Contraception and Sterilization (Wootton)

Question 1

What are the two general contraceptive mechanisms?

Answer 1

1. inhibit the formation and release of the egg
2. imposing a mechanical, chemical or temporal barrier between the sperm and the egg

Question 2

typical failure rate

Answer 2

rate when the method is actually used by the patient

Question 3

What are 5 things to consider when choosing a birth control?

Answer 3

1. efficacy
2. safety
3. availability
4. cost
5. acceptability

Question 4

What are the 6 hormonal contraceptive options?

Answer 4

1. oral contraceptive pills
2. injectables
3. implantable
4. hormone containing IUD
5. contraceptive patches

Question 5

The two types of oral contraceptives pills (OCPs)

Answer 5

1. combination: estrogen and progesterone
2. progestin only - mainly used in breastfeeding women and pts w contraindication to estrogen

Question 6

What is the role of progesterone in OCPs

Answer 6

major player in suppressing LH and therefore ovulation as well thickening the cervical mucous inhibiting sperm migration

Question 7

benefits to OCPs

Answer 7

cycle regularity; improve painful periods; decrease iron deficiency (shorter and less heavy cycles) and low incidence of cancers

Question 8

Serious Side effects of OCPs

Answer 8

venous thrombosis; PE; stroke and MI; hepatic tumors

Question 9

The patch

Answer 9

estrogen and progesterone; one patch every 3 weeks; only women under 198 lbs; greater risk for thrombosis

Question 10

The patch carries which greater risk compared to OCPs?

Answer 10

greater risk for thrombosis

Question 11

vaginal ring

Answer 11

combination of estrogen and progesterone; insert in vagina for 3 weeks; better tolerated; less breakthrough bleeding

Question 12

Annovera vaginal ring

Answer 12

newer ring; segesterone acetate; 13 months in one reusable ring; BMI and weight not assessed (unlike the patch)

Question 13

Contraindications to combined contraceptives

Answer 13

women over 35 who smoke cigarettes
hx of thromboembolic event-DVT/PE
liver disease or liver tumors

Question 14

Injectable hormonal contraceptives

Answer 14

Depo provera; progestin ONLY

Question 15

Depo provera

Answer 15

injectable progestin; every 14 weeks; given first 5 days of menses; not altered by weight (unlike the patch); alterations in bone metabolism (concern for adolescents); not supposed to be used for more than 2 yrs

Question 16

Sides effects of depo provera

Answer 16

irregular bleeding (why most pts discontinue)
weight gain (makes you hungry)
exacerbation of depression (watch for hx)

Question 17

MOA of depo provera

Answer 17

thickening cervical mucous; decidualization of the endometrium; blocks LH surge and ovulation

Question 18

Contraindications of depo provera

Answer 18

active/current thromboembolic event (not a hx of); known or suspected breast malignancy; vaginal bleeding; liver disease; pregnancy

Question 19

Long acting reversible contraceptives (LARCs)

Answer 19

Nexplanon - implantable rod; 3 yrs
IUDs (5): Copper T, Mirena, Liletta, Skyla, Kyleena

Question 20

Major side effects of nexplanon

Answer 20

irregularly irregular vaginal bleeding (most common irritation); headaches; weight gain; breast pain; acne

Question 21

Indication for nexplanon

Answer 21

breastfeeding patients; also pts who want a convenient effective method

Question 22

What is the only absolute contraindication to the nexplanon?

Answer 22

known or suspected breast cancer

Question 23

Complications to the nexplanon

Answer 23

infection; bruising; deep insertion; migration and persistent pain at insertion site

Question 24

What is the only non-hormonal IUD

Answer 24

Copper T (Paragard); used for 10 yrs; MOA - copper interferes with sperm transport or fertilization and prevention of implantation

Question 25

What are 3 major risks with IUDs?

Answer 25

1. infection first 20 days post insertion
2. increased risk for ectopic pregnancy
3. risk of uterine perforation at time of insertion

Question 26

Contraindications to IUDs

Answer 26

breast cancer (does not include copper T)
recent sepsis or septic abortion
active cervical infection
Wilson’s disease (copper T only)
uterine malformations

Question 27

Mirena/Kyleena

Answer 27

IUDs, used for 7 yrs and 5 yrs

Question 28

Liletta

Answer 28

IUD; use for 7 yrs

Question 29

Skyla

Answer 29

IUD; used for 3 yrs; designed for nulliparous women (smaller in diameter)

Question 30

What is the only method of contraception that has protection against STIs?

Answer 30

barrier methods (condoms)

Question 31

Diaphragms

Answer 31

non-hormonal option; dome-shaped device inserted into vagina 6 hrs before intercourse; must be left for 6 to 8 hrs; must be used with spermicide; more likely to get a UTI

Question 32

Women who use diaphragms are more at risk for what?

Answer 32

urinary tract infections (UTIs)

Question 33

Women who use cervical cap (FemCap) are more at risk for what?

Answer 33

Toxic shock syndrome

Question 34

Cervical cap (FemCap)

Answer 34

small diaphragm; placed in cervic; increase risk for toxic shock syndrome; used with spermicide

Question 35

Phexxi

Answer 35

non-hormonal option; vaginal gel inserted into the vagina that raises pH which lowers sperm mobility; increase of vaginal infections

Question 36

Basal body temperature method

Answer 36

check daily temp; 0.5 to 1 degree change, avoid sex for 3 days after

Question 37

Emergency contraceptions

Answer 37

no medical contraindications
1. Plan B - progestin only; 120 hours after unprotected intercourse
2. Ella - ulipristal acetate; 5 days after unprotected intercourse

Question 38

Vasectomy

Answer 38

occlusion of vas deferens; not immediate - takes 10 weeks; safer more easily performed, less expensive and easier to reverse