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Contraception Flashcards

(113 cards)

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1
Q

Why use contraception?

A

Prevent unwanted pregnancies
Space pregnancies
Prevent pregnancy when it’s dangerous or life-threatening to mother

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2
Q

Other Names for Emergency Contraception

A

Postcoital contraception

“Morning after pill”

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3
Q

Examples of Emergency Contraception

A

Plan B: levonorgestrel
Plan B One Step: levonorgestrel
Ella: ulipristal
Copper IUD

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4
Q

Oral Hormonal Emergency Contraception (Levonorgestrel)

A

No pregnancy test or exam
No medical contraindication
OTC
Effective up to 120 after event

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5
Q

SE of Levonorgestrel

A 
N/V
Irregular bleeding the month after treatment
Dizziness
Fatigue
HA
Breast tenderness
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6
Q

Emergency Contraception that Requires Precautions or Some Contraindications

A

Ulipristal

IUD insertion

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7
Q

Levonorgestrel MOA

A

Inhibiting or delaying ovulation

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8
Q

Copper IUD MOA

A

Interfering with fertilization or tubal transport

Prevent implantation by altering endometrial receptivity

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9
Q

Counseling for Emergency Contraception

A

Obtain pregnancy test if no menses 3-4 weeks after EC
Discuss risk of pregnancy & STIs with unprotected sex
Encourage patient to start a regular contraception method OR review correct use of current one
EC is back up, not a primary contraceptive method

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10
Q

Considerations for Choosing a Contraceptive Method

A 
Efficacy (failure rate)
Safety
SE
Convenience
Cost
Personal lifestyle & pattern of sexual activity
Reversibility
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11
Q

Goals for Educating Patients

A

Dispel misconceptions
Review SE & risks
Compare options to maximize choice appropriate to lifestyle & ability to use correctly
Educate proper use
Distinguish between contraception & protection for STIs
Encourage patients to talke about birth control issues with partner
Patient’s personal needs change over time
Discuss EC with all patients

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12
Q

Categories of Contraception

A

Hormonal
IUD (IUC)
Barrier
Permanent

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13
Q

Options for Contraception Failure

A

Inappropriate use
Failure to use
Failure of method

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14
Q

Hormonal Methods of Contraception

A 
Oral pills
Transdermal patch
Injections
Intrauterine devices
Subdermal implants
Intravaginal
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15
Q

MOA of OCP

A

Suppression of GnRH
Stabilizes endometrium to minimize breakthrough bleeding
Influence of progestin

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16
Q

Types of Suppression of GnRH

A

Inhibits the LH surge
Prevents ovulation
Suppresses FSH secretion
Prevents ovarian folliculogenesis

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17
Q

The Influence of Progestin in OCPs

A

Suppress LH secretion
Suppress ovulation
Thickens cervical mucus
Creates atrophic endometrium unfavorable to implantation
Impairs normal tubal motility/peristalsis

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18
Q

Advantages of Newer Progestins

A

Less effect on carb & lipid metabolism
More effective at reducing acne & hirsutism
Higher HDL/lower LDL
Higher sex hormone binding globulin (SHBG)
Greater affinity to progesterone binding sites
Reduced amenorrhea

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19
Q

Other Uses for OCP

A

Endometriosis: reduce pain
Treatment for acne or hirsutism
Treatment for heavy, painful or irregular menstrual periods
Reduce occurrence of recurrent ovarian cysts
PCOS
PMS/PMDD
Decreased risk of ovarian CA & colon CA
Decrease menstrual migraine

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20
Q

Reasons for High Dose Estrogen

A

Spotting or absence of withdrawal bleeding that can’t be managed at lower doses
Dysfunctional uterine bleeding
Reduce recurrent ovarian cysts

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21
Q

OCP Preparation Types

A

Mono phasic
Multiphasic (biphasic or triphasic)
Extended cycle (withdrawal flow every 12 weeks)
Progestin-only pill

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22
Q

Choosing a Pill Formulation

A

Start with monophasic
Perimenopausal women: lower estradiol pill
Consider androgenic influence of progestin
Breastfeeding women: progesterone only pill

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23
Q

Education for Patients on OCP

A

When to start pill
Take at same time everyday
Miss 1 pill: take ASAP
Miss 2 pills: double up for 2 days
High risk if next cycle not started on time
Nausea in first days
Notify office if: severe/frequent HA, SOB, chest pain, or edema
Menses shorter, lighter, with less cramping

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24
Q

Contraceptive Patch

A

Change every 7 days for 3 weeks; then 1 week off

Delivers constant medication

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25
Vaginal Ring
Delivers medication for 3 weeks intravaginally Remove 1 week, then insert new one Falls out: rinse with water & reinsert
26
Absolute Contraindications for Estrogen Contraception
``` Hx of thromboembolic event, stroke, or known thrombogenic mutation Known CVD, cardiomyopathy, BP 160/100 or greater, complicated valvular HD SLE with positive antibodies Women 35+ who smoke Migraines with aura Women 35+ with migraines Hx of cholestatic jaundice Hepatic CA or benign adenoma Active liver disease or severe cirrhosis Breast CA First 21 days postpartum Undiagnosed abnormal uterine bleeding ```
27
Careful Consideration prior to Estrogen Contraception
``` HTN Anticonvulsant therapy Migraines without aura DM Hx of bariatric surgery with malabsorptive procedure Psychotic depression Ulcerative colitis Obese ```
28
Hormone Contraceptive SE
``` Nausea/bloating Breast tenderness Spotting/break through bleeding Amenorrhea Fatigue Headache Depression/moodiness Decreased libido ```
29
Early SE of Hormone Contraceptives
Bloating Nausea Breast tenderness Mood changes
30
Most Common SE of Hormone Contraception
Breakthrough bleeding
31
When should you try a preparation with more estrogen?
Instances of amenorrhea
32
SE of Excess Estrogen
``` H/V Bloating/edema Hypertension Migraine headache Breast tenderness Decreased libido Weight gain Heavy menstrual flow Leukorrhea ```
33
SE of Estrogen Deficiency
Early cycle spotting Breakthrough bleeding Amenorrhea Vaginal dryness
34
SE of Excess Progestin
``` Acne Increased appetite/weight gain Fatigue HTN Depression Hirsutism Vaginal yeast infections ```
35
SE of Deficient Progestin
Late breakthrough bleeding Amenorrhea Heavy menstrual flow
36
Risks with Estrogen-Progestin Contraception
``` CVD HTN: mild elevation Stroke: ischemic (low risk) Carb & Lipid Metabolism Venous Thromboembolic disease Increased incidence of cholilithiasis Breast CA Cervical CA ```
37
Risk of Ischemic Stroke with Estrogen-Progestin Contraception
Extremely low risk Estrogen dose dependent Other factors: smoking, older age, HTN, migraine with aura, obesity, prothrombotic mutations
38
Carbohydrate & Lipid Metabolism
Mild insulin resistance Estrogen: serum triglycerides & HDL increase, LDL decrease Progestin: decrease HDL, increase LDL
39
Venous Thromboembolic Disease & Estrogen-Progestin Contraception
Dose dependent Risk varies with type of progestin Older & obese women at greater risk
40
Hormonal Contraceptive Drug Interactions that may Decrease OCP Efficacy
``` Phenobarbitol Phenytoin Cabamazepine Barbituates Griesofulvin Primidone Topiramate Oxcarbazepine St. John's Wart ```
41
Hormonal Contraceptive Drug Interactions that don't have an Effect on Metabolism
Gabapentin Lamotrigine Levitiracetam Tiagabine
42
What antimicrobial decreases the effectiveness of OCPs?
Rifampicin
43
Progestin Only Mehtods
Depo medroxyprogesteron acetate (DMPA or DepoProvera) Progestin implant Progestin IUD (Mirena, Skyla)
44
MOA of Progestin Only Methods
``` Inhibition of gonadotropin secretion Inhibition of follicular maturation & ovulation Thickens cervical mucus Creates thin, atrophic endometrium Ovum transport slowed ```
45
Individuals with Progestin Only or Not Hormonal Contraception
``` Breast feeding Hepatic disease: acute viral hepatitis, hepatocellular adenoma, liver CA, severe cirrhosis, symptomatic, gallbladder disease, cholestasis Post-partum: first weeks Age 35+ & smoker or HTN Hx of DVT/PE/retinal artery occlusion Anticipated major surgery Migraines with aura: any age Migraines without aura: 35+ or ```
46
Advantages to Progestin Only Methods
Fewer contraindications Fewer drug interactions Long acting Non-contraceptive benefits
47
Types of Non-Contraceptive Benefits with Progestin Only
``` Scanty/no menses Decreased menstrual cramps Decreased risk of endometrial CA, PID Decrease endometriosis pain Low risk of ectopic ```
48
Disadvantages to Progestin Only Methods
``` Menstrual cycle disturbances Possible weight gain Possible moodiness/aggravation of depression Decrease in bone density Increased risk of T2DM ```
49
Depot Medroxyprogesterone Acetate (CMPA or DepoProvera)
Administer every 3 months Safe post delivery Return to fertility may take 18+ months after last injection
50
SE of DMPA
``` Weight gain Dizziness Headache Nervousness Libido decreased Menstrual irregularities ```
51
Clinical Advantages of DMPA
Sickle cell anemia: decrease in crises | Intrinsic anticonvulsant effect
52
Implanon/Nexplanon (Progesterone Implant)
Single rod: etonogestrel Lasts for 3 years Upper arm sub-dermally
53
Jadelle (Progesterone Implant)
2 rods: levonorgestrel | Lasts for 5 years
54
SE of Progestin IUD/IUC
Irregular bleeding Breast tenderness Mood changes Acne
55
Non-hormonal IUC
Copper IUD
56
MOA of Copper IUD
Interfere with sperm transport | Prevents fertilization of ova
57
SE of Copper IUD
Heavy menses | Dysmenorrhea
58
Ideal Candidates for IUC
Not planning pregnancy for 1 year Want reversible form of contraception Want/need to avoid estrogen Want "minimal user effort"
59
IUC Complications
Uterine perforation, embedding, cervical perforation
60
IUCs Disadvantages & Cautions
PID Menstrual problems Expulsion Pregnancy complication if conception occurs
61
Risk Factors of Expulsion of IUD
Nulliparity Heavy menses Severe dysmenorrhea
62
Counseling for Expulsion of IUD
Check for string after each menses
63
Clues of Possible Expulsion of IUC/IUD
``` Unusual vaginal discharge Cramping or pain Intermenstrual or post-coital spotting Dyspareunia Absence or lengthening of IUD string Presence of IUD at cervical os or in vagina ```
64
IUCs & PID
Serious complication Most commonly in first few weeks after insertion Aggressive treatment needed Do not reinsert IUD in patient with hx of PID
65
IUC Contraindications
``` Severe uterine distortion Acute pelvic infection Known or suspected pregnancy Wilson's disease or copper allergy Unexplained abnormal uterine bleeding Current breast CA ```
66
Barrier Advantages & Indications
Intermittent contraception STI protection Decreased cervical neoplasia risk
67
Barrier Disadvantages & Cautions
``` Allergic to spermicide, rubber, latex, or polyurethane Abnormalities in vaginal anatomy Inability to learn correct technique Hx of TSS Repeated UTIs ```
68
Characteristics Associated with Higher Risk of Failure of Barriers
Frequent intercourse
69
Failure of Barrier Methods
Lack of trained personnel to fit device Lack of clinical time to provide instruction in use Full-term delivery within past 6 weeks Recent spontaneous abortion or vaginal bleeding of any cause
70
Diaphragm
Female contraceptive device Dome-shaped cup Partially filled with spermicidal cream/jelly Inserted deep into vagina to cover cervix Left in vagina 6-8 hours after intercourse
71
Women not Good Candidates for Diaphragm
``` Allergic to latex/silicone or spermicides Significant organ prolapse Frequent UTIs HIV infection or high risk Difficulty with insertion Adolescents ```
72
Contraindications of a Diaphragm
Hx of TSS
73
Advantages of a Diaphragm
``` Safe/reusable Inexpensive Offer some protection against gonorrhea & chlamydia Immediately effective & reversible No hormonal SE Can be used during breastfeeding ```
74
Disadvantages of a Diaphragm
``` Willing to insert before each sexual experience & left in place for 6 hours post sexual experience Requires skill to insert Must be within reach prior to coitus May increase frequency of UTIs Refitting after childbirth Not available everywhere ```
75
Failure Rate of Correct Diaphragm Use
6%
76
Failure Rate of Typical Diaphragm Use
12%
77
Cervical Cap
Reusable, deep rubber cup that fits over cervix | Used with spermicide & remain in for 6-8 hours
78
Efficacy of Cervical Cap
Nulliparous: 86% | Paroud women: 71%
79
SE of Cervical Cap
UTIs Vaginal infections TSS
80
Contraceptive Sponge
Disk with nontoxynol-9 Moisten with tap water prior to insertion One size fits all Benefit for 24 hours Left in place for 6 hours after intercourse Increased risk of TSS
81
Define Female Condom
Lines vagina & shields introits providing physical barrier during intercourse
82
Problems with Female Condom
Breakage Slippage Incorrect penetration
83
Failure Rate of Correct Female Condom Use
5%
84
Failure Rate of Typical Female Condom Use
21%
85
Male Condom Advantages
``` Accessible & portable Inexpensive Male participation Erection enhancement Hygienic Prevention of sperm allergy Proof of protection Decreased risk of STIs ```
86
Male Condom Disadvantages
``` Reduced sensitivity Interference with erection Interruption of coitus Latex allergy Embarressment Breakage/slippage ```
87
Failure Rate of Typical Male Condom Use
18%
88
Failure Rate of Correct Male Condom Use
2%
89
Advantages & Indications of Spermicides
``` Purchased OTC Used without partner involvement Immediate protection Back-up option Mid-cycle use to augment other methods Emergency measure if condom breaks Provides lubrication ```
90
Disadvantages & Cautions of Spermicides
Irritation Vaginitis Irritate vaginal lining & enhance spread of viruses
91
Failure Rate of Typical Spermicide Use
28%
92
Failure Rate of Correct Spermicide Use
18%
93
Withdrawal Method of Contraception
Coitus interrupted Require men to withdraw before ejaculation Failure occurs if not timed correctly or pre-ejaculatory fluid contains sperm
94
Failure Rate of Correct Use of Withdrawal
4%
95
Failure Rate of Typical Use of Withdrawal
22%
96
Lactation as a Method of Contraception
Breastfeeding delays ovulation | Subfertility
97
Lactation can only be relied upon to prevent pregnancy when:
Woman is
98
Factors Contributing to Low Utilization of Fertility Awareness-Based Methods
Information limited Provider bias against or lack of education about methods Complicated High failure rate
99
Fertility Awareness Not Recommended when:
Recent menarche Recent childbirth Approaching menopause Recent discontinuation of hormonal contraceptives Currently breastfeeding Cycles 32 days Unable to interpret fertility signs correctly Persistent vaginal infections that affect signs of fertility
100
Fertility Awareness Methods
Ovulation method Symptothermal Cervical mucus BBT alone
101
Ovulation Method of Fertility Awareness
Predict fertile time based on recent cycle history
102
Symptothermal Method of Fertility Awareness
BBT & cervical mucus | Other symptoms of ovulation
103
Cervical Mucus Method of Fertility Awareness
Increase in amount | Thin & slippery
104
BBT Alone Method of Fertility Awareness
BBT increases 0.5-1 degree at ovulation
105
Failure Rate of Correct Use of Fertility Awareness Methods
106
Failure Rate of Typical use of Fertility Awareness Methods
24%
107
Failure Rate of Typical Use of Sterilization
108
Failure Rate of Correct Use of Sterilization
109
Timing of Surgical Sterilization of Women
C-section Early postpartum Interval: laparoscopic or hysteroscopic as office procedure
110
Types of Laparoscopic Sterilization in Women
Bipolar electrocautery Mechanical devices: clips/bands Tubal excision
111
Tubal Ligation
No contraindications Decreases risk of ovarian CA Failure may lead to ectopic pregnancies
112
Factors Associated with Regret of Female Sterilization
Young age:
113
Male Sterilization
Safer Less expensive Lower failure rate No increased risk of: impotence, testicular or prostate CA, atherosclerotic disease, immunologic disease

OB/GYN (12 decks)

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