Chapter 47: Contraception & Infertility Flashcards
(142 cards)
1
Q
How long is a normal menstrual cycle?
A
23-35 days (28 average)
2
Q
When is day one of the menstrual cycle counted?
A
The start of menses (bleeding)
3
Q
What is the follicular phase of the menstrual cycle?
A
The follicular phase is characterized by a surge in estrogen, which causes LH and FSH to increase.
4
Q
What is the ovulatory phase in the menstrual cycle?
A
The LH surge triggers ovulation.
5
Q
Once the egg (oocyte) is released after the LH surge, how long does the egg live?
A
24 hrs.
6
Q
What do ovulation kits predict?
A
Ovulation kits predict the best time for intercourse based on ovulation in order to get pregnant.
7
Q
What do ovulation kits test for?
A
These kits test for LH in the urine and are positive if LH is present.
8
Q
When should a person wishing to get pregnant have intercourse?
A
A person wishing to get pregnant should have intercourse when the LH surge is detected and for the following 2 days.
9
Q
Which hormone presents in the urine as a sign of pegnancy?
A
human chorionic gonadotropin (hCG)
10
Q
When is the hCG level the highest in urine and is the best testing time?
A
In the morning
Morning urine is typically more concentrated, making it the best time for testing.
11
Q
Folic acid should be taken to help prevent birth defects of the ____
A
brain and spinal cord (neural tube defects)
Neural tube defects are serious conditions that occur when the neural tube, which forms the brain and spinal cord, does not close properly during early development.
12
Q
What is the recommended dietary folate per day for any adults?
A
400 mcg per day
13
Q
What is the recommended dietary folate per day during pregnancy?
A
600 mcg DFE/day
DEF: dietary folate equivalent
14
Q
What is one key recommendation for preconception health?
A
Increase folic acid intake
Folic acid is important for reducing the risk of neural tube defects in developing embryos.
15
Q
Name two substances to avoid for better preconception health.
A
- Smoking
- Elicit drugs
- Excessive alcohol
Avoiding these substances can help improve overall health and reproductive outcomes.
16
Q
What is the only reversible contraceptive method that has a delay in return to fertility?
A
Medroxyprogesterone injection
This method is known to prolong the time it takes for fertility to return after discontinuation.
17
Q
Which form of contraceptive can protect against many STDs?
A
Condoms (only if latex or synthetic)
Condoms are effective in reducing the risk of sexually transmitted infections (STIs) when used correctly and consistently.
18
Q
What are non-pharmacologic methods can be used to avoid pregnancy?
A
- Keeping track of body temperature and cervical mucus
- Barrier methods (Diaphragms, caps, condoms)
19
Q
Fill in the blank: Tracking _______ is used to predict ovulation.
A
basal body temperature
20
Q
What types of lubricants are recommended to use with condoms?
A
Water or silicone-based lubricants are recommended.
Oil-based lubricants should not be used as they can cause condoms to break.
21
Q
What spermicide is contained in foams, film, creams, suppositories, sponges, and jelly contraceptives?
A
Nonoxynol-9
22
Q
What do hormonal contraceptives inhibit?
A
The production of FSH and LH
23
Q
What is the primary effect of hormonal contraceptives on ovulation?
A
Prevents ovulation
24
Q
What are the available treatments for hormonal contraception?
A
Progestin-only options and estrogen/progestin combinations
25
Which forms of contraceptives are included in CHC?
* Combination oral contraceptives (COCs)
* Patch
* Vaginal ring
## Footnote
All forms contain hormones similar to pill formulations.
26
What health benefits do hormonal contraceptives provide?
* Decrease in menstrual pain
* Decrease in menstrual irregularity
* Relief from endometriosis pain
* Improvement in acne
* Decreased risk of ectopic pregnancy
* Reduced risk of noncancerous breast cysts/lumps
* Lower risk of endometrial/ovarian cancer
## Footnote
Hormonal contraceptives have multiple health benefits beyond contraception.
27
What does the FDA require to be dispensed with oral contraceptives?
Patient Package Insert (PPI)
## Footnote
The PPI includes important safety information and instructions on proper use.
28
What is the primary estrogen found in most combination oral contraceptives (COCs)?
Ethinyl estradiol (EE)
## Footnote
Ethinyl estradiol is a synthetic form of estrogen used in many hormonal contraceptives.
29
What is a monophasic COC?
A COC with the same dose of estrogen and progestin throughout the pill pack
## Footnote
This formulation provides a consistent hormone level.
30
How do biphasic, triphasic, and quadriphasic COCs differ from monophasic COCs?
They mimic the estrogen and progesterone levels during a menstrual cycle with varying hormone doses
## Footnote
The number in the name indicates how many times the hormone levels change.
31
What is the unique characteristic of drospirenone as a progestin?
It is a mild potassium-sparing diuretic with antimineralocorticoid activity
## Footnote
This helps reduce bloating and PMS symptoms.
32
What benefits are associated with drospirenone-containing COCs?
Reduced bloating, PMS symptoms, weight gain, and acne
## Footnote
Drospirenone has anti-androgenic activity, contributing to these benefits.
33
Name three other progestins with low androgenic activity.
* Norgestimate
* Desogestrel
* Dienogest
## Footnote
These progestins are used in various contraceptive formulations to minimize androgenic side effects.
34
What are COCs used for besides pregnancy?
Dysmenorrhea, PMS, acne in females, anemia, etc.
35
What is the first line treatment for PCOS to regulate menses?
COCs
36
What is the first-line treatment for endometriosis?
COCs
37
What is indicated for heavy menstrual bleeding (menorrhagia)?
1. Natazia (COC)
2. Mirena (a levonorgestrel IUD)
38
POPs prevent pregnancy by ___
suppressing ovulation
39
POPs are primarily used in which patients?
breastfeeding
40
What decreases milk production in lactating women?
Estrogen
41
POPs pill must be taken within ___ hours of the scheduled time.
3
42
What other conditions can POPs be used for?
migraine with aura ppx
43
Who should NOT use the contraceptive patch?
Patients with clotting risk factors
## Footnote
Higher systemic estrogen exposure.
44
What is a specific contraindication for women using the contraceptive patch?
Women over 35 years who smoke
&
BMI >= 30
## Footnote
Increased risk due to higher estrogen exposure.
45
What is the effectiveness of the Xulane patch in women over 198 lbs (90 kg)?
The Xulane patch is less effective in women over 198 lbs.
46
What is the active ingredient in the injection known as Depo-Provera?
Depot medoxyprogesterone acetate (DMPA)
## Footnote
DMPA is a synthetic form of the hormone progesterone.
47
How often is the Depo-Provera injection administered?
Every 3 months
## Footnote
This schedule is crucial for maintaining effective contraception.
48
What are the two methods of administration for Depo-Provera?
IM (intramuscular) or SC (subcutaneous) injection
## Footnote
The choice between IM and SC may depend on patient preference or clinical considerations.
49
What is the typical duration of most COC formulations?
28 days
## Footnote
This includes 4 weeks of pills.
50
How many active hormone pills are usually contained in COC formulations?
21 - 24 pills
## Footnote
The remaining pills contain no hormone.
51
What occurs during the week of inactive pills in COC use?
Bleeding (menses) occurs for 3 - 7 days.
52
What is the schedule for extended-cycle COCs?
84 days of active hormonal pills followed by 7 days of inactive or very low-dose estrogen pills.
53
How often does bleeding occur with extended-cycle COCs?
Every 3 months.
54
What is the effect of taking continuous contraception?
It is possible to suppress menses altogether.
55
What is Amethyst approved for?
Continuous contraception.
56
What is a common issue with continuous contraception?
Spotting (breakthrough bleeding).
57
What can lead to discontinuation of continuous contraception?
Breakthrough bleeding.
58
How long does it typically take for breakthrough bleeding to resolve with continuous use?
3 - 6 months.
59
What does 'Lo' indicate in contraceptive names?
≤ 35 mcg of estrogen
## Footnote
Less estrogen can lead to fewer estrogenic side effects.
60
What does 'Fe' signify in contraceptive products?
An iron supplement is included
## Footnote
Example: Microgestin Fe 1/20.
61
What does '24' indicate in a contraceptive pill?
Shorter placebo time: 24 active + 4 placebo
## Footnote
Example: Minastrin 24 Fe.
62
What does 'Pro' indicate in contraceptive names?
A progestin is included in the product
## Footnote
Example: Depo-Provera.
63
Give examples of Monophasic Formulation.
* Junel 1/20
* Microgestin Fe 1/20
* Sprintec 28
* Loestrin 1/20
* Yasmin 28
* Yaz
* Lo Loestrin Fe
## Footnote
Contains 1 mg norethindrone and 20 mcg EE.
64
What does a 24/2/2 pill pack contain?
## Footnote
What is an example?
24 active combined hormonal pills, 2 pills of just EE, and 2 inactive pills.
## Footnote
Lo Loestrin Fe
65
Name a common Drospirenone Containing Formulation.
Yasmin 28
## Footnote
Other examples include Yaz, Loryna, and Beyaz.
66
What is the application schedule for the transdermal patch?
Apply once weekly for 3 weeks, then off in week 4.
67
What is unique about Annovera?
It is a reusable vaginal ring used for 1 year.
68
What is the injection used in progestin-only contraception?
Depo-Provera.
69
What is a key feature of Slynd?
It is a drospirenone-only pill.
70
What does Opill allow for in terms of prescription?
Approved for use without a prescription.
71
Which brand of COC is an extended cycle formulation?
Seasonique
72
Which brands of contraception are POPs?
Errin, Camilla, Nora-BE
73
What are common side effects of estrogen?
Nausea, breast tenderness/fullness, bloating, weight gain, elevated BP
74
What can COC formulations with less estrogen lead to?
breakthrough bleeding
## Footnote
Breakthrough bleeding refers to unexpected bleeding that occurs between menstrual periods while using hormonal contraceptives.
75
What serious adverse effects can estrogen cause?
**Thrombosis**, including heart attack, stroke, deep vein thrombosis (DVT), pulmonary embolism (PE).
## Footnote
Serious adverse effects are rare.
76
What does the acronym ACHES stand for in relation to estrogen side effects?
Abdominal pain, chest pain, headaches, eye problems, swelling or sudden leg pain.
77
What side effects can progestin cause?
Breast tenderness, headache, fatigue, depression.
78
Why should drospirenone be avoided in certain women?
It has a slightly higher risk of clotting and should not be used in women with clotting risk.
79
What should women take to mitigate bone density loss?
Adequate calcium and vitamin D.
80
What can cause spotting in hormonal contraceptive users?
Missing a pill, leading to a fast drop in estrogen.
81
If spotting persists and the current estrogen dose is **< 30 mcg**, what should be done?
Increase estrogen dose.
82
If spotting persists and the current estrogen dose is **≥ 30 mcg**, what should be tried?
Try a different progestin.
83
What is a boxed warning for all CHC products?
Do not use in women > 35 years old who smoke due to risk of serious cardiovascular events.
84
What is a boxed warning for the estrogen + progestin transdermal patch?
Do not use in women with a BMI ≥ 30 kg/m² due to increased risk of thromboembolism or decreased efficacy.
85
What is a boxed warning for Depo-Provera?
Loss of bone mineral density with long-term use.
86
In what conditions should estrogen not be used?
History of DVT/PE, stroke, CAD, thrombosis of heart valves, acquired hypercoagulopathies, certain cancers, liver disease, uncontrolled hypertension, severe headaches/migraines with aura, diabetes with vascular disease, unexplained uterine bleeding.
87
What type of contraception is preferred for patients with migraine and aura?
Progestin-only or nonhormonal method
## Footnote
Estrogen should not be used in these cases.
88
Which progestin is recommended for patients with hirsutism?
Norgestimate (e.g., Sprintec 28) or drospirenone (e.g., Yaz, Yasmin)
## Footnote
These have lower or no androgenic activity.
89
What is the contraception recommendation for patients in postpartum?
Choose progestin-only (e.g., POPs) or nonhormonal method.
90
What type of oral contraceptive is preferred for heavy menstrual bleeding?
Monophasic COC - extended cycle or continuous with drospirenone
## Footnote
Natazia (a COC) and Mirena (a levonorgestrel-releasing IUD) are also indicated.
91
True or False: Estrogen formulations are contraindicated if blood pressure is uncontrolled.
True
92
What should be done if a patient wishes to avoid monthly cycles?
Use extended (91-day) or continuous formulations
## Footnote
Alternative: monophasic 28-day formulation and skip placebo pills.
93
Name drugs that can decrease hormonal contraception efficacy.
* Rifampin
* St. John's wort
* Anticonvulsants (e.g., carbamazepine, phenytoin, oxcarbazepine, primidone, topiramte)
* Ritonavir
* Smoking tobacco
94
What is the recommendation for using Mavyret with hormonal contraceptives?
Not recommended with any formulation containing > 20 mcg of ethinyl estradiol.
95
What is the risk of Mavyret with any formulation containing > 20 mcg of ethinyl estradiol?
Liver toxicity
96
What is the effect of smoking tobacco on hormonal contraceptives?
It may decrease the efficacy of contraception.
97
How long should a backup contraception method be used after stopping rifampin?
6 weeks
98
What caution should be taken with drospirenone?
Risk of hyperkalemia; caution with other drugs that increase potassium.
99
What is the recommendation for patients with nausea when starting hormonal contraception?
Take at night, with food; consider decreasing estrogen dose or switching to progestin-only method.
100
How many days of hormonal pills are required to achieve contraceptive efficacy with Combination Oral Contraceptives (COCs)?
7 days
## Footnote
Back-up (nonhormonal) contraception is required for the first 7 days unless started within 5 days after the start of a period.
101
What is the best practice recommendation for starting Combination Oral Contraceptives?
Start today (quick start)
## Footnote
This maximizes the time protected from unintended pregnancy.
102
What is the Sunday start method for Combination Oral Contraceptives?
Starts the Sunday after onset of menstruation
## Footnote
This method allows menstruation to occur during the week but may lead to missed doses if refills run out over the weekend.
103
When should Combination Oral Contraceptives be started for immediate protection?
On the first day of menses
## Footnote
No back-up method of birth control is needed if started within 5 days after the start of the period.
104
When can Progestin-Only Pills be started?
At any time
## Footnote
Another method of birth control should be used for the first 48 hours unless within 5 days of the start of menses.
105
What should be done if a missed COC pill is remembered?
Start as soon as remembered
## Footnote
If more than one COC pill is missed, back-up contraception is required for 7 days.
106
What action should be taken if more than one COC pill is missed?
Back-up contraception required for 7 days
## Footnote
If missed pills are in the third week of the cycle, omit the hormone-free week and start the next package of pills immediately.
107
What is the protocol for two missed pills in the second week of COC?
Take the most recent missed pill as soon as possible and discard any other missed pills
## Footnote
Back-up contraception is required for 7 days.
108
What is required if more than two COC pills are missed?
Omit hormone-free week and start next pack immediately
## Footnote
Back-up contraception required for 7 days.
109
What should be done if a Progestin-Only Pill is taken more than 3 hours late?
Take pill as soon as possible and take next dose on schedule
## Footnote
Back-up contraception is required for 48 hours.
110
What is the recommendation regarding emergency contraception (EC) after missed POP pills?
Consider EC if there was unprotected sex in the last 5 days
## Footnote
This is especially relevant if multiple pills were missed.
111
What are the hormonal IUDs brand name?
**Mirena**, Skyla, Kyleena, Liletta
## Footnote
These IUDs contain the progestin levonorgestrel.
112
What is the brand name for the copper- T IUD?
Paragard
113
What is the copper-T IUD used for?
Emergency contraception and/or regular birth control
## Footnote
The copper-T IUD can be used for up to 10 years.
114
What is the implant contraception brand name?
Nexplanon
115
Nexplanon releases ____ for how long?
Etonogestrel for 3 years
116
What are the oral options for emergency contraception?
* Levonorgestrel
* Ulipristal acetate
## Footnote
These are also known as the 'morning after pill.'
117
What is the effectiveness of the copper IUD as emergency contraception?
99.9% effective
## Footnote
Must be placed within 5 days of unprotected intercourse.
118
When should ulipristal acetate be taken?
ASAP, within 5 days
## Footnote
It is more effective than levonorgestrel.
119
What is the time frame for taking levonorgestrel?
ASAP, within 3 days
## Footnote
Remains moderately effective within 5 days.
120
What should be done if sexual assault occurs?
Empiric STI treatment and HIV post-exposure prophylaxis may be required
## Footnote
Vaccines for HBV and HPV may also be necessary.
121
What is the active ingredient in Plan B One-Step?
1.5 mg of levonorgestrel
## Footnote
.
122
What is the preferred regimen for taking Plan B One-Step?
1.5 mg as a single dose
## Footnote
This is the recommended dosage for emergency contraception.
123
What is the mechanism of action of levonorgestrel?
Prevents or delays ovulation and thickens cervical mucus
## Footnote
These actions help reduce the risk of pregnancy.
124
What is the most common side effect of Plan B?
Nausea
can use OTC antiemetic
125
126
What is ulipristal acetate commonly known as?
abortion pill or RU-486
## Footnote
Ulipristal is used as emergency contraception.
127
What is the mechanism of action of ulipristal acetate?
Prevents or delays ovulation and may alter the endometrium
## Footnote
This mechanism can impair implantation, which may be controversial for some patients.
128
What is the dosage for ulipristal acetate?
30 mg as a single dose
## Footnote
This medication requires a prescription.
129
What should be avoided when using ulipristal acetate?
Progestin-containing contraceptives
## Footnote
They should not be used in combination or within 5 days of ulipristal administration.
130
What are common side effects of ulipristal acetate?
* Headache
* Nausea
* Abdominal pain
## Footnote
Changes in menstrual cycle may occur, but periods typically restart within one week.
131
What is infertility defined as?
Not being able to get pregnant after one year or longer of unprotected sex.
132
What is clomiphene?
A selective estrogen receptor modulator (SERM) used to induce ovulation.
133
How does clomiphene trigger ovulation?
It causes LH and FSH to surge, which triggers ovulation.
134
What common side effect does the surge in LH from clomiphene cause?
Hot flashes.
135
What risks do SERMs have?
Clotting risks.
136
What are gonadotropins used for?
To trigger ovulation by acting similar to endogenous FSH or LH.
137
What risk is associated with fertility medications like gonadotropins and clomiphene?
They can cause multiple eggs to be released, increasing the risk of multiple births.
138
How are gonadotropins administered?
By SC or IM injection.
139
What are some characteristics of gonadotropin drugs?
They act as LH, FSH, or hCG (similar to LH).
140
What are some brand names for gonadotropin drugs?
Menopur, Follistim AQ, Gonal-f, Pregnyl, Novarel, Ovidrel.
141
Fill in the blank: Clomiphene acts as _______ to trigger ovulation.
estrogen.
142
Fill in the blank: Aromatase inhibitors cause ovulation by suppressing _______.
estrogen to increase FSH
