Contraception L3-4 LARCs

Question 1

3 actions of LNG-IUS

Answer 1

thins lining, inhibits sperm movement, thickens cervical mucus

Question 2

T or F: IUDs prevent ovulation

Answer 2

F

Question 3

list 4 uses of LNG-IUS

Answer 3

contraception
treatment of heavy or abnormal uterine bleed
dysmenorrhea
provide endometrial protection from estrogens (from those who can not tolerate progesterone)- not an approved indication

Question 4

which is larger? the mirena or kyleena

Answer 4

mirena

Question 5

the mirena initially releases ___/day, which reduces to ___ /d by 5yrs

Answer 5

20 to 10

Question 6

the Kyleena initially releases ___/day of levonorgestrel, which reduces to ___ by 2 mths, then ___ by 5 yrs

Answer 6

17-15-7

Question 7

T or F: majority of pts with LNG-IUS experience reduced vaginal bleeding, with amenorrhea common

Answer 7

T

Question 8

list 3 AEs of LNG-IUS

Answer 8

irregular bleeding- spotting common in first 3-6mths
pain with placement in abdomen/ pelvis
systemic LNG levels may result in mood eff, breast tenderness, headache
malposition
expulsion

Question 9

with the LNG-IUS, when is irregular bleeding most likely to happen?

Answer 9

first 3-6mths

Question 10

how does the copper IUD prevent fertilization

Answer 10

copper ions inhibit sperm movement and ability to fertilize ovum

Question 11

duration of Cu-IUD

Answer 11

5-10yrs

Question 12

which is cheaper, Cu-IUD or LNG-IUS

Answer 12

Cu-IUD

Question 13

Cu-IUD AEs

Answer 13

irregular bleeding/ BTB
dysmenorrhea/pelvic pain/ cramps

Question 14

which has more BTB and dysmenorrhea/ pelvic pain/ cramps
1. LNG-IUS
2. Cu-IUD

Answer 14

Cu-IUD

Question 15

how long does it take for hormonal IUDs to start working?

Answer 15

7d, unless inserted within 7 days of start of period (check with yuksul)

Question 16

advantages of Cu-IUD over hormonal

Answer 16

cheaper, no hormonal SEs, may be alt for choosing nonhormonal option

Question 17

IUD contraindications include

Answer 17

pregnancy
current PID
current/hx breast cancer (PR +)-LNG-IUD only
liver disease- LNG-IUD
undiagnosed abnormal uterine bleeding
pueperal sepsis
cervical or endometrial cancer
postpartum =>48hrs to <4wks

Question 18

how long after delivery can you get an IUD inserted

Answer 18

must be either <48hrs since delivery or >4wks

Question 19

T or F: misoprostil administration prior to insertion is usually necessary

Answer 19

F- do not always need to soften cervix for IUD penetration

Question 20

can you keep an IUC in when being treated for STI

Answer 20

yes

Question 21

4 main risks with IUD

Answer 21

expulsion, uterine perf, PID, vasovagal/fainting with insertion

Question 22

rank the following based on most common to least when using IUC
PID, uterine perf, expulsion, fainting

Answer 22

expulsion > perforation > PID >fainting

Question 23

expulsion of IUD is most common in

Answer 23

the first year

Question 24

risk factors for uterine perf with IUD

Answer 24

inexperienced inserter, postpartum or breastfeding women

Question 25

RF for PID

Answer 25

risk in first mth of insertion higher if BV, cervicitis, contamination with instrument

Question 26

risks factors for fainting with IUD insertion

Answer 26

previous vasovagal rxn cervical stenosis

Question 27

what chemical does the subdermal progestin implant contain

Answer 27

etonogestrel 68mg

Question 28

duration of subdermal implant

Answer 28

3yrs

Question 29

where is the progestin implant placed

Answer 29

under skin of upper arm

Question 30

the progestin implant releases ___mcg etonogestrel daily for the first mth, then decreases down to ___mcg daily at the end of 3 yrs of use

Answer 30

60mcg 30mcg

Question 31

AEs of contraceptive implant

Answer 31

irregular bleeding, BT, spotting progestin related AEs

Question 32

most common AE of implant

Answer 32

irregular bleeding

Question 33

interactions with implant include

Answer 33

CYP3A4 inducers

Question 34

how to switch from CHC oral/ patch/ ring to LNG-IUS or implant

Answer 34

continue CHC for 7 dyas after insertion for LNG-IUS or implant

Question 35

how to switch from depot to LNG-IUS or implant

Answer 35

insert LNG-IUS or implant no later than 13wks after last inj (around wk 12-13)

Question 36

T or F: hormonal contraceptives can be safely used in those with seizure disorders

Answer 36

T

Question 37

if an individual is on an anticonvulsant that induces enzymes for hormonal contraceptives, options include

Answer 37

use IUDs use CHC with min 30-35mcg EE and progestins with longer half lives

Question 38

list 3 progestins with a longer half life

Answer 38

levonorgestrel, desogestrel, drospirenone

Question 39

T or F: migraines with neuro/ aura are a CI for POP, IUDs, implant

Answer 39

F- can have all of those, can't have CHC

Question 40

how to regimen CHC if migraine without aura

Answer 40

identify if migraines are due to fluctuations in hormones = use continuous CHC or estrogen in HFI

Question 41

the transdermal patch is not recommended for __kg

Answer 41

>90kg

Question 42

what is a concern for CHC in obesity? what can be used instead

Answer 42

VTE use IUDs (including LNG-IUS) instead

Question 43

T or F: breastfeeding delays return of ovulation

Answer 43

T

Question 44

what OC should be considered if <6wks postpartum and breastfeeding?

Answer 44

avoid CHC try POP

Question 45

what OC to use if 6wks-6mths postpartum and breastfeeding

Answer 45

POP over CHC

Question 46

what OC to use postpartum if not breastfeeding

Answer 46

if <3wks postpartum and not breastfeeding = avoid CHCs due to hypercoagulable state (if risk for VTE = wait 6wks) POP good for any stage of repro cycle