Contraception and Sterilization - Wootton Flashcards Preview

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Flashcards in Contraception and Sterilization - Wootton Deck (42)
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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