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Flashcards in Contraception Deck (22):
1

rate of pregnancy in a year without contraception

85%

2

what works best to prevent STDs?

condoms
abstinence

3

How do OCPs work? (combined estrogen and progesterone)

-inhibit follicle development
-inhibit ovulation
-change endometrial quality
increase cervical mucus to -inhibit sperm transporation
-prevent fertilization and implantation

with ideal use, 99% effectiveness

4

Side effects of OCP:

nausea
HA
bloating
mood changes
increased risk of blood clots

NOT weight gain

5

Contraindications to using OCPs

pregnancy (accidental use in early pregnancy is not associated with congenital anomalies)

history of thromboembolism (DVT, PE), or inherited thrombophilia

history of estrogen- dependent tumor (endometrial or breast carcinoma)

cerebrovascular disease (history of stroke) or CAD

poorly- controlled hypertension

smokers >35yo

hepatic disease/neoplasm (adenoma, cancer, hepatitis, cirrhosis)

abnormal vaginal bleeding of unknown etiology

migraine with aura, neurologic or vascular involvement (increased risk of stroke)

6

Advantages of combination OCPs

Reliable (

7

Disadvantages of OCPs

daily dosing
do not protect against STDs
breakthrough bleeding
estrogen SE:bloating, breast tenderness, nausea, HA

Progesterone SE: depression, acne, hypertension

increased risk of DVT
elevated TG

8

What type of liver pathology is associated with OCP use?

reversible cholestasis

hepatic adenoma
-benign liver tumor which may undergo malignant transformation
-incidence 3-4 per 100,000 longterm users, vs. 0.1 per 100,000 in the general population
-development typically requires high-dose estrogen for >5 years

Budd- Chiari syndrome from hepatic vein thrombosis or IVC thrombosis

Veno-occlusive disease of the terminal hepatic venules and hepatic sinusoids (similar to Budd-Chiari)

Hepatocellular carcinoma
Resulting cirrhosis, portal hypertenion, or liver failure from one of the above

9

What medications reduce effectiveness of OCP by inducing CYP450 metabolism?

Guiness, Coronas, PBRs, induce chronic alcoholism

Griseofulvin
Carbamazepine
Phenytoin
Barbiturates
Rifampin
St. John's Wart
chronic alcoholism

Use back up contraception during this time

Other antiepileptics: phenobarbitol, phenytoin, carbamazepine, topiramate, oxcarbazepine, primidone

10

Progesin-only contraceptives

pill
IM injection
implant (implanon)

these work primarily by thickening the cervical mucus

11

Progestin- only pill

ideal effectiveness of 92-95%

12

IM progestin (Depo-Provera)

causes 3-5 pounds of weight gain, primarily through water retention

high dose progestin can stimulate appetite

irregular bleeding

difficult to predict return to ovulation (may accidentally give a year's worth)

osteoporosis, so stop depo every 2 years to allow bones to regenerate

13

Progestin implant (implanon)

lasts for 3 years
almost 100% effective
breakthrough bleeding

14

Transdermal patch

estrogen-progesterone into the skin, worn for ~3 weeks, then go a week without it

skips first- pass metabolism, so there may be higher rates of estrogen- related side effect- we aren't sure

patch less effective in heavier women

15

intravaginal ring

estrogen/progesterone release for 3 weeks

16

Emergency contraception

1. high-dose combined OCP
2. Levanorgestrel (Plan B)
-prevents ovulation so that there is no egg to fertilize
3. Copper IUD, placed within 5 days with high effectiveness, likely due to strong inflammatory response
4. Mifepristone
progesterone antagonist

17

Barrier methods don't work well

condoms are the most widely used
diaphragms
chemical- contraceptive sponge (25% failure rate)
spermicide (30% failure rate)

18

Sexual practice methods

abstinence
rhythm method
withdrawal method
lactation

19

Copper IUD

10 year device
inflammatory device

20

Progesterone IUD

5 years

21

What are the contraindications to IUD placement?

Current vaginal or cervical infection

Known pregnancy or desire for pregnancy in the near future

Severe uterine distorion (bicornuate uterus, cervical stenosis, fibroids distorting the uterine cavity)

Uterine bleeding that has not yet been worked up

Copper allergy or Wilson disease- avoid copper IUD

Breast cancer- avoid progesterone IUD

22

Surgical methods

vasectomy
tubal ligation
tubal occlusion

99.5% effectiveness
increased risk of ectopic pregnancy