Contraception and Sterilization - Wootton Flashcards Preview

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Flashcards in Contraception and Sterilization - Wootton Deck (42):
1

Function of progesterone component in oral contraceptives

- Suppress LH and ovulation
- Thicken cervical mucous, inhibiting sperm migration
- Creating unfavorable atrophic endometirum

2

Function of estrogen component in oral contraceptives

- Improve cycle control by stabilizing endometrium and allowing less bleeding

3

Progestin-only oral contraceptives - fxn

Used by who?

Bad thing about it?

Making cervical mucous thick and impermeable

Breastfeeding women, or those w/ estrogen contraindication

MUST be taken w/in 2-3 hours of same time every day, or else must use backup for 2 days

4

Benefits of oral contraceptives

- Cycle regularity
- Less dysmenorrhea
- Less iron deficiency
- Less endometrial and ovarian cancer

5

Benign side effects of oral contraceptives

- Breakthrough bleeding (10-30%)
- Amenorrhea (1-5%)
- Bloating, weight gain, breast tenderness, nausea, fatigue, headache

6

Serious side effects of oral contraceptives

Venous thrombosis, PE, GB disease, stroke, MI, hepatic tumors

7

Transdermal patch - caution?

Side effects?

Not effective if > 198 lbs

Same, increased thrombosis risk (more than oral)

8

Vaginal ring - benefits

Better compliance, less breakthrough bleeding, can be removed for 3 hrs w/o losing efficacy

9

Groups that can't use combo contraceptives

- Smokers > 35
- Personal Hx of thromboembolic event
- Hx of CAD, CVD, CHF, or migraine w/ aura
- DM, chronic HTN, SLE
- Moderate to severe liver disease (ex. hepatitis) or tumors

10

Depo -- drug?

How to use?

MoAs

Medroxyprogesterone acetate

IM injection w/in first 5 days of menses, every 3 months

Thicken mucous, decidualize endometrium, block LH and ovulation

11

Benefit to Depo vs. patch

NOT affected by weight

12

Depo-provera -- black box warning

Important in who?

Bone metabolism issue w/ decreased estrogen level

Adolescents

13

Side effects of Depo (3)

- Irregular bleeding (add back estrogen to help)
- Weight gain (HANGRY)
- Depression exacerbation (post-partum)

14

Indications of Depo vs. combo drugs (5)

- No estrogen (can use in contraindication)
- Want better compliance
- Women w/ seizures
- Sickle cell anemia
- Anemia 2º to menorrhagia

15

Contraindications to Depo (5)

- Pregnancy
- Unknown bleeding
- Breast malignancy
- Active or recent thrombophlebitis/thromboembolic event
- Liver dysfunction/disease

16

Nexplanon - what is it

Used for how long?

MoA?

Etonogestrel - rod implant

3 years

Thicken mucous, inhibit ovulation

17

Main side effect of rod implant

Irregularly irregular vaginal bleeding (no control of cycle)

18

Indications for rod implant

- Want a convenient method
- Breastfeeding

19

Contraindications for rod implant

SAME AS DEPO - pregnancy, thrombosis, liver disease, bleeding, breast cancer

20

Side effects of rod implant insertion

Infection, bruising, deep insertion, migration, persistent pain or paraesthesia at insertion site

21

3 IUDs in US (w/ durations)

Paragard (copper) - 10 years
Mirena (Levonorgestrel) - 5 years
Skyla (Levonorgestrel) - 3 years

22

Risks of IUDs

- Infection in first 20 days
- Ectopic pregnancy
- Uterine perforation at insertion
- Malposition

23

If IUD and pregnancy, do what?

Remove it (if string is visible)

24

Contraindications to IUD

- Breast cancer (Levonorgestrel ones)
- Recurrent puerperal sepsis
- Recent septic abortion
- Active cervical infection
- Wilson's disease (copper one)
- Uterine malformations)

25

Benefits of IUD (4)

- Decreased menstrual bleeding
- Less dysmenorrhea
- Protection of endometrium in obesity (high estrogen)
- Convenient and long term

26

MoA of Copper IUD (Paragard)

- Interferes w/ sperm transport or fertilization and implantation

27

Only contraceptive method that protects from STIs

Condoms

28

Barrier methods are cheap, but ___

Have higher failure rate than others

29

Bad things about diaphragms (4)

- Must be used w/ spermicide
- Must be left in for 6-8 hours after intercourse
- Must be fitted and re-fitted
- More likely to get UTIs

30

Differences about cervical cap than diaphragm

- Fits cervix itself
- High risk of displacement and toxic shock syndrome

31

Sponge

Better in who

Bad things??

Small pillow w/ spermicide that fits on/over cervix

Nulliparous women

- Only one size
- Toxic shock risk if left in

32

What is Plan B?

For who?

Progestin only (Levonorgestrel) - 2 pills 12 hrs apart

OTC if older than 17

33

What is ella?

Ulipristal acetate

34

Male sterilization

How long to be effective?

Vasectomy - occlusion of vas deferens

10 weeks

35

Laparascopy - methods

Occlude fallopian tubes via...
- Electrocautery
- Clips
- Bands
Bands
Salpingectomy (removal of tube)

36

Most common surgical procedure for sterilization

Mini-laparotomy
- Small infraumbilical or supraumbilical incision

37

Hysteroscopy - 2 approaches w/ this

- Transcervical tubal ligation
- Essure system
- Small coils in the fallopian tube, cause complete occlusion

38

Essure system - contraindications

Nickel or contrast allergies
Pelvic infection
Pregnancy

39

Essure system - benefits

Good for obese patients

40

Things w/ estrogen in it

Things w/ just progestin in it

Patch, ring, combo pills

IUD, Depo, progestin-only pills

41

26, G3P3, was using basal body temp system but wants a more reliable, less intensive method. Not ready for permanent sterilization. PHx of DVT. Does not smoke. What are her best options?

What if she was morbidly obese, did not want any more kids, and FHx of breast cancer?

IUD or Depo (NO ESTROGEN)


Essure

42

Biggest risk for patient w/ permanent sterilization

Regret