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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
What hormones are used in hormonal contraception?
Estrogen | Progesterone
26
What are the delivery systems of hormonal contraception? (x6)
``` pill shot vaginal insert patch intrauterine implant ```
27
What are examples of estrogen-progestin hormonal contraceptives? (x3)
Combination OCP Transdermal patch Vaginal ring
28
What are example of progestin-only hormonal contraceptives?
``` Progestin-only OCs (“mini-pills”) DMPA (Depo-Provera) Implant (Nexplanon) IUD (Mirena, Skyla) Plan B emergency contraception ```
29
What are the 3 actions of estrogen-progestin contraceptives? What is their efficacy?
1. suppression of ovulation 2. thinning of endometrium 3. thickening of cervical mucus Correct use: <1% Actual use: 9%
30
what are the risks of estrogen-progestin contraceptives who is at a greater risk?
MI, HTN Ischemic stroke Venous thromboembolism Hepatic adenoma
31
What increases the risk for venous thromboembolism when using estrogen-progestin contraceptives?
``` Obesity >40 y/o Use of 3rd generation progestins (?) Hereditary thrombophilia --> Factor V Leiden, protein S deficiency **Ask about FHx! ```
32
OCs is associated w/ an overall increase ___ and ___ CA, and decreased risk of __ CA
Increased: Cervical and Breast Decreased: Ovarian
33
What are contraindications to estrogen-progestin contraceptives?
``` 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
34
What are side effects of estrogen-progestin contraceptives? What is the most common side effect?
``` Breakthrough bleeding- Most common! Amenorrhea Nausea Breast tenderness Bloating HA ```
35
What causes breakthrough bleeding while on estrogen-progestin contraceptives? Which form of contraception is a women more likely to experience this?
Thinning of the endometrium Missed pills Low-dose OCP or extended cycle OCP
36
How long can a woman expect to experience break through bleeding?
x3 cycles
37
What are non-contraceptive benefits of estrogen-progestin contraceptives?
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
What makes combined OCs different from one another?
Amount of estrogen Type of progestin Pattern of delivery Cost
39
What are the 3 ways that a patient can begin taking their OCPs? (i.e. day of the week)
Sunday start - avoid weekend menses Quick start - not effective until 2nd week 1st day of menses start
40
What are the types of cycle control options you can offer?
21/7 24/4 12 week continuous
41
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).
down; down down; up
42
What drugs can interact w/ OCPs?
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
Who should not take OCPs? Why?
Women >35 y/o who smoke; Risk of DVT/clotting
44
Estrogen-progestin patches are work for __ days and taken off for __ days What is a disadvantage of using this method?
21/7 DVT risk is increased with this method
45
The patch has a (better/worse) steady state than OCPs?
Better *they have the highest average serum levels of estrogen than all contraceptive methods
46
How often should the vaginal ring be changed? What is the risk for using this method?
Monthly (21/7) Increased vaginal discharge
47
What are progestin-only types? What is the pregnancy rate?
``` Progestin-only OCs (“mini-pills”) DMPA (Depo-Provera) Implant (Nexplanon) IUD (Mirena, Skyla) Plan B emergency contraception` ``` Correct use: <1% Typical use: 9%
48
How do progestin-only OCPs work?
1. thicken cervical mucus 2. thins endometrium 3. variable suppression of ovulation
49
What is the rule w/ progestin-only pill?
Must take VERY regularly at the same time each day!
50
What are contraindications to progestin-only pills?
Breast CA Undiagnosed abnormal uterine bleeding active liver dz No contraindications for women w/ hx of stroke, MI, DVT
51
What are side effects of progestin only pills?
Irregular bleeding | Amenorrrhea (no cycling w/ this method)
52
For what population of women are POPs good for?
Women who are breast-feeding
53
___ is a 3 month injection used for contraception What is the pregnancy rate?
DMPA ('Depo") Correct use: <1% Typical use: 6%
54
What are the modes of action for DMPA ("depo")? (x4)
1. suppression of ovulation 2. thickens cervical mucus 3. thins endometrium 4. decreases tubal motility
55
What are contraindications for DMPA ("depo") use?
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
What are side effects of DMPA ("depo")?
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
The common feature of highly-effective methods of contraception is that eliminate _____
User failure
58
What does LARC stand for? What are examples of these?
Long-acting reversible contraceptives Implant, IUD
59
____ is a progestin-only implant that has a __ yr effectiveness. It must be inserted and removed by trained providers What is the pregnancy rate?
Nexplanon 3 yr Correct use: <1% Typical use: <1%
60
What is the mode of action for Nexplanon?
Thickens cervical mucus Decreases tubal motility Some inhibition of ovulation in early stages Endometrial thinning
61
What are contraindications of Nexplanon use?
Breast CA Undiagnosed abnormal uterine bleeding Active liver dz NO association between the etonogestrel implant and risk of MI, stroke or VTE
62
What are side effects of Nexplanon?
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
T/F IUDs are commonlly used in the US
F, only 7% use this method
64
What is the pregnancy rate for IUDs? What are examples of these? How long can they stay implanted for before removal?
Correct : <1% Typical use <1% Paragard: copper 10 yr method Mirena: 5 yr Skyla: 3 yr
65
What is the mode of action of IUDs?
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
What are the advantages of using Paragard?
Superior for hormone-intolerant women Most economical Longest duration
67
What are the advantages of Mirena/Skyla
They decrease: - menstrual bleeding - dysmenorrhea - pain from endometriosis - sx from leiomyomata
68
What are contraindications to IUDs?
Active pelvic infection Known or suspected pregnancy Undiagnosed abnormal uterine bleeding Severely distorted uterus
69
What are contraindications to use of paragard?
Wilson's dz | Copper allergy
70
What are contraindications to Mirena/Skyla?
Current breast CA
71
What are adverse events that occur w/ IUDs?
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
What are side effects of contraception for paragard?
Increase in dysmenorrhea and menstrual bleeding
73
What are side effects of Mirena/Skyla?
Irregular bleeding Amenorrhea Hormonal side-effects (Acne, weight gain, N, HA, breast tenderness, mood changes)
74
What are traditional methods of permanent sterilization?
Male = Vasectomy: safer, less cost, more effective Tubal sterilization: 5x more common Hysteroscopic sterilization
75
What are operative risks of female sterilization? What about post-operative risk?
Bleeding Infection Damage to internal organs Anesthesia complications Ectopic pregnancy
76
What is the most common risk of female sterilization?
Regret | Occurs in 3-25%
77
What are examples of emergency contraceptives?
Plan B (levonorgestrel) – OTC Ella (ulipristal) -- Rx ParaGard (copper) IUD – Office placement
78
Plan B can be used up to __ hrs post coitus and causes (harm/no harm) to an existing pregnancy Is it Rx or OTC?
72 hrs NO HARM OTC
79
How does Plan B emergency contraception work?
Delays ovulation
80
Ella (uplipristal) can be used up to ____ hrs post-coitus and is (more/less effective) than Plan B Is it OTC or RX?
120 MORE Rx (pregnancy must be excluded)
81
How does Ella (ulipristal) work?
Anti-progestin | Delays ovulation
82
___ is the most effective post-coital method that inhibits fertilization and can be used up to __ days post-coitus Is it OTC or Rx?
ParaGard IUD 5 days Required office procedure and exclusion of pregnancy
83
Describe the MOA of mifepristone
progesterone and cortisol receptor antagonist When P receptors are blocked, endometrium destabilizes despite the presence of a corpus luteum
84
Other than abortions, what is Mifepristone used for?
Control hyperglycemia secondary to hypercortisolism in Cushing’s syndrome who have failed or are not candidates for surgery
85
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
misoprostol 9 weeks
86
What is the efficacy of Mifepristone and Misoprostol.
97% effective
87
Misoprostol is used to empty uterus (similar to early miscarriage) and will abort within __-__ hrs of taking misoprostol
4-5 hrs
88
what are some s/s of using mifepristone/misoprostol
``` Cramps heavy bleeding dizziness N/V/D abd pain ```
89
when should a woman f/u with their physician after taking mifepristone/misoprostol
w/i 2 weeks to confirm evacuation of pregnancy | otherwise D&C may be needed

Repro. Med 2 (12 decks)

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