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Women's health trigger > Lecture 7: Contraception > Flashcards

Lecture 7: Contraception Flashcards

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1
Q

How common are unintended pregnancies?

A

45%

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2
Q

What is the main cause of 40% of unwanted pregnancies?

A

Not using birth control

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3
Q

what are reasons for using contraception (5)

A
  1. dont want kids
  2. space out children
  3. limit family size
  4. avoid effects of pre-existing illness on pregnancy
  5. endometriosis, PCOS, PMDD tx.
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4
Q

Top 3 reasons for not using contraception

A
  1. They dont care if they get pregnant
  2. Worried about the side effects
  3. Did not think they’d get pregnant

MC nonuse in low income, uninsured, nonmarried, and zero/1 parity

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5
Q

What is the general consensus regarding contraceptives in adolescents?

A

Give it to them!

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6
Q

What other disorders may use contraceptives as a form of tx? (3)

A
  1. Endometriosis
  2. PCOS
  3. Premenstrual dysphoric disorder (PMDD)
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7
Q

What are the 4 most effective contraceptive methods?

A
  • Implant (F)
  • Vasectomy (M)
  • Tubal occlusion (F)
  • IUD (F)
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8
Q

What methods are considered the worst for contraception?

A
  • Coitus interruptus (pull-out method)
  • Postcoital douche
  • Periodic abstinence
  • Lactational amenorrhea

Not using any birth control products

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9
Q

When is it appropriate to restart contraceptives after delivery?

A

3 months after

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10
Q

What is the most effective determinant of periodic abstinence?

A

Serum LH peak

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11
Q

What is the MC method of periodic abstinence?

A

Calendar method
avoid coitus 2 days prior to ovulation until 2 days after ovulation

It is also the least reliable 35% fail rate/yr

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12
Q

What is the billings method/cervical mucus method for periodic abstinence?

A
  • Checking ovulation by checking cervical mucus
  • Thin/watery = right before ovulation
  • Thicker = rest of cycle

Thin/watery = you are about to ovulate

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13
Q

What is the likely most effective method for periodic abstinence?

A

Symptothermal: Cervical mucus + temperature

thick mucus + 3rd day after elevated temp should be safe?

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14
Q

How does temperature vary in ovulation?

A
  • Drops slightly 24-36 hrs before ovulation
  • 3rd day after onset of elevated temp = fertile period over
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15
Q

List the periodic abstinence methods in order of most to least efficacious

(symtpthermal,cervical mucous, combined temp/calendar, temp, calendar, serum LH)

A
  1. serum LH
  2. symptothermal
  3. combined temp+calendar. cervical mucus.
  4. temp alone
  5. calendar alone.
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16
Q

what is the difference between COCs and POPs

A
  • COC - combination oral contraceptives. contains an estrogen and a progesterone. (used interchangeably w OCPs)
  • OPO - progesterone only pills.
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17
Q

what is the efficancy of OCPs

A
  • user-dependent
  • ranges from 3-9 pregnancies per 100
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18
Q

What is in COC (combination oral contraceptives)?

A
  1. Estrogen: ethanyl estradiol (MC), mestranol, 17b-estradiol, or estradiol valerate
  2. Progestin: norethindrone, levonorgestrel, desogestrel, norgestimate, drosperinone
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19
Q

Which progestin ingredient is a spironolactone analogue?

A

Drosperinone, which is less androgenic but higher VTE risk.

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20
Q

what is the difference between multiphasic and monophasic COCs

A

monophasic - same dose of hormones daily
Multiphasic - different doses of hormones during cycle.

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21
Q

What is the cycle of COCs?

A
  • 21 days of active hormones
  • 7 days of placebo

Newer is 24-4 (can also be 84-7 or just 365)

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22
Q

What should patients expect after stopping active COCs?

A

Withdrawal bleed 2-5 days after

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23
Q

What are the 3 ways of beginning the administration of COCs?

A
  • Ideal: first day of menstrual cycle
  • Traditional: first sunday following menses
  • Quickstart: day you get it

encourage regular routine of pill taking

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24
Q

what is the protocol for missed pills in COCs?

A
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25
What is the MOA of COCs?
Suppression of ovulation (estrogen) ## Footnote Alters consistency of mucus Makes endometrium less receptive to implantation
26
what drugs interact w COC's
1. Anticonvulsants (MC) 2. Abx (controversial) - macrolides, PCNs, rifampin 3. other - warfarin, tylenol, SSRIs
27
What are the benefits of using COCs? (8)
1. Reduced ovarian cx 2. Reduced endometrial cx 3. Improved bone mass 4. Decreased progression of RA 5. Improves acne 6. Lower risk of ectopic + PID 7. Decreased risk of benign fibrocystic breast dz 8. Improvement in dysmenorrhea and premenstrual s/s
28
What are the major SEs of COCs? (6)
* VTE * MI * Stroke * Liver dz * Cervical dysplasia/cancer * Breast cancer (controversial) | clotsx3, liver + cervix
29
CIs to COCs (8)
* Pregnant * Undxd vaginal bleeding * **Migraine w/ aura** * Prior hx of VTE/MI/Stroke * Increased risk for CV issues (SLE, DM, HTN uncontrolled) * **Smoking over 35** * Current/hx of breast cx * Active liver dz | Bottom 5 are all things it enhances
30
What should we keep in mind regarding POCs (progestin-only contraceptives)?
Does not suppress ovulation | Estrogen suppresses ovulation by inhibiting FSH
31
what is the pregnancy risk of POCs? what is the MOA
* approx 2-7 pregnancies per 100 * MOA - unknown but theorized to make cervical mucus less permeable.
32
Why would someone take POCs?
* No estrogen effects * No special sequence for pill-taking
33
Cons of using POCs? (3)
* Must take at **same time daily** * Higher rates of **irregular bleeding** * **High overall bleeding** rate
34
CIs to POCs (5)?
* Unexplained uterine bleeding * **Breast cx** * **Hepatic neoplasms** * Pregnancy * **Active liver dz** | Primarily liver issues
35
What are the 3 methods for **emergency contraception**?
* Yuzpe method * Levonorgestrel * Copper IUD | After you have unprotected sex or misused contraceptive
36
Describe the Yuzpe method, including dosages and dosing
* COCs containing **levonorgestrel** * 100mcg ethinyl estradiol + 500-600mcg levono * 2 doses, 12 hrs apart * **1st dose must be taken within 72 hrs of sex**
37
Main SEs of Yuzpe method (2)
**N/V**, recommended to premedicate.
38
Describe levonorgestrel/Plan B/Aftera, including dosages and dosing
* Single dose of 1500mcg of levono or 2 12hrs apart * **Take within 72hrs** * Prevents LH surge | **Single dose**or double if you want ## Footnote Yuzpe is double
39
Describe Ulipristal/Ella, including dosages and dosing
* Single dose of 30mg * **Within 72 hrs of sex** * **Prevents LH surge**/may delay ovulation post LH surge | Single dose, similar to levono/plan B ## Footnote Yuzpe is the only 2 pill emergency
40
When does a copper IUD need to be inserted to be used as emergency contraception?
5-7 days from the time of sex
41
When does a levono IUD for emergency contraception need to be implanted relative to last time of intercourse?
5 days from the time of sex
42
Why are IUDs preferred for emergency contraception? (3)
1. Better efficacy 2. No drop in efficacy if BMI increases 3. Left in place
43
When are vaginal rings worn? | Nuvaring/Eluryng/annovera
* 3 weeks a month * Designed to be left in place * Can be disposable or reusable
44
How often are transdermal patches applied for birth control?
New patch Q 3 weeks | Same schedule as vaginal ring
45
If a contraceptive patch becomes detached, how long do you have to apply it back?
< 24 hrs | Otherwise, use a backup method for 1 week and then new patch.
46
Compared to COCs, what SEs are transdermal patches more likely to have?
* Breast symptoms * Dysmenorrhea * **Higher failure rate if obese**
47
How often is a Depo Shot given?
Progesterone shot IM **Q 3 mo**
48
Major SE of Depo Shots?
Decreased bone density
49
What is contained within the nexplanon implant?
Progesterone
50
How long does nexplanon work?
approved for 3 yrs | May work up to 5 ## Footnote Small rod, small time
51
MC SEs of nexplanon (3)
* Irregular menses * Wt gain * HA
52
How long is a copper IUD good for?
10 years
53
CIs to Copper IUD (5)
* Intrauterine contents: Pregnancy/displaced uterus * Infections * Uterine/cervical cx (known or suspected) * **Wilsons** * Allergy
54
How long does a levono IUD last?
8 years | Mirena
55
How does usage of a levono IUD work initially? | Mirena
* **First causes irregular menses for 3-4 months** * Decreases menorrhea after * Then improves
56
How long do kyleena and skyla, the lower dosage levono IUDs, last?
* Kyleena: only up to 5 yrs * SKYla: only up to 3 yrs | Kyleen is sky's big sister
57
What are the 2 main benefits of Mirena over Kyleena and Skyla?
* Longer lasting (up to 8y) * Can also be used to **treat heavy menses or dysmenorrhea** | Mirena is kyleen's older sister
58
CIs to progesterone IUDs
* Intrauterine contents * Infections * Cancer (uterine/cervical/breast) * Acute liver dz * HSR * **Prior ectopic**
59
How do you check if an IUD is still in place?
Check if the string is still hanging out
60
What is the primary ingredient of most spermicides?
Nonoxynol-9 (destroyer of sperm): much cheaper
61
What is the alternative, more expensive option to nonoxyl-9 for spermicide?
Phexxi, which is **acid based** and lowers vaginal pH. | Also makes a physical barrier ## Footnote PHexxi = affects pH
62
Patient education regarding using spermicides (5)
* Place **right before sex: lasts 1 hr** * Avoid douching for 6 hrs after * They suck(mostly because ppl suck at using them tho) * **DO NOT PROTECT AGAINST STDs** * Can cause local inflammation
63
What is a contraceptive sponge?
Sponge impregnated with nonoxyl-9 | Leave in for 6 hrs after, but you can place it 24 hrs prior ## Footnote For if you're not sure if you're doin it
64
What are condoms generally made of?
Latex
65
Which condom material is permeable?
Lamb's cecum
66
What might an internal/female condom might be useful for?
**Reducing risk of HIV**
67
What are the components of a diaphragm + spermicide?
* Physical barrier * Spermicide on **cervical side**
68
What are the issues with a diaphragm + spermicide setup? (2)
* Need spermicide to work * Need to fit them | 6 hours prior, 6-24 after
69
What is a cervical cap?
* Literally a cup for your cervix * Can put spermicide in it * Gotta check after sex everytime
70
What is the MC method of contraception worldwide for women?
Sterilization
71
Who legally cannot get **permanent contraception**?
* **Pts < 21** (for most states) * Mentally incompetent
72
4 methods for female tubal sterilization
1. Electrocoagulation (low failure, high complication) 2. **Mechanical tubal occlusion (favorable long-term)** 3. Ligation of tube with suture material 4. Salpingectomy (complete removal, estimated high efficacy)
73
Which female tubal sterilization technique is most associated with **ectopic pregnancy**?
Electrocoagulation | The one with high complication rate
74
Why do we not use chemical tubal occlusion?
Carcinogenesis and toxigenesis
75
Why is male sterilization preferable?
* Easier to reverse * Much lower failure rates and postop complications
76
Safest and most effective method for abortion?
Suction curettage | **12 wks or less gestation**
77
What are the 4 combinations used for medical abortion? MC and effective among them?
1. **Mifepristone (mifeprex) + Misoprostol (Cytotec): MC and effective** (mi & mi) 2. Methotrexate + misoprostol 3. Misoprostol alone 4. Oral anti-progestin followed by misoprostol 48h after | Primarily used in **1st trimester**, **< 49d from FDLMP** ## Footnote Cytotec is in ALL 4 METHODS
78
After the **1st trimester**, what are some of the abortion methods? (3)
1. Intra-amniotic instillation (**replacement of amniotic fluid** with hypertonic saline) 2. **Dilation and evacuation (MC)**: modified suction curettage 3. Hysterectomy/hysterotomy (cervical stenosis)
79
When is menstrual regulation used primarily?
Lack of access to pregnancy tests
80
What is the MOA of cytotec/misoprostol?
Synthetic PGE1 | Causing contractions and ripening
81
When are we concerned about long-term for abortion sequelae?
**2 or more procedures (increased risk of mid-trimester loss)**
82
After abortion, how long should intra-vaginal products be avoided?
**2 weeks** | Including sex

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