Contraception: Behavior, Barrier, Hormones

Question 1

Methods of contraception? (6)

Answer 1

1) behavioral
2) barrier
3) hormonal
4) IUD
5) sterilization
6) emergency

Question 2

Failure Rate is?

Answer 2

% of preggos per yr on particular method

Question 3

Typical Use vs Expected Rate?

Answer 3

Typical Use = actual fail rate due to human error

Expected = fail rate when used correctly

Question 4

Most effective REVERSIBLE methods?

Answer 4

Implants

IUD

Question 5

Most effective IRREVERSIBLE methods?

Answer 5

sterilization

Question 6

Next most effective methods?

Answer 6

Hormones

Diaphragm

Question 7

Behavioral Methods: Abstinence

Benefits?

Risks/Disadv?

Answer 7

Benefits:
↓ STI risks (NOT no risk)
No s/e
100% effective

Risks:
Difficult
Leaves situation open to NO contraception or STI prevention

Question 8

Behavioral Methods: Fertility Awareness Based (FAB)

Includes? (5)

Answer 8

1) Basal temp
2) Calendar
3) Cervical mucus
4) Symptothermal (all 3 above)
5) Lactational amenorrhea

Question 9

Behavioral Methods: FAB

Benefits?

Risks/Disadv?

Answer 9

Benefits:
no hormones or s/e

Risks:
Difficult
High failure ~24%

Question 10

Behavioral Methods: Withdrawal

Benefits?

Risks/Disadv?

Answer 10

Benefits:
No hormones

Risks:
Difficult
High failure

Question 11

Barrier methods action?

Answer 11

prevent sperm from contacting egg

Question 12

Barrier Methods: Spermicides action?

Answer 12

Block entrance

Immobilized sperm

Question 13

Barrier Methods: Spermicides

Use? (2)

Benefits? (3)

Risks/Disadv? (5)

Answer 13

10 min wait post insertion
leave in 8 hrs post intercourse

Benefits:
most W can use
convenient
easy to get/cheap

Risks:
easy to use wrong
irritation
Not for HIV+ W
↑ HIV/STDs
high fail

Question 14

Barrier Methods: Sponges

Use? (4)

Benefits? (3)

Risks/Disadv? (4)

Answer 14

Use:
cover cervix
up to 24 hrs prior to action
leave in 6 hrs post
max placement 30 hrs

Benefits:
most W can use
immediate use
easy to get/cheap

Risks:
can break apart
sulfite allergy
toxic shock
high fail

Question 15

Barrier Methods: Male Condom

Benefits? (5)

Risks/Disadv? (3)

Answer 15

Benefits:
most effective barrier method w/ correct use,
convenient,
best STI protection (o/t abstinence),
easy to get/cheap

Risks:
↓ sensation
irritation
(P) breakage

Question 16

Barrier Methods:Female Condom

Benefits? (2)

Risks/Disadv? (3)

Answer 16

Benefits:
some STI protection
easy to get/cheap

Risks:
slippage
↓ sensation
irritation

Question 17

Barrier Methods: Diaphragms/Caps

Use? (5)

Benefits? (3)

Risks/Disadv? (6)

Answer 17

Use:
Must be fitted
covers cervix
use w/ spermicide
leave in 6 hrs post
max placement 24 hrs (diaph), 48 hrs (cap)

Benefits:
immediate use
not felt
good for 2 yrs

Risks:
need pelvic exam
Rx only
BLADDER INFECTIONS
allergy/irrit
↑ toxic shock
high fail (esp caps)

Question 18

Hormonal contraception action?

Answer 18

prevent ovulation

Question 19

Hormonal Methods: Combined Oral Contraceptives Action? (6)

Answer 19

Estrogen (inhibit FSH)
Progesterone (inhibits LH)
Prevents ovulation
Thickens cervical mucus (barrier)
Alter endometrium (unreceptive)
DOES NOT interrupt already implanted egg

Question 20

Hormonal Methods: COC Types? (3)

Answer 20

1) Monophasic (constant E2/Prog thru entire cycle)
2) Biphasic (2 prog doses -> ↑ 1/2 way thru cycle)
3) Triphasic (3 E2 doses -> ↑ thru cycle)

Question 21

Hormonal Methods: COC start options? (3)

Answer 21

1) Quick Start (begin immediately but need 7 days of backup method)
2) Sunday Start (start 1st Sunday after 1st day of bleed)
3) First Day of Start

Question 22

Hormonal Methods: COC use? (3)

Pregnancy may happen if? (3)

Answer 22

R/O pregnancy first
Take daily
Works best if same time ea day

start pills too late in cycle
miss >1 pill in a row
take in wrong order

Question 23

Hormonal Methods: COC

Contraindicated for? (14)

Answer 23

1) ≥ 35 and smokes
2) Hx MI or embolic CVA
3) Hx heart valvulopathy
4) Hx uncontrolled HTN
5) Controlled HTN and smokes
6) Hx thromboembolism
7) Hx blood coagulopathy
8) Unexplained vag bleeding
9) Hx breast/uterine CA
10) Liver dz
11) DM assoc’d vascular conditions
12) Pregnant
13) Prolonged bedrest post surgery
14) Migraine HA w/ Aura

Question 24

Hormonal Methods: COC

Benefits? (10)

Answer 24

Reg/short/lighter periods
↓ cramps
↓ PMS/depression
↓ ectopics
↓ ovarian cysts/ovarian CA
↓ acne
↓ bone loss
↓ body hair
↓ vag dryness/painful intercourse
Quick return of fertility

Question 25

Hormonal Methods: COC Risk/Disadv? (7)

Answer 25

``` Rx Daily Nausea, bloating, tender breasts (P) spotting No STI protection ↑ MI/Stroke/Clots esp if smoker Meds ↓ effectiveness: TB abx, anti-seizure, anti-fung, HIV meds ```

Question 26

Factors that ↑ VTE w/ oral contraceptive?

Answer 26

1) ≥ 35 and smokes 2) < 21 days postpartum 3) Prolonged bedrest post surgery 4) Hx of DVT or PE 5) Hereditary thrombophilia 6) IBD 7) Corticosteroids 8) SLE

Question 27

Hormonal Methods: Extended Cycle OC use?

Answer 27

E2/Prog combo | 91 day: 12 wks active pills, one wk inactive

Question 28

Hormonal Methods: ECOC Benefits? Risk/Disadv?

Answer 28

Benefits: same as COC fewer periods Risks: same of COC (P) unrealized pregnancy (P) unplanned spotting

Question 29

Hormonal Methods: Patch Use? Benefits? Risk/Disadv? (4)

Answer 29

Use: weekly for 3 wks, 1 wk off Benefits: same COC easier compliance ``` Risks: Rx and exam Weight max = 190# Irritation ↑ VTE than other COC (more E2) ```

Question 30

Hormonal Methods: Ring Action? Use?

Answer 30

Action: same as COC E2/prog Use: in place 3 wks, out 1 wk, loses effectiveness if out > 3hrs during "in" wks

Question 31

Hormonal Methods: Ring Benefits? Risk/Disadv? (6)

Answer 31

Benefits: convenient no fitting necess no spermicide necess ``` Risks: same COC Rx VAGINAL D/C Irritation (P) felt during action higher cost ```

Question 32

Hormonal Methods: Progestin Only Pills Action? Use?

Answer 32

Action: Less inhib of ovulation than COC Thins endometrium Thicken cervical mucus Use: MOST USED by breastfeeding Continuous active pills (no placebo interval) Do have to take at same time ea day

Question 33

Hormonal Methods: POP Benefits? Risk/Disadv? (6)

Answer 33

Benefits: E2 contraindication alternate Safe for breastfeeding ``` Risks: Menstrual ∆s Depression ↓ libido Acne Breast tenderness ↑ follicular ovarian cysts ```

Question 34

Hormonal Methods: Injections Action? Use?

Answer 34

Prevents ovulation (P) thickening of cervical mucus Use: Q 3 monts (IM or SQ) Preg test every time Immediate protection if given during 1st 5 days of bleed

Question 35

Hormonal Methods: Injections Benefits? (5) Risk/Disadv? (4)

Answer 35

Benefits: VERY EFFECTIVE (better than tubal ligation), No E2 so few s/e, Safe in lactation, PREVENTS endometrial CA (thins membrane), Safer for >35yo, overweight, smokers w/ clot hx and high BP ``` Risks: (P) spotting or amennorhea ↓ BMD Weight gain HA/dizzy/fatigue Long lead time to returned fertility ```

Question 36

Hormonal Methods: Implants Action? Benefits?

Answer 36

Progestin Benefits: MOST EFFECTIVE lasts 3 yrs rapid return to fertility Risks: same as injection UNSCHEDULED bleeding

Question 37

IUD: Copper Action?

Answer 37

Imobilizes sperm in uterus Prevents implantation by ∆ing uterine lining Good for 10 yrs

Question 38

IUD: Hormonal Action?

Answer 38

Low progestin Thickens mucus Prevents implantation by ∆ing uterine lining Good for 5 yrs

Question 39

IUD insertion?

Answer 39

Complete H&P to r/o STIs and abnormalities Insert at any time but heaviest day is best MUST ensure not pregnant Post delivery or abortion -> wait 4 wks

Question 40

IUD Benefits?

Answer 40

Best for non-compliant pts Works immediately Remove any time Not felt

Question 41

IUD Risks/Disadv?

Answer 41

``` Cramping after placement Spotting Dysmennorhea Menorrhaiga Miscarriage Punctured uterus ```