Contraception

Question 1

List the women more likely to experience unintended births

Answer 1

1. Black Women
2. Women w/ low education or income
3. Unmarried Women

Question 2

What is the Standard Days Method? Who is the most appropriate for?

Answer 2

1. Women who have regular menstrual cycles: 26-32 days
2. Must abstain from sex between days of 8-19 of cycle

*Highly motivated couples

Question 3

What is the Calendar Method?

Answer 3

1. 1st day of fertile period= subtract 18 days from total length of shortest menstrual cycle
2. Last day of fertile period= subtract 11 days from total length of longest cycle
3. Avoid sex during this time

*Must track menses x6 months before you can utilize

Question 4

Define Cervical Mucus method

Answer 4

Abstinence with any cervical secretion until 4 days after last day of wet, car, slippery mucous

Question 5

Define 2 day method

Answer 5

If no mucus secretions on 2 consecutive days, ok to have intercourse

Question 6

Define Basal Body Temperature method

Answer 6

Abstain from sex from end of menstrual period until 3 days after rise in temperature (0.5-1 degrees)

Question 7

What is the Symptothermal Method?

Answer 7

Cervical Mucus + Basal Body Temp Method
Fertile period:
First sign of ovulation until 3 days after temperature OR
4 days after peak mucus

Question 8

What are the advantages of women controlled barrier methods?

Answer 8

1. Immediately active: Spermicides requires 15 minutes for activation
2. No effect on menses/hormones

Question 9

What are the disadvantages of women controlled barrier methods?

Answer 9

1. UTI risk: Diaphragm
2. No HIV protection
3. NOT for HIV+ and/or high risk for HIV
4. Failure rate fairly high

Question 10

Who is transdermal patches less effective in?

Answer 10

Obese women: >198 lbs

Question 11

What are the advantages to prescribing CHC’s?

Answer 11

1. Can be initiated at any time

2. No back up needed if started in first 5 days of bleed

Question 12

What is the only thing you need to monitor PRIOR to starting a women on CHC’s?

Answer 12

BP

Question 13

What is the MAIN MOA in CHC’s?

Answer 13

Suppress Ovulation=90-95%

Question 14

CI to CHC’s

Answer 14

1. Current breast CA
2. Severe HTN or vascular dz (PE/DVT)
3. Heart dz
4. Complicated DM (or DM >20 yrs)
5. Smoke > or equal to 15 cigs/day
6. Migraine w/ aura
7. Certain liver dz’s (cirrhosis) or GB dz
8. Seizure disorders

Question 15

What happens if you miss 1 pill?

Answer 15

Take missed pill ASAP and take next pill as usual

Question 16

What happens if you miss 2 or more missed pills?

Answer 16

1. Take most recent missed pill asap
2. Remaining pills should be continued at usual time
3. Backup contraception for 7 days
4. Consider EC

Question 17

What is the MAIN MOA of Progestin Only pills?

Answer 17

Thickens cervical mucus to prevent sperm entry to upper reproduction tract

Question 18

What is one of the main advantages of Progestin Only pills?

Answer 18

May be used by women with CI or ADE’s to Estrogen

Question 19

Progestin Only pills SE’s

Answer 19

1. Increased spotting/bleeding

2. Intermittent amenorrhea

Question 20

What is considered a “missed pill” in Progestin Only pills? Recommendations?

Answer 20

> 3 hrs late dose taking pill

1. Take another pill
2. Use back up x2 days
3. Consider EC

Question 21

IUD CI/Limitations

Answer 21

1. Cervical CA
2. Purulent cervicitis
3. Current chlamydia or gonorrhea
4. High individual likelihood of STI exposure (partner w/ infix)
5. Increased risk of spontaneous AB and preterm delivery if become pregnant

Question 22

With failure of the Mirena or Paragard IUD, what are women @ an increased risk for?

Answer 22

Ectopic pregnancy

Question 23

Levonorgestrel IUD MOA

Answer 23

Causes Cervical mucus to become thicker

Question 24

Copper IUD MOA

Answer 24

1. Copper ions inhibit sperm motility

2. Inflammatory reaction in the endometrium phagocytes the sperm

Question 25

What is one of the main advantages of the Etonogestrel Implant?

Answer 25

Good for women with estrogen CI

Question 26

List the EC pills options

Answer 26

1. Ulipristal acetate: More effective than levonorgestrel between days 3-5 2. Levonorgestrel (Plan B) 3. Combined Estrogen and Progestin: 2 doses-less effective and more SE's

Question 27

How long do you need to use back up for with the use of LNG and combined estrogen/progestin EC?

Answer 27

x7 days

Question 28

Hysteroscopic sterilization MOA? How long do you need to use back up for?

Answer 28

Tubal occlusion | Backup x3 months until you have confirmed sterility

Question 29

List the risk of regret in women who are sterilized (Hysteroscopic or tubal ligation)?

Answer 29

1. Age <30 2. Low parity 3. Sterilization @ time of C-section 4. Changes in marital status 5. Poverty 6. Minority status 7. Minisinformation about permanence 8. Hurried decision

Question 30

How long do you need to use alternative contraception with a vasectomy?

Answer 30

Until 2 consecutive sperm samples who no motile sperm