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Contraception and Sterilization Flashcards

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1
Q

What are the two general contraceptive mechanisms?

A
  • Inhibit the formation and release of the egg

- Imposing a mechanical, chemical, or temporal barrier between the sperm and the egg

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2
Q

What is looked at when comparing the different methods?

A
  • Method failure rate or the rate inherent in method if used correctly
  • Typical failure rate or the rate when the method is actually used by the patient
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3
Q

What are the five basic things you have to think about when choosing a birth control?

A
  • Efficacy
  • Safety
  • Availability
  • Cost
  • Acceptability
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4
Q

What are the most effective reversible contraception?

A
  • Hormonal contraceptives
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5
Q

What are the different types of hormonal contracetpives?

A
  • Oral contraceptive pills
  • Injectable: Depo medroxyprogesterone acetate
  • Implantable: etonogestrel rod implant
  • Hormone containing IUD: levonorgestrel
  • Contraceptive patches
  • Contraceptive rings
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6
Q

How do oral contraceptive pills work?

A
  • Suppress the hypothalamic gonadotropin releasing factors with subsequent suppression of pituitary production of FSH and LH
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7
Q

What does progesterone do in OCP?

A
  • Major player
  • Suppresses LH and therefore ovulation as well as thickens the mucosa, inhibiting sperm migration and creating unfavorable atrophic endometrium for implantation
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8
Q

What does estrogen do in OCP?

A
  • Improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
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9
Q

What are the different ways OCPs are packaged?

A
  • Phasic formations: monophasic and triphasic
  • Classic packaging is 21 days of hormones with 7 days of placebo; now could see 24 days of hormones and 4 days of placebo
  • Also have continuous regimens versus every 3 month cycling
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10
Q

What is the use of progestin only OCPs?

A
  • Primarily used for making cervical mucous thick and impermeable
  • Ovulation continues in 40%
  • Mainly used in breastfeeding women and women who have a contraindication to estrogen
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11
Q

What must be done in progestin only OCPs due to the low dose?

A
  • Taken at the same time every day starting on the first day of menses (if late for more than 3 hours, then should use backup method for 48 hours)
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12
Q

What are the benefits of OCPs?

A
  • Menstrual cycle regularity
  • Improve dysmenorrhea
  • Decrease risk of iron deficiency anemia
  • Lower incidence of endometrial and ovarian cancers, benign breast and ovarian disease
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13
Q

What are some mild/moderate side effects of OCPs?

A
  • Breakthrough bleeding
  • Amenorrhea
  • Bloating
  • Weight gain
  • Breast tenderness
  • Nausea
  • Fatigue
  • Headache
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14
Q

What severe side effects of OCPs?

A
  • Venous thrombosis
  • PE
  • Cholestasis and gallbladder disease
  • Stroke and MI
  • Hepatic tumors
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15
Q

What are some details about the patch?

A
  • Apply one patch weekly for 3 weeks
  • Can apply anywhere but breasts
  • Caution in use in women over 198 lbs
  • Side effects are similar to OCPs but greater risk to thrombosis
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16
Q

What is the ring associated with?

A
  • Greater compliance due to once a month use

- Better tolerance since not going through GI tract and less breakthrough bleeding

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17
Q

Who can’t use hormonal contraceptives?

A
  • Women who smoke and are over 35
  • Women with personal history of DVT/PE
  • Women with history of CAD, cerebral vascular disease, CHF, or migraine with aura, uncontrolled HTN
  • Diabetes, chronic HTN, lupus get individualized prescribing
  • Women with moderate to severe liver disease or tumors
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18
Q

How often is depo provera injected?

A
  • Every 11-13 weeks
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19
Q

How long are the levels of progestin maintained after a depo provera injection?

A
  • About 14 weeks
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20
Q

When is the depo provera injected?

A
  • Within first 5 days of menses and if not, use a back up method for 2 weeks
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21
Q

What is the MOA for depo provera injection?

A
  • Thickening of cervical mucosa
  • Decidualization of the endometrium
  • Blocks LH surge and ovulation
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22
Q

What is the efficacy of depo provera?

A
  • Equivalent to sterilization and not altered by weight
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23
Q

What is the relationship between depo provera and bone density?

A
  • Alterations of bone metabolism associated with decreased estrogen levels
  • Particular concern in adolescents
  • Reversible after discontinuation
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24
Q

What are some side effects with depo provera?

A
  • Irregular bleeding
  • Weight gain
  • Exacerbation of depression
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25
How does depo provera affect bleeding?
- Decreases bleeding with use and 80% are amenorrheic after 5 years - Can improve bleeding profile with short term use of estrogen - Menses can take up to a year to regulate
26
What are some indications for depo provera?
- Desire for effective contraception - Need a method with better compliance - Breastfeeding - Can use when estrogen is contraindicated - Women with seizure disorders - Sickle cell anemia - Anemia secondary to menorrhagia - Endometriosis - Decrease risk of endometrial hyperplasia
27
What are some contraindications to depo provera?
- Known or suspected pregnancy - Unevaluated vaginal bleeding - Know or suspected malignancy of breast - Active thrombophlebitis, or current/past history of thromboembolic events or cerebral vascular disease - Liver dysfunction/disease
28
What is nexplanon?
- Single, radiopaque, rod-shaped implant containing 68 mg etonogestrel, 4 cm long and 2mm in diameter
29
How long is nexplanon used?
- For 3 years | - Preferred to be inserted in first 5 days of menses and if not then use backup for 7 days after insertion
30
What is the MOA of nexplanon?
- Thickens cervical mucous | - Inhibits ovulation
31
What are some side effects of nexplanon?
- Irregularly irregular vaginal bleeding - Headache - Vaginitis - Weight increase - Acne - Breast pain
32
What are the indications of nexplanon?
- Desires a convenient effective method of contraception | - May be used in breastfeeding patients
33
What are some contraindications of nexplanon?
- Known or suspected pregnancy - Current or past history of thrombosis or thromboembolic disorders - Liver tumors or active liver disease - Undiagnosed abnormal uterine bleeding - Known or suspected breast cancer
34
What are some complications with insertion?
- Infection - Bruising - Deep insertion - Migration - Persistent pain or paraesthesia at insertion site
35
What are the different types of IUDs?
- Copper T (paragard) | - Levonorgestrel releasing (Mirena/Liletta, Skyla/Kyleena)
36
What are some risks of an IUD?
- Increased risk of infection within first 20 days post-insertion - Increased risk of ectopic pregnancy if pregnancy would occur - If becomes pregnant, should be offered removal if the strings are visible - Risk of uterine perforation at time of insertion requiring laparoscopy for removal - Risk of malposition and necessitating hysteroscopy for removal
37
What are some contraindications of IUDs?
- Breast cancer (levonorgestrel containing only) - Recent puerperal sepsis or chorioamnionitis - Recent septic abortion - Acute cervical infection - Wilsons disease (Copper T only) - Uterine malformations
38
How long is mirena/kyleena used?
- 5 years
39
How long is liletta used?
- 3 years
40
What is skyla used for?
- Used for 3 years | - Originally used for nulliparous women
41
What are the benefits of hormonal IUDs?
- Decrease in menstrual blood loss - Less dysmenorrhea - Protection of the endometrial lining from unopposed estrogen - Convenient and long term
42
How long can the copper IUD be used?
- 10 years
43
What is the MOA for the copper IUD?
- Copper interferes with sperm transport or fertilization and prevention of implantation
44
What are some details about barrier methods?
- Depend on the proper use before, or at the time of intercourse - Higher failure rate - Inexpensive - Require little to no medical consultation
45
What is special about condoms when compared to all barrier methods?
- Only method with protection against STI
46
What are condoms made out of?
- Latex - Non-latex - Animal membrane
47
What may decrease risk of condom breakage?
- Reservoir tip
48
What is a female condom?
- Vaginal liner - Slippage and breakage rate of 3% - Recommended to be left in for 6-8 hours after intercourse
49
What is a diaphragm?
- Small latex covered dome shaped device - Must be used with a spermicide - May be inserted up to 6 hours before intercourse and must be left in for 6 to 8 hours after - Several sizes and must be fitted to the individual by a healthcare professional
50
What are women more at risk for when they use diaphragms?
- UTI
51
What is a cervical cap?
- Smaller version of a diaphragm - Applied to the cervix itself - High risk of displacement and toxic shock syndrome - Used with a spermicide - Left in place for 6 hours after intercourse
52
What is a sponge?
- Small, pillow shaped sponge containing spermicide - Dimple in sponge fits over the cervix/opposite side has a loop for removal - Only one size - More effective in nulliparous women - Left in place for 6 hours after
53
What is the calendar method?
- Calculation of fertile period and avoid sex during that time - Cycle beads
54
What is the basal body temperature method?
- Check temperature daily before getting out of bed and will not a 1/2 or 1 degree change at time of ovulation and avoid sex 3 days after
55
What is the cervical mucus method?
- Women assesses her cervical mucus and notes changes around ovulation and avoid sex for 4 days after peak - Stretchier it is, the closer to ovulation
56
What is the symptothermal method?
- Combines cervical mucus and basal body temperature | - Awareness of other signs of ovulation --> cramping, breast tenderness, changes in position or firmness of cervix
57
What is the use of emergency contraception?
- Woman who have unprotected sex
58
What are the two types of emergency contraception?
- Plan B | - Ella
59
What is plan B?
- Progestin only --> 2 pills taken 12 hours apart - Over the counter for women older than 17 - Must be used within 120 hours after unprotected intercourse - Failure rate 1.1%
60
What is ella?
- Ulipristal acetate 30mg - Indicated for up to 5 days after unprotected intercourse - Postpones follicular rupture/inhibits or delays ovulation
61
What is sterilization?
- Highly effective birth control without ongoing expense - Most frequently used method in US - All methods prevent sperm from meeting egg - Should be considered permanent
62
What do you talk about when counseling patients?
- Permanent - Address all other options - Reasons for choosing sterilization - Discuss procedure - Screen for indicator of regret - Possibility of failure and increase risk of ectopic pregnancy - Need to use condoms for STI protection
63
What is a vasectomy?
- Occlusion of the vas deferens - Safer - Not immediately effective --> complete azoospermia complete within 10 weeks
64
What are some post operative complications of a vasectomy?
- Bleeding - Hematomas - Acute/chronic pain - Local skin infections
65
How can a female be sterilized?
- Done by laparoscopy, mini-laparotomy and at time of C section
66
How is a laparoscopy sterilization done?>
- Small incisions, low rate of complications | - Occlude the fallopian tubes with electrocautery, clips,, bands, or a salpingectomy
67
What sterilization method has the highest fail rate but the best chance for reversibility?
- Hulka clips
68
What is a mini-laparotomy?
- Most common approach in the world | - Use small infraumbilical incision in postpartum period or suprapubic incision as an interval procedure

Endo/Repro (31 decks)

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