceptive pills have been shown to have improved efficacy?

shortened hormone free week
(24 days on 4 days off)

How well did you know this?

Not at all

Perfectly

what would an ideal OCP look like?

30 mcg EE + levonorgestrel
shortened/erased placebo week
monophasic

How well did you know this?

Not at all

Perfectly

CHC patches may have lower efficacy in what patient populations?

obese patients

How well did you know this?

Not at all

Perfectly

NuvaRing lasts […] month(s)

one

*new ring every month

How well did you know this?

Not at all

Perfectly

Annovera (contraceptive ring) lasts […] month(s)

*same ring for 12 months, in for 24 days out for 4

How well did you know this?

Not at all

Perfectly

what forms of CHC can be used continuously?

ring and pill

How well did you know this?

Not at all

Perfectly

what forms of CHC cannot be used continuously?

patch

How well did you know this?

Not at all

Perfectly

breast cancer in CHC users usually occurs in women in what age range?

40s

(RR of breast cancer due to CHC use is very low)

How well did you know this?

Not at all

Perfectly

patients who use estrogen containing contraception have lower rates of what cancers? [3]

ovarian
colon
endometrial

How well did you know this?

Not at all

Perfectly

there is a known causal link between estrogen and what chronic disease?

hypertension

How well did you know this?

Not at all

Perfectly

CHCs raise systolic BP by […] mmhg and diastolic by […]mmhg

CHCs raise systolic BP by [8] mmhg and diastolic by [6]mmhg

How well did you know this?

Not at all

Perfectly

what type of contraception is contraindicated in patients with hypertension?

CHC

(increased risk of MI, ischemic stroke)

How well did you know this?

Not at all

Perfectly

do progestin only contraceptives still carry risk of VTE?

(suitable option for women with hx/risk factors of VTE)

How well did you know this?

Not at all

Perfectly

progestin only pills (POPs) [2]

norethindrone (micronor)
drospirenon (slynd)

How well did you know this?

Not at all

Perfectly

[norethindrone vs drospirenon]
primary mechanism: cervical mucus thickening

norethindrone (POP)

How well did you know this?

Not at all

Perfectly

[norethindrone vs drospirenon]
primary mechanism: inhibits ovulation

drospirenon (POP)

How well did you know this?

Not at all

Perfectly

[norethindrone vs drospirenon]
requires extremely punctual dosing

if the dosing is more than 3 hrs late, need to use a backup for 48 hrs

norethindrone (POP)

How well did you know this?

Not at all

Perfectly

[norethindrone vs drospirenon]
window for missed pill is 24 hours

drospirenon (POP)

How well did you know this?

Not at all

Perfectly

how can you be “reasonably sure” a patient is not pregnant?

actively menstruating
hasn’t had sex since last period
reliably using a form of birth control
within 7 days of spontaneous or induced abortion
4 weeks postpartum
fully or nearly fully breastfeeding

How well did you know this?

Not at all

Perfectly

what are the risks of giving progesterone/estrogen in pregnancy?

none

(so can start any form of hormonal contraception and do a pregnancy test in 2-4 weeks if unsure a patient is pregnant; cannot use IUD though)

How well did you know this?

Not at all

Perfectly

why are women with obesity are at a higher risk of endometrial cancer? [2]

increased peripheral conversion of estrogen
higher rates of anovulation

(contraception offsets risk)

How well did you know this?

Not at all

Perfectly

IUDs decrease the risk of [...] cancer

endometrial

what type of IUD actually reverses 90% of benign endometrial hyperplasia?

LNG-IUD

52 mg LNG IUD (mirena) is now approved for [...] years of use

20% of patients with the 52 mg LNG IUD (mirena) experience [...] at one year

amenorrhea

recent data supports the copper IUD is effective for [...] years

data suggests the copper IUD is effective through menopause if placed after age [...]

most common reasons patients stop using progestin implant (Nexplanon)

irregular bleeding

bleeding with the progestin implant (nexplanon) is highest in the [...] months

first three (decreases over the first year, plateaus in year 2/3)

most effective form of reversible, prescription contraceptive

progestin implant (nexplanon)

injection (depo-provera) is administered every [...] weeks

12-13 grace period up to 15

side effect of depo is delayed fertility. it may take [...] months for fertility to return

9-10

patients who use depo-provera experience a bone mineral density loss of 1-2% per year. Because of this, the FDA recommends use is limited to [...]

2 years (BUT: ACOG and WHO disagree, no evidence of increased fx risk and reverses within 12 months)

MOA spermicidal

copper IUD

MOA changes cervical mucus [2]

LNG IUD northindrone (POP)

MOA inhibits ovulation [4]

implant (nexplanon) DMPA (depo-provera) drospirenon (POP) CHC (pill/patch/ring)

common side effect is heavier menses

copper IUD

common side effect is light/rare/absent menses

LNG IUD

common side effect is light/rare/absent menses/ **irregular** bleeding

progestin implant | nexplanon

common side effect is light/rare/absent menses/ **irregular** bleeding and possible **weight gain**

DMPA (depo-provera)

common side effect is lighter menses

POP

common side effect is lighter menses, HA, nausea, breast tenderness

CHC (pill/patch/ring)

good up to 10 years (FDA), 12 yrs (evidence)

copper IUD

good 3-8 years (FDA)

LNG IUD

good for up to 3 yrs (FDA), 5 yrs (evidence)

progestin implant | nexplanon

taken every 3 months

DMPA (depo-provera)

taken daily [2]

POPs CHC pill

taken weekly

CHC patch

taken monthly

CHC ring

minimum exam requirements for IUD placement

pelvic exam, exclude pregnancy

minimum exam requirements before prescribing any contraceptive with estrogen

blood pressure

CHC can be used to treat what medical symptoms/problems? [4]

menorrhagia dysmenorrhea acne/hirsutism endometriosis

common side effects of estrogen containing contraception [3]

headache nausea breast tenderness

when do the common side effects of estrogen containing contraception typically resolve?

after 1-2 cycles

[...] will improve acne, decrease menstrual flow, and regulate menstrual cycles

CHC

CHC [...] will result in lighter menses, but continuous use is not recommended so the patient will have a monthly period

patch

what method of contraception is most consistently associated with weight gain?

depot (5-6 kg over 3-5 years)

weight gain within the first [...] months of use has been shown to predict future weight gain with depot

6 months

if the CHC patch falls off, what should the patient do?

replace the patch hormones are delivered through the adhesive

the patch is NOT recommended to be placed where on the body?

breasts can be on back, abdomen, buttocks

hypertension is a direct contraindication to what types of contraception?

estrogen containing

associated with delay in return to fertility, 9-10 months after stopping

DMPA (related to IM route of administration)

DMPA is administered every [...]

12-13 weeks grace period through 15 weeks

in evaluating risk of contraceptive methods for a patient, it is important to weight the risks of the method against [...]

pregnancy

B8-012 Contraception Flashcards

(67 cards)