Contraceptives (2)

Question 1

Method failure rate vs typical failure rate

Answer 1

Method: rate if method is used correctly

Typical: rate when method is used by pt

Question 2

What form of contraception provides the most effective reversible variant?

Answer 2

HC (hormonal contraception)

Question 3

What does estrogen and progesterone do in combination OCs?

Answer 3

Progesterone: suppresses LH and thus ovulation, thickens cervical mucous inh sperm migration, creates atrophic endometrium (not good for implantation)

Estrogen: improves cycle control by stabilizing the endometrium > less breakthrough bleeding

Question 4

Progestin-only OC do primarily what? What scenario are they used in?

Answer 4

Make cervical mucous thick and impermeable

Breast feeding women (estrogen limits milk production) and women contraindicated to estrogen

Question 5

Benefits of OCs?

Answer 5

Menstrual cycle regularity

Improved dysmenorrhea

Dec risk of Fe-def anemia (shorter and less heavy cycles)

Lower CA risk (ovarian, breast)

Question 6

SE’s of OCs include:

Answer 6

Breakthrough bleeding
Nausea
Fatigue
HA
Venous thrombosis
PE

Wt pain is only perceived

Question 7

What’s included in the transdermal patch? How often is it applied? What’s the wt limit? SEs?

Answer 7

Estrogen and progesterone

Once a week for 3 weeks

198lbs

Greater risk of thrombosis

Question 8

What’s the vaginal ring consist of? What’s a large advantage regarding pharmacokinetics? How often is it replaced? Can it be removed?

Answer 8

Estrogen and progesterone

No first pass metabolism through the liver

Once a month (insert for 3 weeks)

Yes, for 3 hours, but don’t recommend to pt

Question 9

Who can’t use HC?

Answer 9

Women > 35 who smoke

H/o thromboembolism, FH needs to be looked at thoroughly

H/o CAD, CVD, CHF, migraine w/ aura, uncontrolled HTN

H/o mod/sev liver dx or liver tumors

Question 10

How long does MPA work for? What is it? What does it do? What isn’t there? How effective is it? SEs?

Answer 10

14 weeks but prescribe injections every 11-13

IM injection of progestin

Lowers E levels, thickens cervical mucous, decidualization (blocks LH surge and ovulation)

Wt limit

Efficacy roughly equivalent to that of sterilization

Reversible dec bone density d/t dec E levels (caused by high P, consider changing to diff tx after 2 years), irregular bleeding (goes away), wt gain (P makes one hungry), exacerbation of depression

Question 11

What are some long term issues w/ stopping MPA tx?

Answer 11

Menses can take a year to regulate after d/c

Depression may linger

These are d/t the drug staying within the system for long periods of time after MPA is d/c

Question 12

Can MPA be used during breast feeding? When estrogen is contraindicated? In seizure disorders?

What are its effects on sickle cell? Endometrial hyperplasia?

Answer 12

Yes
Yes
Yes

Can dec sickle cell crises

Can lower endometrial hyperplasia

Question 13

What are some SEs and risks of MPA?

Answer 13

Shouldn’t be used during preg or in a female suspected to be preg, unevaluated vaginal bleeding, known or suspected breast malignancy, active thromboembolic events, liver dx

Question 14

What does LARC stand for? What are they?

Answer 14

Long-Acting Reversible Contraceptive

Implants and IUDs

Question 15

How long does a rod LARC last? When should it be implanted? MOA?

Answer 15

3 years

Within the first 5 days of menses

Thickens cervical mucous, inh ovulation

Question 16

What are some risks associated w/ a LARC?

Answer 16

Irregular bleeding (goes away!), HA, vaginitis, wt inc, acne, breast pain

Question 17

Can a LARC be used during breastfeeding?

Answer 17

Yes

Question 18

Contraindications to the implant? Complications?

Answer 18

Known or suspected preg

H/o thromboebolic event or disorder

Liver tumors or active liver dx

Abnormal undiagnosed uterine bleeding

Deep insertion, migration, infection, bruising, persistent pain

Question 19

What’s the IUD expulsion rate? Where’s insertion done?

Answer 19

1-5%

In the office!

Question 20

Risks w/ IUDs?

Answer 20

Inc infection risk

Inc risk of ectopic preg

Risk of uterine perforation at time of insertion which then req surgery

Risk of malposition that requires hysteroscopy for removal

Question 21

Contraindications for IUDs include:

Answer 21

B-CA (levonorgestrel only)

Recent sepsis or septic abortion

Active cervical infection

Wilson’s dx (Copper T only)

Uterine malormations

Question 22

What are the 3 levonorgestrel IUDs and how long do they last? How effective are they?

Answer 22

Mirena = 5 years
Liletta = 3 years
Skyla = 3 ears

Very, 0.2% pregnancy rate

Question 23

What are the benefits of IUDs?

Answer 23

Decrease in menstrual blood loss (50%)

Less dysmenorrhea

Convenient and long-term

Protects endometrium against estrogen

Question 24

How long do Cu IUDs last for? How?

Answer 24

10 years

Cu interferes w/ sperm transport and prevents implantation

Question 25

Pros and cons to barrier methods.

Answer 25

Pros: inexpensive, little to no medical consultation, condoms protect against STDs Cons: higher failure rate, still requires proper use

Question 26

What're the directions for diaphragms? What's a common risk?

Answer 26

Must be used w/ spermicide Can be inserted up to 6 hours prior to intercourse, must be left in 6-8 hours afterwards (but no more than 24h) Inc risk of UTIs d/t poor vaginal low and obstruction of urethra > urinary retention

Question 27

How long must vaginal liners be left in after intercourse?

Answer 27

6-8 hours

Question 28

Risks of cervical caps (smaller diaphragms)? How long are they left in for and where are they applied?

Answer 28

Displacement, toxic shock syndrome (TSS) 6 hours post-intercourse, no more than 48h Applied to cervix

Question 29

How long are sponges left in for after intercourse?

Answer 29

6h but no more than 30 (or inc risk of toxic shock syndrome)

Question 30

What does E-contraception do? Contraindications? How many pregnancies could it yearly prevent if used regularly?

Answer 30

Prevents ovulation and fertilization No contraindications 1.5 million

Question 31

What's Plan B?

Answer 31

Levonorgestrel 2 pills taken 12 hours apart OTC for women older than 17 Must be taken within 120h, more effective if before 72h

Question 32

What is the most frequent method of BC in the US?

Answer 32

Surgical sterilization 1/3 couples Considered a permanent method

Question 33

Is a Vasectomy immediately effective? What is the benefit of a salpingectomy?

Answer 33

No, complete azoospermia usually comes after 10 weeks Dec risk of ovarian CA

Question 34

What's a contraindication for hysteroscopy/the Essure system?

Answer 34

Nickel or contrast allergies, acute pelvic infection, suspected preg