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Naplex 2025 > Contraception & Infertility > Flashcards

Contraception & Infertility Flashcards

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1
Q

How long is the normal menstrual cycle?

A
  • 23 - 35 days (~ 28 days)
  • The start of bleeding = the start of the next cycle
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2
Q

What are the phases of the menstrual cycle?

A
  • Follicular
  • Ovulatory
  • Luteal
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3
Q

What happens during the follicular phase?

A
  • A surge in estrogen = increased LH & FSH
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4
Q

What happens during the ovulatory phase?

A
  • LH & FSH trigger ovulation (24 - 36 hours) = release of egg from ovary
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5
Q

What happens during the luteal phase?

A
  • The start of ovulation = luteal phase lasting for ~ 14 days
  • Progesterone is the dominant hormone
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6
Q

What is the hormone that shows that someone is pregnant?

A
  • Human Chorionic Gonadotropin (hCG) - detected in the urine (best first thing in the morning to test)
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7
Q

If a woman is planning to conceive; what are some of the things that should be done to protect the health of the baby?

A
  • Increase folic acid intake (folate or Vit B9)
  • Stop smoking, using illegal drugs, and drinking alcohol
  • Get current vaccinations
  • Avoid those teratogenic drugs
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8
Q

What are the most effective contraceptive methods?

A
  • Implant - 0.05% (Reversible)
  • IUD - 0.2 to 0.8% (Reversible)
  • Vasectomy - 0.15% (Irreversible)
  • Laparoscopic, Hysteroscopic - 0.5% (Irreversible)
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9
Q

What are the moderately effective contraceptive methods?

A
  • Injectables - 6%
  • The Pill - 9%
  • Patch - 9%
  • Ring - 9%
  • Diaphragm - 12%
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10
Q

What are the least effective contraceptive methods?

A
  • Male Condom - 18%
  • Female Condom - 21%
  • Withdrawl - 22%
  • Sponage - 24%
  • Fertility - Awareness Based Methods - 24%
  • Spermicide - 28%
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11
Q

What is the ONLY 100% effective way to not get pregnant?

A
  • Abstinence
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12
Q

What is the way that temperature and cerival mucus can be used to identify pregnancy?

A
  • Helps with predicting ovulations
  • ~1 degree increase could indicate ovulation & cerivcal mucas changes (color, texture, volume)
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13
Q

What is the MOA of hormonal contraceptives? What are some of the available treatments?

A
  • Inhibits the production of FSH & LH
  • Progestin-ONLY (Pill, Injectable, Implant, IUD)
  • Estrogen/Progestin (Pill, Patch, Vaginal Ring) - CBCs (combination oral contraceptives)
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14
Q

What do most combination oral contraceptives contain? What are the different formulations?

A
  • Ethinyl Estradiol & Progestin (Norethindrone, Levonorgestrel, Drospirenone)
  • Forms: Monophasic - Same dose during WHOLE pack; Biphasic, Triphasic, Quadriphasic - mimics E & P levels during menstrual cycle

Drospirenone - helps reduce any common adverse effects normally seen with COCs

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15
Q

What are some other indications that COCs can help with?

A
  • Dysmenorrhea (Menstrual Cramping)
  • PMS
  • Acne (in females)
  • Anemia (by reducing blood loss)
  • Polycystic Ovary Syndrome (PCOS) - 1st line
  • Endometriosis - 1st line
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16
Q

What is important to note about the progestin only pills (POPs)?

-

A
  • Contains NO estrogen & suppresses ovulation
  • Mainly used in those that are breastfeeding (estrogen decreases milk)
  • Require good adherence - must be taken within 3 hours of scheduled time
  • SAFE in those with migraines with aura
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17
Q

What is important to note about injectable contraception?

A
  • Depo-Provera, Dep-SubQ Prover 104 are Medroxyprogesterone
  • Given IM or SubQ every 3 months

SOMETHING DONE IN PUP; VERY IMPORTANT TO KNOW

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18
Q

What are some general tips about the contraceptive names?

A
  • “Lo”: < 35 mg of estrogen (less side effects)
  • “Fe”: contains iron
  • “24”: shorter placebo (24 active + 4 inactive pills)
  • “Pro”: Progestin product
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19
Q

What are some of the monophasic formulations of Combination Oral Contraceptives (COCs)?

A
  • Junel Fe 1/20, Microgestin Fe 1/20, Sprintec 28, Loestrin 1/20, Yasmin 28 (21 actives, 7 inactives)
  • Yaz (24 actives, 4 inactives)
  • Lo Loestrin Fe (24 actives, 2 of EE ONLY, 2 Inactive with iron)

These ALL have the same doses of progestin & estrogen throughout the pack

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20
Q

What are some of the Bisphasic, Triphasic formulations of Combination Oral Contraceptives (COCs)?

A
  • Tri-Sprintec, Ortho Tri-Cyclin Lo, Notrel 7/7/7, Trivora-28, Velivet (3 differenct weeks [7/7/7])

Bi = two phases & tri = three phases

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21
Q

What are some of the Quadriphasic formulations of Combination Oral Contraceptives (COCs)?

A
  • Natazia (doses change over 26 days [estradoil valerate & dienogest] followed by 2 inactive pills - four phases)
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22
Q

What are some of the Extended Cycle formulations of Combination Oral Contraceptives (COCs)?

A
  • Jolessa (84 days of EE + LNG followed by 7 days of inactive)
  • Seasonique, Camrese, Camrese Lo, Amthia (84 days of EE + LNG followed by 7 days of low dose EE)
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23
Q

What are some of the Continuous formulations of Combination Oral Contraceptives (COCs)?

A
  • Amethyst (28 days of EE + LNG; NO INACTIVES)
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24
Q

What are some of the Drospirenone Containing formulations of Combination Oral Contraceptives (COCs)?

A
  • Yasmin 28, Yaz, Loryna, Ocella, Nextstellis, Nikki, Safyral, Syeda, Beyas (mild Potassium sparing Diuretic - reduces bloating and other side effects)
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25
What are some of the **patch formulations** of **Combination Oral Contraceptives (COCs)**? ## Footnote Contains Estrogen & Progestin
- **Xulene**, Zafemy, Twirla (Weeks 1 - 3 once daily; Week 4 **OFF**) [Has higher estrogen than pills]
26
What are some of the **Ring formulations** of **Combination Oral Contraceptives (COCs)**? ## Footnote Contains Estrogen & Progestin
- **NuvaRing**, EluRyng, Haloette, Annovera (**insert monthly**: leave in for 3 weeks; remove for 1 week
27
What are some of the **Progestin-Only Pills formulations** of **Combination Oral Contraceptives (COCs)**? ## Footnote "Mini Pill or POPs"
- **Errin, Camila, Nora-BE**, Incassia (Have fixed dose of **Norethindrone**) - **Opill** (OTC - **NO** Prescription needed)
28
What are some of the **Injections formulations** of **Combination Oral Contraceptives (COCs)**?
- **Depe-Provera** (Contains Depot Medroxyprogesterone [DMPA]; **injected every 3 months** [150 mg **IM** or 104 mg **SubQ**])
29
What are some of the **side effects** for **estrogen**?
- Nausea - Breast Tenderness - Bloating - Weight Gain - Increased Blood Pressure ## Footnote Reducing estrogern to reduce side effects = possible spotting
30
What are some of the **more severe side effects** for **estrogen**? ## Footnote **"ACHES"**
- **A**bdominal Pain (severe) - i.e.; Mesenteric or Pelvic Vein **Thrombosis** - **C**hest Pain - Sharp, crushing or heavy pain could be a Heart Attack. SOB with pain could be PE (**Clotting Risk**) - **H**eadaches - Sudden & Severe with vomiting or weakness to one side could be a stroke (**Again Clotting**) - **E**ye Problems - Blurry Vision, Flashing light, Vision Loss could be **clot** in eye - **S**welling or Sudden Leg Pain - Could be DVT (**AGAIN clots bruh**)
31
What are some **Side effects** for **progestin**?
- Breast Tenderness - Headaches - Fatigue - Depression
32
What is **important** to know about **Drospirenone's Side Effects**?
- Higher risk of **clotting** (do not use in those with clotting risks) - **Increase Potassium** (is potassium sparing duh) - **DO NOT** use in those with **Kidney, Liver, or Adrenal Gland Diseases**
33
What is **breakthrought bleeding**? What to do if it **Persists**?
- "Spotting" that can resolve within **2 - 3 Months** - If **Persists**: Incresae dose or try different progestin
34
What are some of the **boxed warnings** for **ALL CHC products (pills, patch, ring)**?
- **DO NOT USE** in women **> 35 yo** who **smoke** due to risk of serious **cardiovascular** events
35
What are some of the **boxed warnings** for **Estrogen + Progestin Transdermal Patch)**?
- **DO NOT USE** in women with a **BMI > 30** due to increased risk of **Thromboembolism** or decreased efficacy
36
What are some of the **boxed warnings** for **Depo-Provera**?
- Loss of **Bone Mineral Density** with long term use
37
What are some of the **condition** where you **DO NOT** want to use **Estrogen**?
- Hx of **DVT/PE, Stroke, CAD** (due to thrombosis) - Hx of **Breast, Ovarian, Liver, Endometrial Cancers**, Uncontrolled HTN, **Migraine with Aura**
38
For someone with **Acne or Hrsutism** what **contraceptive product** should be considered?
- COC with **Progestin** has **lower androgenic** activity [Sprintec 28] or **no androgenic** activity [Yaz, Yasmin]
39
For someone with **breastfeeding** what **contraceptive product** should be considered?
- **Progestin-ONLY** (POPs) or **Nonhormonal** Methods
40
For someone with **Estrogen Contraindications (i.e.; Clotting Risk)** what **contraceptive product** should be considered?
- **Progestin-ONLY** or **Nonhormonal**
41
For someone with **Migraine** what **contraceptive product** should be considered?
- **WITH** Aura: **Progestin-ONLY** or **Nonhormonal** - **WITHOUT** Aura: **Any method**
42
For someone with **Fluid Retenion/Bloating** what **contraceptive product** should be considered?
- **Drospirenone** containing product (helps against this)
43
For someone with **Heavy Menstrual Bleeding (Menorrhagia)** what **contraceptive product** should be considered?
- If **BP uncontrolled** - **NO** Estrogen - Choose **Progestin-ONLY** or **Nonhormonal**
44
For someone with **mood changes/disorder** what **contraceptive product** should be considered?
- Use **monophasic** COC - **Extended cycle** or continuous with **drospirenone** is preferred
45
For someone with **nausea** what **contraceptive product** should be considered?
- Take **at night, with food** - Possibly **decrease estrogen** dose OR switch to **Progestin-ONLY**, Ring or Nonhormonal methods ## Footnote Really after a **3 month trail**
46
For someone with **Overweight** what **contraceptive product** should be considered?
- **ANY** Method - Counsel on the **patch** (reduced effectivness & BMI > 30) - **DO NOT** use **DMPA** if trying to avoid weight gain
47
For someone with **postpartum** what **contraceptive product** should be considered?
- DO NOT use CHCs for **3 weeks**, or for **6 weeks** if patient has increased risk factors for VTE - **CAN** use **progestin-ONLY** or **NONHORMONAL**
48
For someone with **Premenstrual Dysphoric Disorder** what **contraceptive product** should be considered?
- **Drospirenone** containing product (Yaz) - **SSRIs** maybe needed
49
For someone with **spotting/"Breakthrough bleeding"** what **contraceptive product** should be considered?
- Start **exteneded cycle** or **continuous regimens** - If **Early** spotting = increase estrogen dose; **later** spoting = increase progestin dose
50
For someone with **wishing to avoid monthly cycle/menses** what **contraceptive product** should be considered?
- **Exteneded** or **continuous** forms
51
What are some of the **drug interactions** with **hormonal contraceptions**?
- Antibiotics (**Rifampin, Rifabutin** - back up is needed) - Anticonvulsants (**Carbamazepine, Oxcarbazepine, Phenytion, Primidone, Topiramate**) - **St Johns Wart** - Smoking **tobacco** - **Ritonavir** - **Colesevelam** - separate by 4 hours - **Mounjaro** - use back up for 4 weeks after start and dose increses
52
What are some of the **risks with Hep C Treatment** and **Contraceptions**?
- Mavyret (Glacepivir/Pibrentasvir) is **NOT** recommened with any form containing **> 20 mcg** of EE = **Liver Toxicities**
53
What are some of the **Drospirenone drug interactions**? ## Footnote -
- Those that **risk of increasing potassium**: Aldosterone Antagonists, ACEs, ARBs, Heparin, Canagliflozin, Calcineruins...
54
What is **Important** to know about **starting** **conbination oral contraceptions**? What are some of the **common "starts"** for them?
- Normally takes **7 days** before its at **max efficacy** - **Back us** is required for the 7 days (Unless **COC is started within 5 day of start of period**) - **"Start Today"** - Recommended to help maximize protection - **"Sunday Start"** - start Sunday after menstration (common for those that want the period to be over before the weekend) - **"First day Start"** - start of frist day of period (**starting within 5 days of period** = no back up)
55
If you **miss or are late to 1 pill** of your **COCs** what is the recommended thing to do?
- Take the missed pill **ASAP** and take the next dose **ON** schedule (even if that is 2 pills in one day) - **NO** back is required - **Emergency Contraceptive** not really needed
56
If you **miss or are late to 2 pills** of your **COCs** what is the recommended thing to do?
- Take the **most recent missed pill ASAP** then take the next dose at the normal time (even if that is 2 pills in one day) - If during **Week 3**: **omit hormone free week** start next pack of pills right after finishing the current pack - **Back up required** for **7 days** - Should **consider emergency contraception**
57
If you are **> 3 hours past your schduled time** for your **POPs**, what is the recommended thing to do?
- Take pill **ASAP** and take next scheduled dose - **Back up required** for next **48 hours** - Consider **Emergency contraception** if unprotected sex withinpast 5 days
58
What are some of the **emergency contraceptions** that are available? When is the **best time** to take them?
- **Copper IUD (Paragard)** - THE most effective (take within **5 days**) - **Ulipristal Acetate (Ella)** (Take **ASAP or Within 5 days**) - **Levnorgesterel (Plan B One Step)** (Take **ASAP or within 5 days**) ## Footnote All are have **improved efficacy** the sooner you take them within that 5 day window
59
What is **important** to know about **Ella**?
- Very chemically similar to mifepristone (aka **"abortion pill" or RU-486**) - Helps **prevent or delay ovulation** - Requires a **Prescription** (levonorgestrol does not) - Can be more effective than levonorgestrol
60
Where on the **body** should the **patch** be applied too?
- Butt, Stomach, Upper Arm or Upper Torso - Start on **Day 1** or **Sunday**

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