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Repro. Med 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

T/F Unintended pregnancy has increased over the last 20 yrs

A

True (from 45% to 49%)

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2
Q

Women who live below the poverty line are __x more likely to have an unintended pregnancy

Among what group of women has unintended pregnancies decreased?

A

5x

Middle income women

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3
Q

What are the most effective contraceptives?

A

LARCs (high initial price)

  • Copper IUD
  • Levonorgestorel IUD
  • Etonogestrel implant
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4
Q

What are some considerations when prescribing contraception? (many!)

A 
efficacy
convenience
cost
accessibility 
non-contraceptive benefit
side effects
medical contraindications
reversibility 
medical status
reproductive desires
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5
Q

Which two forms of contraception do not cause unscheduled bleeding?

A

Male condoms

Diaphragm

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6
Q

How is the pregnancy rate determined when considering contraception?

A

The # of women, out of 100 women using this method of contraception, who will become pregnant over the course of 1 year

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7
Q

What are the barrier methods of contraception?

A

diaphragm
cervical cap
female
male condom (correct use 2%, typical use 18%)

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8
Q

What are the risks of barrier methods?

A

No systemic health risks
UTI association (diaphragm)
Possible local irritation from device or spermicide

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9
Q

What is the efficacy of barrier methods?

A

12-18% failure rate (typical use)

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10
Q

What is the cost (low, medium, high) of barrier method contraceptives?

A

Relatively low (device, spermicide)

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11
Q

What are non-contraceptive benefits of barrier methods?

A

STI protection w/ condom use

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12
Q

What are the 3 types of male condoms?

A

Latex (97%)
Natural membrane ($$$)
Synthetic ($$)

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13
Q

You (can/cannot) use oil based lubricants w/ latex male condoms.
What about natural made condoms?
What about synthetic condoms?

A

Can NOT

Yes you can!
YES!

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14
Q

T/F Natural made condoms definitively do not allow viruses to pass through

A

F: is may allow the passage of viruses (HIV)

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15
Q

___ must be fitted by a provider and fits the length of the vagina

What can cause a women to need a new size?

A

Diaphragm

Giving birth

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16
Q

Diaphragms have a ___% pregnancy rate and can be used for up to ___ years before they need to be changed out.

A

12%

2 years

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17
Q

What are the rules of diaphragm use?

A

Must be used w/ a spermicide

Should be inserted <2 hrs before intercourse

Should be left in place for at least 6 hrs after intercourse

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18
Q

What are some risks of using a diaphragm?

A

Increase incidence of UTI
Toxic shock syndrome (TSS) if left >24 hrs
Device may shift w/ pelvic relaxation
May increase susceptibility to HIV

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19
Q

Do you need a Rx for a cervical cap?

A

Yes

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20
Q

What determines the size you need for a cervical cap?

A

Whether the pt has given birth or not

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21
Q

How long is a cervical cap left in place after intercourse?

What is the max amount of time it can be left in place?

A

6-8 hrs

48 hrs

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22
Q

What is more effective–a diaphragm or a cervical cap?

A

A diaphragm

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23
Q

A vaginal sponge can be placed __ hrs prior to sex

What is the effectiveness of a vaginal sponge?

A

24 hrs

76-88%

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24
Q

What are the 2 ways that a vaginal sponge works?

A
  1. blocks sperm

2. releases spermicide

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25
Q

What hormones are used in hormonal contraception?

A

Estrogen

Progesterone

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26
Q

What are the delivery systems of hormonal contraception? (x6)

A 
pill
shot
vaginal insert
patch
intrauterine
implant
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27
Q

What are examples of estrogen-progestin hormonal contraceptives? (x3)

A

Combination OCP
Transdermal patch
Vaginal ring

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28
Q

What are example of progestin-only hormonal contraceptives?

A 
Progestin-only OCs (“mini-pills”)
DMPA (Depo-Provera)
Implant (Nexplanon)
IUD (Mirena, Skyla)
Plan B emergency contraception
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29
Q

What are the 3 actions of estrogen-progestin contraceptives?

What is their efficacy?

A
  1. suppression of ovulation
  2. thinning of endometrium
  3. thickening of cervical mucus

Correct use: <1%
Actual use: 9%

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30
Q

what are the risks of estrogen-progestin contraceptives

who is at a greater risk?

A

MI, HTN
Ischemic stroke
Venous thromboembolism
Hepatic adenoma

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31
Q

What increases the risk for venous thromboembolism when using estrogen-progestin contraceptives?

A 
Obesity
>40 y/o
Use of 3rd generation progestins (?)
Hereditary thrombophilia --> Factor V Leiden, protein S deficiency 
**Ask about FHx!
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32
Q

OCs is associated w/ an overall increase ___ and ___ CA, and decreased risk of __ CA

A

Increased: Cervical and Breast
Decreased: Ovarian

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33
Q

What are contraindications to estrogen-progestin contraceptives?

A 
Smoker >35 y/o
Uncontrolled THN
Hx of stroke or ischemic heart dz
History of VTE
Inherited thrombophilia
Lupus (SLE)
Migraine with aura
Breast cancer
Cirrhosis
Liver tumor

**usually caused by the estrogen

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34
Q

What are side effects of estrogen-progestin contraceptives?

What is the most common side effect?

A 
Breakthrough bleeding- Most common!
Amenorrhea 
Nausea
Breast tenderness
Bloating
HA
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35
Q

What causes breakthrough bleeding while on estrogen-progestin contraceptives?

Which form of contraception is a women more likely to experience this?

A

Thinning of the endometrium
Missed pills

Low-dose OCP or extended cycle OCP

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36
Q

How long can a woman expect to experience break through bleeding?

A

x3 cycles

37
Q

What are non-contraceptive benefits of estrogen-progestin contraceptives?

A

Decreased

  • menstrual bleeding
  • dysmenorrhea
  • incidence of ovarian cysts
  • benign breast disease
  • cancer risk: endometrium, ovary, colon

Improvement of

  • PMS sxs (extended cycle)
  • acne

Prevention of menstrual migraine (extended cycle)
Control of hirsutism
Management of uterine leiomyomata (fibroids)
Suppression of endometriosis

38
Q

What makes combined OCs different from one another?

A

Amount of estrogen
Type of progestin
Pattern of delivery
Cost

39
Q

What are the 3 ways that a patient can begin taking their OCPs? (i.e. day of the week)

A

Sunday start - avoid weekend menses
Quick start - not effective until 2nd week
1st day of menses start

40
Q

What are the types of cycle control options you can offer?

A

21/7
24/4
12 week
continuous

41
Q

As estrogen levels go (up/down), many side effects of OCs (HA, N, breast tenderness) go (up/down).

As estrogen levels go (up/down), rates of irregular bleeding on OCs go (up/down).

A

down; down

down; up

42
Q

What drugs can interact w/ OCPs?

A

ANTICONVULSANTS
Phenytoin, phenobarbital, carbamazepine, topiramate decrease OCP effectiveness (liver enzyme induction)

ANTIBIOTICS

  • Rifampin is the ONLY antibiotic proven to reduce estradiol and progestin levels in OC users
  • No documented effect on hormone levels from other antibiotics (backup contraception ‘officially’ not needed) as long as the GI tract is functioning normally.

St John’s wort?*

43
Q

Who should not take OCPs? Why?

A

Women >35 y/o who smoke; Risk of DVT/clotting

44
Q

Estrogen-progestin patches are work for __ days and taken off for __ days

What is a disadvantage of using this method?

A

21/7

DVT risk is increased with this method

45
Q

The patch has a (better/worse) steady state than OCPs?

A

Better

*they have the highest average serum levels of estrogen than all contraceptive methods

46
Q

How often should the vaginal ring be changed?

What is the risk for using this method?

A

Monthly (21/7)

Increased vaginal discharge

47
Q

What are progestin-only types?

What is the pregnancy rate?

A 
Progestin-only OCs (“mini-pills”)
DMPA (Depo-Provera)
Implant (Nexplanon)
IUD (Mirena, Skyla)
Plan B emergency contraception`

Correct use: <1%
Typical use: 9%

48
Q

How do progestin-only OCPs work?

A
  1. thicken cervical mucus
  2. thins endometrium
  3. variable suppression of ovulation
49
Q

What is the rule w/ progestin-only pill?

A

Must take VERY regularly at the same time each day!

50
Q

What are contraindications to progestin-only pills?

A

Breast CA
Undiagnosed abnormal uterine bleeding
active liver dz

No contraindications for women w/ hx of stroke, MI, DVT

51
Q

What are side effects of progestin only pills?

A

Irregular bleeding

Amenorrrhea (no cycling w/ this method)

52
Q

For what population of women are POPs good for?

A

Women who are breast-feeding

53
Q

___ is a 3 month injection used for contraception

What is the pregnancy rate?

A

DMPA (‘Depo”)

Correct use: <1%
Typical use: 6%

54
Q

What are the modes of action for DMPA (“depo”)? (x4)

A
  1. suppression of ovulation
  2. thickens cervical mucus
  3. thins endometrium
  4. decreases tubal motility
55
Q

What are contraindications for DMPA (“depo”) use?

A

Breast CA
Undiagnosed uterine bleeding
Active liver dz
Osteoporosis or risk factors –> DMPA is associated w/ reversible (?) bone loss in long-term users (BLACKBOX)

56
Q

What are side effects of DMPA (“depo”)?

A

Change in bleeding pattern

  • Frequent, irregular bleeding x 6 months
  • Subsequent amenorrhea (very common, esp @ 1 year)

Wt gain

HA

Mood changes

Increased w/ preexisting depression?

Unpredictable return to fertility (6 months-2 years)
- not the greatest choice for a 33 y o in grad school who wants to conceive a year from now

57
Q

The common feature of highly-effective methods of contraception is that eliminate _____

A

User failure

58
Q

What does LARC stand for?

What are examples of these?

A

Long-acting reversible contraceptives

Implant, IUD

59
Q

____ is a progestin-only implant that has a __ yr effectiveness. It must be inserted and removed by trained providers

What is the pregnancy rate?

A

Nexplanon
3 yr

Correct use: <1%
Typical use: <1%

60
Q

What is the mode of action for Nexplanon?

A

Thickens cervical mucus
Decreases tubal motility
Some inhibition of ovulation in early stages
Endometrial thinning

61
Q

What are contraindications of Nexplanon use?

A

Breast CA
Undiagnosed abnormal uterine bleeding
Active liver dz

NO association between the etonogestrel implant and risk of MI, stroke or VTE

62
Q

What are side effects of Nexplanon?

A

Unscheduled bleeding

  • 15% will d/c use for this reason
  • May persist for the life of the device
  • Most women will have ~5 days of bleeding/month, not predictable
HA
Wt gain
Acne
Breast tenderness
Mood changes
63
Q

T/F IUDs are commonlly used in the US

A

F, only 7% use this method

64
Q

What is the pregnancy rate for IUDs?

What are examples of these? How long can they stay implanted for before removal?

A

Correct : <1%
Typical use <1%

Paragard: copper 10 yr method
Mirena: 5 yr
Skyla: 3 yr

65
Q

What is the mode of action of IUDs?

A

Prevention of fertilization

  • Device creates “hostile intrauterine environment”
  • Toxic to ova and sperm
  • Impairs implantation
  • Not an abortifacient

Hormonal IUDs also

  • Thicken cervical mucus
  • Cause endometrial thinning
66
Q

What are the advantages of using Paragard?

A

Superior for hormone-intolerant women
Most economical
Longest duration

67
Q

What are the advantages of Mirena/Skyla

A

They decrease:

  • menstrual bleeding
  • dysmenorrhea
  • pain from endometriosis
  • sx from leiomyomata
68
Q

What are contraindications to IUDs?

A

Active pelvic infection
Known or suspected pregnancy
Undiagnosed abnormal uterine bleeding
Severely distorted uterus

69
Q

What are contraindications to use of paragard?

A

Wilson’s dz

Copper allergy

70
Q

What are contraindications to Mirena/Skyla?

A

Current breast CA

71
Q

What are adverse events that occur w/ IUDs?

A

Missing strings

Expulsion risk ~5%

  • Sxs: cramping, abnormal bleeding, changes in string
  • Confirm with pelvic ultrasound

Uterine perforation

  • Usually at the time of insertion
  • Recognition may be delayed

Partner discomfort

“Buyer’s regret”

Pelvic infection

  • Risk limited to the insertion process (first 20 days after insertion
  • Associated with STI (chlamydia, gonorrhea)– consider testing prior to insertion
  • Long-term use of IUD is NOT associated with increased risk of pelvic infection
72
Q

What are side effects of contraception for paragard?

A

Increase in dysmenorrhea and menstrual bleeding

73
Q

What are side effects of Mirena/Skyla?

A

Irregular bleeding
Amenorrhea
Hormonal side-effects (Acne, weight gain, N, HA, breast tenderness, mood changes)

74
Q

What are traditional methods of permanent sterilization?

A

Male = Vasectomy: safer, less cost, more effective
Tubal sterilization: 5x more common
Hysteroscopic sterilization

75
Q

What are operative risks of female sterilization?

What about post-operative risk?

A

Bleeding
Infection
Damage to internal organs
Anesthesia complications

Ectopic pregnancy

76
Q

What is the most common risk of female sterilization?

A

Regret

Occurs in 3-25%

77
Q

What are examples of emergency contraceptives?

A

Plan B (levonorgestrel) – OTC
Ella (ulipristal) – Rx
ParaGard (copper) IUD – Office placement

78
Q

Plan B can be used up to __ hrs post coitus and causes (harm/no harm) to an existing pregnancy

Is it Rx or OTC?

A

72 hrs

NO HARM

OTC

79
Q

How does Plan B emergency contraception work?

A

Delays ovulation

80
Q

Ella (uplipristal) can be used up to ____ hrs post-coitus and is (more/less effective) than Plan B

Is it OTC or RX?

A

120
MORE

Rx (pregnancy must be excluded)

81
Q

How does Ella (ulipristal) work?

A

Anti-progestin

Delays ovulation

82
Q

___ is the most effective post-coital method that inhibits fertilization and can be used up to __ days post-coitus

Is it OTC or Rx?

A

ParaGard IUD
5 days

Required office procedure and exclusion of pregnancy

83
Q

Describe the MOA of mifepristone

A

progesterone and cortisol receptor antagonist

When P receptors are blocked, endometrium destabilizes despite the presence of a corpus luteum

84
Q

Other than abortions, what is Mifepristone used for?

A

Control hyperglycemia secondary to hypercortisolism in Cushing’s syndrome who have failed or are not candidates for surgery

85
Q

mifepristone is used alone or in combo with ____ about 3 days later to end early pregnancy
these can be dosed up to __ weeks after first day of last menstrual period and must be given in the providers office

A

misoprostol

9 weeks

86
Q

What is the efficacy of Mifepristone and Misoprostol.

A

97% effective

87
Q

Misoprostol is used to empty uterus (similar to early miscarriage) and will abort within __-__ hrs of taking misoprostol

A

4-5 hrs

88
Q

what are some s/s of using mifepristone/misoprostol

A 
Cramps
heavy bleeding
dizziness
N/V/D
abd pain
89
Q

when should a woman f/u with their physician after taking mifepristone/misoprostol

A

w/i 2 weeks to confirm evacuation of pregnancy

otherwise D&C may be needed

Repro. Med 2 (12 decks)

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