Male & Female Health: Contraception & Infertility

Question 1

How do pregnancy tests work

Answer 1

detect Human chorionic gonadotropin (hCG), which is released when fertilized egg attaches to lining of uterus

detecting hCG in urine = pregnancy

urine test can detect sooner if first urine of morning

Question 2

folate recommendation for pregnant women

Answer 2

600mcg/day

Question 3

which reversible contraceptive has delay to fertility?

Answer 3

Medroxyprogesterone injection

Question 4

which condoms dont protect against STD?

Answer 4

“natural” sheep skin ones

Question 5

How do hormonal contraceptives work?

Answer 5

inhibiting production of FSH and LH, preventing ovulation

Question 6

Monophasic contraceptives have….

Answer 6

same dose of estrogen and progestin throughout the pill pack

Question 7

Bi-tri- and quad- phasic contraceptives….

Answer 7

mimic estrogen and progesterone lvls during a menstrual cycle.

prefix indications how many times they have changes in hormones.

Question 8

Progestin only pills

Answer 8

28 days of active pills in each pack

prevent pregnancy by suppressing ovulation, used primarily in those breastfeeding because estrogen decreases milk production

Question 9

How soon after delivery can progestin only pills be restarted

Answer 9

3-6 wks

sooner than estrogen containing due to inc risk of thrombosis

Question 10

Who should patches not be used in?

Answer 10

anyone with high clotting risk ( > 35 + smoke, cerebrovascular disease or past blood clots, post partum) women BMI > 30

Question 11

“Lo” indicates

Answer 11

< 35mcg of estrogen, less estrogen = less estrogenic side effects

Question 12

“Fe” indicates

Answer 12

contains iron supplement

Question 13

“24” indicates

Answer 13

24 active + 4 placebo

Question 14

Side effects of estrogen

Answer 14

Nausea
Breast tenderness/fullness
bloating
weight gain
inc blood pressure
Melama = dark skin patches, most often on face

Question 15

Serious adverse side effects of estrogen

Answer 15

thrombosis = rare inc as women age and have higher clot risk ie diabetes/hnt/smoking

higher estrogen = higher risk

Question 16

Progestin side effects

Answer 16

breast tenderness
headache
fatigue
depression

Question 17

Drospirenone side effects

Answer 17

slightly higher risk of clotting, dont use in women with clotting risk

can cause inc potassium, dont use with kidney, liver or adrenal gland disease

check potassium lvls in cases

Question 18

Medroxyprogesterone shot side effects

Answer 18

can cause loss in bone mineral density

calcium + vit D supplement recommended

Question 19

Break through bleeding and what to do

Answer 19

usually resolves in 2-3 months, if continue then……

taking < 30mcg estrogen daily then increase estrogen
taking > 30mcg estrogen daily then try different progestin

Question 20

if want to avoid monthly cycle, have patient take

Answer 20

extended or continuous formulations

Question 21

If having breakthrough bleeding,

Answer 21

if mid cycle = inc estrogen
if later in cycle = inc progestin

Question 22

Using contraceptive postpartum

Answer 22

dont use 3wks, or 6wks if risk factor for VTE

progestin only or nonhormonal methods

Question 23

if HTN, use

Answer 23

progestin only or non-hormonal

Question 24

if breast feeding or estrogen CI, use

Answer 24

progestin only

Question 25

Which contraceptives indicated for heavy menstrual bleeding

Answer 25

Natazia IUD Mirena oral with only 4 placebo pills will also decrease bleeding time

Question 26

Mavyret couldn't be used with ethinyl estradiol due to

Answer 26

inc risk of liver toxicity

Question 27

"Quick start"method

Answer 27

start today, req back up for 7 days while starting

Question 28

"Sunday start" method

Answer 28

starts Sunday after onset of menstration require back up for 7 days

Question 29

If start contraceptive within first 5 days after menses start then do you need backup?

Answer 29

No

Question 30

Starting progestin only pills?

Answer 30

use another form of birth control for 48hrs

Question 31

Late or missed birth control pills

Answer 31

take as soon as remember if missed more than 1, need to use back up method If miss in 3rd week of cycle, skip hormone free week and start next pack without skipping any days. need back up for 7 days

Question 32

Progestin only missed pills

Answer 32

if > 3 hrs since supposed to take need back up for 48hrs

Question 33

Cooper IUD

Answer 33

Paraguard good for 10yrs causes heavier bleeding/cramping can be inserted within 5 days for emergency contraception

Question 34

Emergency contraceptives

Answer 34

Ulipristal (Ella) = less effective if > 195lbs or BMI > 30 use within 5 days Plan B (Levonorgestrel) = less effective if > 165lbs or BMI > 25 use within 3 days

Question 35

If vomit within 2 hours of taking planB, pt should...

Answer 35

take again

Question 36

How many times per cycle can Ella be used?

Answer 36

only once per cycle

Question 37

Drugs that can be used to induce ovulation

Answer 37

Clomiphene (SERM) and Letrozole (aromatase inhibitor) and Gonadotropins