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PBL PY2 Fall > Progestin Only Contraceptives > Flashcards

Progestin Only Contraceptives Flashcards

1
Q

what are the 4 main forms of POC?

A
  1. progestin only pill (POP)
  2. Depo Medroxyprogesterone acetate injection (DMPA)
  3. Levonorgestrel-releasing IUS
  4. Etonogestrel-releasing implant
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2
Q

what does LARC stand for?

A

long-acting contraceptive

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3
Q

are IUD and IUS the same thing?

A

no, IUS released medication

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4
Q

in 2018, what % of women in Canada were of childbearing age?

A

52%

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5
Q

what are the 2 most common forms of birth control in Canada?

A

condoms and combined oral contraceptives (followed by withdrawal)

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6
Q

imperfect contraceptive adherence is thought to account for __% of unplanned pregnancies

A

69%

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7
Q

what is the direct cost (dollar amount) for unintended pregnancy in Canada?

A

$320 million

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8
Q

up to __% of pregnancies are unintended

A

40%

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9
Q

what forms of contraception can PhC prescribe? What cant they prescribe?

A

everything except intrauterine contraception and implants

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10
Q

what is the effect of endogenous progesterone on ovulation?

A

negative feedback on hypothalamus/pituitary gland –> decrease in release of GnRH –> decrease release of FSH & LH –> no primary follicle (no ovulation) –> no follicle induced release of estrogen –> low estrogen –> no estrogen peak –> no LH surge (no ovulation)

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11
Q

aside from effects on follicle formation, how does progesterone contribute to contraception? (2 more ways)

A
  1. produces thick hostile cervical mucous

2. changes endometrial lining (may lead to atrophy)

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12
Q

what is the active drug in progestin only pill?

A

norethindrone 0.35mg

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13
Q

what is the active drug and concentration in the Depo shot?

A

medroxyprogesterone acetate 150mg

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14
Q

what is the active ingredient in IUS?

A

levonorgestrel

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15
Q

what is the active ingredient in the implant?

A

etonogestrel

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16
Q

what is the main MOA of the progestin only pill? The secondary MOA?

A

primary: hostie cervical mucous and low endometrium
Secondary: decreased ovulation

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17
Q

what is the primary MOA of Depo?

A

decreased ovulation

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18
Q

what are the 2 main MOAs of an IUS?

A

making hostile cervical mucous and low endometrium

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19
Q

what is the main MOA of the implant?

A

decreased ovulation

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20
Q

definition of menses or “period”

A

part of normal, physiologic hormone cycle: shedding of the uterine lining if implantation does not occur

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21
Q

definition of irregular vaginal bleeding

A

abnormal or irregular flow of blood from uterus between menses

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22
Q

what are 5 possible causes of irregular vaginal bleeding?

A
  1. hormonal imbalances
  2. pregnancy
  3. fibroids (noncancerous growths)
  4. infection
  5. cancer
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23
Q

what are 2 terms used to describe irregular vaginal bleeding?

A

BTB and spotting

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24
Q

what is the general definition of BTB?

A

irregular bleeding requiring the use of pad or tampon

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25
Q

what is the general definition of spotting?

A

irregular bleeding that is less than BTB and does not require pads/tampons etc.

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26
Q

definition of withdrawal bleeding

A

bleeding that occurs when using some hormonal methods of contraception are stopped (drop in progesterone), resulting in bleeding

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27
Q

t/f withdrawal bleeding occurs on a regular and predictable basis

A

t

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28
Q

what is the trigger for withdrawal bleeding?

A

a drop in exogenous progesterone

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29
Q

what is the trigger for menses?

A

lack of implantation which leads to regression of corpus lutem and the a decrease in endogenous progesterone

30
Q

t/f what is expelled during menses and withdrawal bleeding is basically the same, but the reason for start is different

A

t

31
Q

will menses occur with the POP?

A

depends on if ovulation is supressed or not (this is not consistent with POP)

32
Q

if POP is started on day 1-5 of cycle, when will the menses occur?

A

the last 7 days of the pack

33
Q

is there a hormonal free interval with any form of progesterone only contraceptives?

A

no

34
Q

is there a withdrawal bleed with progestin only contraceptives?

A

no, bc there are no HFIs

35
Q

what % of women have a normal cycle after 12 months of DMPA injections?

A

11%

36
Q

will there be a menses on IUS?

A

ovulation is not suppressed, irregular bleeding for a few months and eventually the endometrium becomes not responsive

37
Q

will there be a menses with the implant?

A

ovulation is suppressed, there will be irregular bleeding for a few months and eventually the endometrium will be come unresponsive

38
Q

what POC has the highest rate of irregular bleeding?

A

POP

39
Q

which IUS has higher rate of ammenorrhea? Why?

A

Mirena bc it has higher concentration of levonorgestrel

40
Q

ammenorrhea occurs in __% of people on IUS by 1 year

A

50

41
Q

what % of people have ammenorrhea by 1 year? 2 years?

A

1 year: 55%

2 years: 68%

42
Q

what % of people have ammenorrhea with the implant?

A

22-30%

43
Q

what are some common ADRs with POP?

A

BTB, headaches, breast tenderness, nausea, mood disturbances

44
Q

what are the danger signs for POP?

A

abdominal pain (cyst, ectopic pregnancy)
Delayed period after several months (pregnancy)
Repeated, severe headaches

45
Q

which POP causes a delay in fertility?

A

DMPA

46
Q

what POP causes reversible decreased BMD?

A

DMPA

47
Q

how long does it take for fertility to come back after stopping DMPA?

A

6 months

48
Q

does DMPA cause weight gain?

A

yes, up to 2.5kg in 1 yr

49
Q

what are some danger signs with a IUS?

A
  1. change in strings
  2. pain/bleeding in sex
  3. pregnancy
  4. exposure or sx of STI
  5. pelvic pain or sore abdomen
  6. fever or chills
50
Q

can the implant cause weight gain? How much>

A

yes; 1.9kg over 2 years

51
Q

what POC cause weight gain?

A

all of them,but especially DMPA and implant

52
Q

what POC causes reversible BMD loss?

A

depo shot

53
Q

what is an absolute c/i for POC use?

A

breast cancer

54
Q

what are some common drugs that interact with POC?

A

anticonvulsants (like phenytoin, carbamazepine), antibiotics (like rifampin), st. John’s wort

55
Q

what POC can be used in breastfeeding?

A

all of them

56
Q

how long do the IUS last?

A

5 years

57
Q

how long do the implants last?

A

3 years

58
Q

how often is a depo shot needed?

A

3 months

59
Q

which POC may result in amenorrhea?

A

all but the pills

60
Q

if starting POP within 5 days of menses, how long is backup needed?

A

no backup needed

61
Q

if starting POP >5days of cycle, how long is backup needed? Why?

A

48 hours bc sperm can penetrate the cervical mucous if the interval is >24 hours

62
Q

POP need to be taken at the same time each day within a ___hour window

A

3

63
Q

if it has been more than a 3 hour window of when you’re supposed to take your POP, how long do you need to use backup?

A

48 hours

64
Q

if starting a depo shot within the first 5 days of menses, how long do you need backup?

A

24 hours

65
Q

if depo is given >5 days of the cycle, how long do you need backup?

A

7 days

66
Q

pregnancy must be ruled out if its been ___weeks or more since the last shot

A

14

67
Q

what is the dose of levonorgestrel in a Mirena IUS?

A

52mg that releases 14mcg/day

68
Q

what is the dose of levonorgestrel in Kyleena IUS?

A

19.5mg with 9mcg/day

69
Q

how long is backup needed after inserting IUS (regardless of cycle day started)?

A

7 days

70
Q

if an implant is started >5days of cycle, how long is backup needed?

A

7 days

71
Q

when should initial monitoring be done with POC?

A

within first 4 weeks

72
Q

how often should POC be monitored?

A

every 12 weeks

PBL PY2 Fall (21 decks)

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