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contraception Flashcards

(93 cards)

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1
Q

Factors to Consider for contraception

A

Efficacy
Convenience
Duration of action
Reversibility and time to return of fertility
Effect on uterine bleeding
Frequency of side effects and adverse events
Affordability
Protection against sexually transmitted diseases

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2
Q

LARC

A

long acting reversible contraception

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3
Q

failure rate for NFP

A

20%

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4
Q

rate of pregnancy in people not planning for anything

A

25%

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5
Q

failure rate for withdrawl

A

18-20%

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6
Q

Lactation Amenorrhea Method

A

<6mo postpartum
exclusively breastfeeding
amenorrheic

can still get pregnant

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7
Q

Barrier methods

A

Male Condom-NOT WITH OIL BASED LUBE
Female Condom
effectiveness increased with spermicide

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8
Q

How do you use a diaphragm

A
  1. Pregnancy rate 16% with typical use
  2. Requires fitting by a clinician
  3. Not for preventing STD
  4. Leave in 6-8 hrs after intercourse then remove and wash
  5. May increase risk of UTI

can increase the risk of transmission of HIV positive

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9
Q

Cervical Cap can be left in

A

for up to 48 hrs

must be fitted like diaphragm

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10
Q

Monophasic pills

A

dose is the same throughout the pac

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11
Q

Triphasic

A

dose of progesterone is the same throughout but estrogen changes

when we talk about dosing it is always talking about estrogen dosing

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12
Q

implantable devices are what kind of hormone

A

progesterone only

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13
Q

benefits of taking BC pills

A

treats

endometrial cancer
acne
risk of ovarian cancer
dysmenorrhea

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14
Q

if you put someone on continuous extended cycle the need to be on this type of pill

A

monophasic

might do this with endometriosis

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15
Q

the weeks off

A

progesterone withdrawal to get withdrawal bleed

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16
Q

most current BC pills contain ____ estrogen

A

20-35 mcg

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17
Q

most SE with BC are due to

A

progesterone

PRO GESTASION

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18
Q

in women on a 20 mcg pill what would you do for breakthrough bleeding

A

after 3 months if their HPO axis is still not on track increase the dose

Very low dose (20 mcg) pills may cause more breakthrough bleeding than higher doses

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19
Q

when would you start people on 20mcg pill

A

teens and women who have not had bc beforev

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20
Q

has anti-mineralocorticoid and anti-androgen properties

A

Drospirenone

Marketed for pts with acne

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21
Q

this has a low androgen binding affinity it is indicated for pts with

A

Norgestimate

Indicated for pts with PCOS, acne

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22
Q

Synthetic progestins have this effect on pts

A

progestins bind to progesterone and androgen receptors

Androgen binding affinity can cause unwanted side effects (weight gain, acne)

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23
Q

what to do for ASE

A 
i.	Irregular menstrual bleeding – 32%
	Menses often get lighter and less painful with time
ii.	Nausea – 19%
        Usually resolves within 3 months
        Take W/ food
iii.	Weight gain – 14%
iv.	Mood swings – 14%
v.	Breast tenderness – 11%
vi.	Headache – 11%
vii.	CV or thromboembolic events
     higher rate for pts with hx of migraine of family hx
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24
Q

CI for combo pill

A

Previous thromboembolic event or stroke

Migraine esp w/ aura but menst migraine workds

History of an estrogen-dependent tumor

Liver disease

Pregnancy or breast feeding

Undiagnosed abnormal uterine bleeding- fibroids or endometrial cancer

Cerebral vascular or coronary artery disease (past or current history)

Complicated valvular heart disease

Women over age 35 years who smoke –> increases your risk for thromboembolic event or stroke

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25
indications for progesterone only pill meaning this person should NOT be on estrogen
pretty much the same as the CI of estrogen combo pill Migraine headaches with aura but probably anyone now Age over 35 years and smoker or obese History of thromboembolic disease Cardiac disease, especially coronary artery disease or congestive heart failure Cerebrovascular disease Early postpartum period Hypertension with vascular disease or older than 35 years of age Systemic lupus erythematosus with vascular disease, nephritis, or antiphospholipid antibodies Hypertriglyceridemia
26
what are the risks of progesterone only pill
More breakthrough bleeding Slightly higher failure rate Must be taken at the same time (within 3 hours) every day; no placebo period
27
advantage of a Sunday start
never have period on a weekend
28
quick start method
neg UPT | back up method for 7 days
29
First day start
– start on 1st day of menses
30
Quick start method of BC what do you need
start on day Rx is given (neg UPT) need to use back up for 7 days
31
Sunday start
start on 1st Sunday after menses never have period on weekend!
32
Minipill, when do you have to use back up mehtod
when miss it more than 3 hours
33
Combined oral contraceptives- when do you have to use back up method
if >2 pills in a month are missed, use a back-up method for the rest of the pack
34
benefits of nuvaring
lower absorption of hormones (no progesterone!) Rapid return to ovulation after discontinuation Lower doses of hormones so won’t get a lot of the PMS symptoms Ease and convenience Improved cycle control
35
CI to nuvaring
Same contraindications as estrogen pills
36
Transdermal estrogen patch risks
Similar side effect and efficacy data to NuvaRing and oral contraceptive pills Same cardiovascular disease risk as birth control pills probably need to rotate to avoid irritation safer than the pill but you still get absorption of estrogen
37
why does birth control lower libido
estrogen binds to sex hormone binding globulin | lowering libido
38
name of Injectable contraceptives
Depot medroxyprogesterone acetate (DMPA)
39
pro/con with Injectable progestin
99.7% effectiveness Amenorrhea and weight gain may occur Cannot use > 2 years due to risk of osteoporosis Recommend giving first injection while the pt is on their period (know they are not pregnant) get a UPREG every time too Document negative pregnancy test
40
subdermal implants are what type of hormone?
progesterone only
41
fertility return with implanon
Contraception is provided for three years Fertility returns rapidly after removal of the rod
42
primary reason for d/c the implanon
Irregular bleeding was the primary reason for discontinuation in premarketing studies
43
ideal candidates for IUD
1. Are at low risk of acquiring sexually transmitted infections 2. Are not planning a pregnancy for at least one year 3. Want to use a reversible contraceptive 4. Want or need to avoid estrogen-based methods
44
CI for IUD
1. Severe uterine distortion a. Bicornuate uterus, cervical stenosis, or leiomyomata distorting the uterine cavity 2. Active pelvic infection 3. Known or suspected pregnancy 4. Wilson’s disease or copper allergy (copper IUD) 5. Unexplained abnormal uterine bleeding 6. Current breast cancer (Mirena IUD)
45
disadvantages of IUD
```  Changes in bleeding patterns • Amenorrhea • Unscheduled bleeding  Breast tenderness  Mood changes  Acne ```
46
advantages of iUD
 Reduction in menses & dysmenorrhea  Treatment of endometrial hyperplasia  Endometrial protection at perimenopause  Treatment of endometriosis
47
who should the insertion be scheduled when f/u
1. Cycle day 5-10 ideal 2. Patient has been abstinent since LMP 3. Documented negative pregnancy test 4. Screening for STDs 5. NSAIDs 30-60 minutes prior to procedure 6. Insert IUD 7. RTC in 4 weeks to check strings, side effects
48
ASE for IUD
1. Abnormal bleeding a. Intermenstrual bleeding or spotting b. Common in first 3 months c. Heavy bleeding (decreased with NSAIDs) 2. Pregnancy complications / ectopic pregnancy 3. Pain or partner feels strings 4. Expulsion (more likely with Skyla) a. 3-10% copper; 6% Mirena 5. Infection within first 20 days: 1/1,000 6. Perforation: 1/1,000 a. Risk with inexperience, immobile/retroverted uterus
49
what can you do for pts with break through bleeding and IUD
put on a very small dose of estrogen
50
risks of IUD
1. Uterine perforation  due to inexperienced provider 2. Syncope 3. Diaphoresis 4. Vomiting 5. Unable to insert 6. Cramping/bleeding 7. Expulsion 8. Embedment in myometrium
51
permanent sterilization for women
BTL
52
primary ocntraception methods for women in the US
``` OCP Female sterilization condoms male sterilization injectables other ```
53
pregnancy rates with diaphragm and spermacide
Pregnancy rate 16% with typical use Really only effective when you use spermacide
54
how long can you leave a diaphragm in for
Leave in 6-8 hrs after
55
who is the diaphragm not recommended for
Not recommended for HIV positive pts
56
what are the pregnancy rates with a cervical cap and what affects this
Pregnancy rate 16%; 32% if previous births
57
cervical cap come sin this many sizes and can be left in for how long
Leave in vagina 6-8 hrs (up to 48 hrs), then remove and wash
58
sponge rates of pregnancy
same as the cervical caps | Pregnancy rate 16% for typical use; 32% if previous births
59
what do you have to do before inserting a sponge
wet with water
60
Nonoxynol-9 is
spermacide
61
problems with spermacide
May cause local irritation, some increase in bacterial vaginosis infections, and may be messy Effectiveness is reduced if the patient does not wait long enough for the spermicide to disperse before having intercourse, if intercourse is delayed for more than one hour after administration
62
Estrogen/progestin-induced inhibition of the midcycle surge of
gonadotorpin
63
gnrh
released in pulses from the hypothalamus determines FSH and LH release (anterior pituitary) and these control the maturation of the ovarian follicles
64
Theca cells
has LFH receptors which sti,ulate a precursor to estrogen granulosa cells have FSH receptors that also have a precursor needed to convert the theca cell precursor into estrogen negative feedback signal to the pituitary less FSH means only enough to stimulate one follicle
65
lactation amenorrhea only works if
1. The woman is less than six months postpartum 2. She is breastfeeding exclusively (ie: not providing food or other liquid to the infant) 3. She is amenorrheic
66
can you leave a cervical cap, diaphragm, or a sponge in for longer
cervical cap 48 hours sponger 30 diaphragm 8 hrs
67
to avoid breakthrough bleeding
monophasic
68
excess estrogen has this effect on the menstrual cycle
block gnRh and the development of the follicle
69
rates of pregnancy with OTC
8% with regular use | 1% with perfect use
70
cyclic pills have this on and off
21 or 24 active followed by 7 or 4 inactive pills
71
nausea weight gain moodiness
progesterone
72
cardiac SE
estrogen
73
drospirenone
progesterone with anti-mineralcorticoid properties that lower testosterone helps with bloating and acne PMDD PCOS
74
Norgestimate
Ortho Tri-Cyclen and Previfem these have low androgen binding affinity
75
drospirenone
Yasmen and angeliq these have mineralocorticoid
76
weight gain is the result of
progesterone
77
Migraine headaches with aura | CI for OCP
increased risk of stroke NO ESTROGEN
78
Undiagnosed abnormal uterine bleeding why is this CI with OCP
Could be fibroids and don't want to feed
79
Liver disease | why no OCP
because liver needs to destroy hormones and excess estrogen can cause strain
80
F/U for OCP
``` in the months sxs SE satisfaction BP HA assessment with chronic headaches ``` then can refill prescriptions annually
81
emergency contraception
``` copper paraguard (within 5 days) ella and plan B (ASAP) ```
82
when can you take emergency contraception how does it work
with 120 hours but most effective within 72 disrupts uterine lining with whopping dose of progesterone and then withdraw = bleeding
83
hormones in plan be
Plan B contains two 0.75mg tabs levonorgestrel to be taken 12 hrs apart Plan B One-Step contains one higher dose tab of levonorgestrel Next Choice One-Step is another brand of levonorgestrel (one pill)
84
10 year pregnancy rates with copper vs levo
levo 1.1 | copper 2,.2
85
copper IUD CI
Dysmenorrhea or menorrhagia | Wilson’s disease or copper allergy
86
CI with morena
Hormonal sensitivities | Current breast cancer
87
uterine distortion that would be CI with IUD
Bicornuate uterus, cervical stenosis, or leiomyomata distorting the uterine cavity
88
Levonorgestrel IUD
200mcg progesterone released daily (Mirena) Progestin effect is primarily local Hormonal side effects, such as breast tenderness, mood changes, and acne may occur Mirena, Skyla
89
higher expulsion with copper or morena
morena
90
Tubal ligation (BTL)
Mechanical blockade using clips, rings, coils, or plugs Coagulation-induced blockage
91
Coagulation-induced blockage works by
using electrical current or chemical agents
92
Hysteroscopic Sterilization
Essure 2 part procedure Fibrotic reaction causing stenosis of tubes 3 mo after fiber placed need to do HSG
93
Only method of permanent sterilization that gives confirmation of sterilization
Hysteroscopic

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