Contraception

Question 1

only method that protects from STDs

Answer 1

condoms

Question 2

non-contraceptive health benefits from this method

Answer 2

hormonal contraceptives

Question 3

obamacare and birth control

Answer 3

cost sharing preventative services, covers new plans sponsored by employers, plans purchased in individual market, coverage through medicaid

Question 4

womens preventative services

Answer 4

well woman visits, gestational dm screen, HPV testing, STI counseling, HIV screening and counseling, breastfeeding support and supplies, domestic violence screening, all contraceptive methods and sterilization

Question 5

methods for women contraception

Answer 5

sterilization surgery, implantable rod, copper IUD, progestin IUD, injection, patch, vaginal ring, oral contraceptive pills, oral progesterone pill, oral extended release pills, diaphragm with spermicide, sponge w spermicide, cervical cap w spermicide, female condom

Question 6

pt characteristics to review before starting contraceptive

Answer 6

age, smoking, steroid use, excessive alcohol/drug use

Question 7

medical hx before starting contraception

Answer 7

screen for cardiovascular issues, DVTs, medications, migraines, leg pain, skin changes, BMI, HTN. family hx of cardiac, stroke or PE, breast cancer, osteoporosis

Question 8

obstetric hx

Answer 8

any pregnancies. live births, terminations, miscarriages. future childbearing plans

Question 9

menstrual hx

Answer 9

last period. regularity of menses. length of menses. type of flow - number of pads, bleeding after sex, their belief about their period

Question 10

how to exclude pregnancy

Answer 10

pregnancy test. questions if answer yes then they are not pregnant: have you abstained from intercourse since your last period? have you had a normal period this week? have you been using reliable contraception? have you had a miscarriage or abortion this week? have you had a baby within 4 weeks? baby within 6 months and fully/nearly fully breast feeding and not had a period since delivery

Question 11

physical exam before contraceptive

Answer 11

BMI. blood pressure. consider a pap. bimanual exam and cervix inspection considered for IUDs. breast exam. well woman visit if possible

Question 12

WHO eligibility category 1

Answer 12

no restriction on use of contraception

Question 13

who stage 2

Answer 13

benefits outweigh risks of contraception

Question 14

who stage 3

Answer 14

risks outweigh benefits

Question 15

who stage 4

Answer 15

unacceptable health risk if used

Question 16

stages if smoking

Answer 16

stage 3 less than 15 cigarettes each day, 4 if more than 15

Question 17

stage 4 conditions

Answer 17

systolic > 160, hx or current DVT, surgery w prolonged immobilization, thrombogenic mutations, hx ischemic heart disease or stroke, heart valve disease, dm w vascular disease, migraine w aura — use progesterone only methods

Question 18

dm and contraception

Answer 18

if well controlled can use any method. assess for changes in meds, bp, weight, lipids when choosing contraception. if vascular issues can use IUD, progestin only pills or implants

Question 19

obesity and contraception

Answer 19

No hormones if bmi > 35 due to risk of cardiac issues. bariatric surgery can decrease absorption. eating disorders can reduce absorption. use hormones in women over 35 years old with caution d/t risk of VTE. body fat effects contraception due to absorption, increase liver enzyme metabolism and metabolic rate. transdermal less effective. those on the pill have higher pregnancy rates due to this. more difficult to insert IUDs

Question 20

hyperlipidemia and contraception

Answer 20

category 2 or 3 depending on severity. use progestin only in those rated as a 2

Question 21

sickle cell contraception

Answer 21

injectables reduce number of painful crises. reduces number of bleeding and improves hemoglobin levels

Question 22

crohns and contraception

Answer 22

absorptive surface of intestines is poor due to inflammation, nausea and vomiting also decreased reliability of absorption. use injectable, patches or IUDs instead

Question 23

poc and contraception

Answer 23

combined oral contraception w progestin to regulate menses, acne, and protect against endometrial cancer

Question 24

liver meds and contraception

Answer 24

meds that affect the liver may reduce effectiveness of combined hormone medications and progesterone meds. lamotrigine - lamictal seizure med, hiv meds, tb meds will all affect progesterone only meds — injectables, mirena and non hormonal contraceptives are not affected

Question 25

barrier methods

Answer 25

barrier between sperm and egg. diaphragms inserted 1 hour before and 6 hours after sex

Question 26

cervical cap

Answer 26

blocks sperm from entering cervix

Question 27

sponge

Answer 27

absorbs sperm to prevent them from entering cervix

Question 28

the pill

Answer 28

combined oral contraception. two hormones: estrogen and progesterone. prevents ovulation by supression secretion of gonadotropins, thins uterus lining, thickens cervical mucosa. 3 week cycles, 7 day break. consider bmi and bp before prescribing.

Question 29

transdermal patch

Answer 29

same hormones as the pill and same action, risk factors also bmi and bp. hormones delivered via the derma but not on breast, same as pill 3 weeks on 2 weeks off

Question 30

Vaginal ring

Answer 30

same action and hormones as the pill, delivered via a flexible ring placed in the vagina for 3 weeks and removed 4 week

Question 31

side effects of pill, patch and ring

Answer 31

breast tenderness, spotting, nausea, mood swings, weight gain, headaches

Question 32

contradindications for pill, patch and ring

Answer 32

age over 35, bmi > 35, elevated bp, hx dvt/cva/hear disease, hyperlipidemia, migraines, gall bladder disease, hx breast cancer, post partum

Question 33

benefits of estrogen-progestin contraceptives

Answer 33

reduce dysmenorrhea, reduce pelvic pain, improves iron deficiency anemia, reduces ectopic pregnancy, decrease s/s of premenstual disorder, reduces risk of benign breast disease, reduce risk of ovarian cysts, reduce ovarian cancer d/t inhibited ovarian stimulation and endometrial cancer d/t progestin, reduce colorectal cancer, reduce moderate acne and hirsuitsm, regulates cycle

Question 34

progesterone only mini pill

Answer 34

just progestrone, thickens cervical mucosa and suppresses ovulation, taken daily, 3-12 hour window, can change bleeding pattern. side effects: acne, breast tenderness, weight changes, headache

Question 35

contraindications of minipill

Answer 35

current/past history of stroke, heart disease, liver disease, lupus, breast caner current or last 5 years

Question 36

depo provera

Answer 36

150mg medroxyprogesterone acetate - synthetic progesterogen. every 12 weeks deep IM into butt, suppresses ovulation, thickens cervical mucosa and makes endometrium atrophic. can change bleeding patterns or cause amenorrhea

Question 37

adverse effects of depo provera

Answer 37

nausea, back ache, breast discomfort, acne, depression, alopecia

Question 38

s/e depo

Answer 38

abnormal bleeding 1-2 years, amenorrhea, weight gain, delay in fertility, decreased bone mass

Question 39

IUD

Answer 39

sits in uterus, copper causes sperm dysfunction and prevent fertilization, periods longer and heavier, good if you dont want hormones, lasts for 5-10 years

Question 40

mirena

Answer 40

contains levonorgestrel sits in uterus, causes endometrial atrophy, ovulation is shorter and lighter, can cause amenorrhea, nuisance bleeding 3-6 months, lasts 5 years

Question 41

IUD patient prep

Answer 41

vaginitis 2. hight STI risk 3. gonorrhea 4 treat first. IUD may not be the best choice if at high risk for STI, dont remove IUD with an STI present

Question 42

IUD inserted when

Answer 42

the first 7 days of period, back up contraception is not needed. expulsion rate 2-10%

Question 43

emergency contraception IUD

Answer 43

copper

Question 44

cant find strings

Answer 44

common, use back up method, try to visualize strings, take a urine pregnancy test, if neg use cytology brush to find strings, refer to specialist for dilation and US

Question 45

contraindication for IUD

Answer 45

recently exposed to STI. hx PID. Irregular bleeding. cervical or endometrial cancer. uterus abnormalities

Question 46

progesterone only implant

Answer 46

subdermal rod, inhibitis ovulation and increases cervical mucosa, lasts for 3 years, can cause nuisance bleeding

Question 47

why rod is desirable

Answer 47

any migraine headaches, age > 35 + smoker + obese, hx thromboembolic disease, cardiac disease, cva, early postpartum, htn w vascular disease or htn older than 35, lupus w vascular disease, hypertriglyceridemia

Question 48

contraindications to rod

Answer 48

liver disease, liver tumors, cirrhosis, vaginal bleeding, breast cancer

Question 49

morning after pill

Answer 49

elevated dose of progesterone-like hormone (levonorgesterel). egg release can be prevented, fertilization could be prevented

Question 50

contraception > 35 years

Answer 50

Combination hormonal contraceptive are a concern in women over 35 w risk for MI, stroke, VTE, breast ca, bone density, osteoporosis

Question 51

breast cancer and contraception

Answer 51

family hx breast ca no restriction, current is level 4, last 5 years in remission is level 3

Question 52

osteoporosis

Answer 52

depo a/w decreased bone mineral density that can be reversed in young women, no restriction with older women. loss of estrogen first 3 years menopause is the cause.

Question 53

noncontraceptive benefits of contraception in >35

Answer 53

reduction in endometrial cancer, regulate periods, decrease blood loss, helps w hot flashes

Question 54

when to stop in healthy nonsmoking nonobese women

Answer 54

until age 55 when 96 percent of women are menopausal.