Week 3 pt 1

Question 1

1) ~____% unintended pregnancies occur among couples who were using a contraceptive method in the month the woman became pregnant
2) What are the 2 reasons for this?

Answer 1

1) ~50%
2) Either the method did not work properly OR the couple did not use it consistently or correctly.
(The other 50% were sexually active but not using any birth control)

Question 2

List factors affecting contraception choice

Answer 2

1) Efficacy
2) Safety
3) Availability
4) Cost
5) Personal acceptability to pt and partner
6) Side effects
7) Route of delivery: PO, transvaginal, intrauterine, SQ

Question 3

What are some different frequencies of contraceptive delivery?

Answer 3

QD (daily), Q weekly, Q mo, Q 5 yr, Q 10 yr

Question 4

True or false: Ability to provide STD protection and career/life choices are both factors influencing contraceptive choice

Answer 4

True

Question 5

True or false: Responsibility of contraception for which partner and Past Medical History both influence contraceptive choice

Answer 5

True

Question 6

Define the Pearl Index (PI)

Answer 6

The number of contraceptive failures per 100 women
-years of exposure and uses as the denominator the total months or cycles of exposure from the initiation of the product to the end of or the discontinuation of the product.

Question 7

How do you calculate the pearl index?

Answer 7

(Number of pregnancies x 12) x 100 / (Number of women in the study x Duration of study in months)

*Lower score is better

Question 8

Name a statistical estimation of pregnancy risk per year

Answer 8

Pearl Index (PI)

Question 9

List hormonal contraceptives that inhibit the development and release of the egg

Answer 9

1) OCP
2) Long-acting progesterone injection/shot
3) Intradermal implant
4) Contraceptive patch
5) Contraceptive ring
6) IUD

Question 10

Give examples of Imposing a mechanical, chemical, or temporal barrier between sperm and egg

Answer 10

Condom
Diaphragm
Sponge
Spermicide
Fertility awareness
Natural family planning
Intrauterine contraception (IUC or IUD)

Question 11

Describe secondary mechanisms of contraceptives that are imposing a mechanical, chemical, or temporal barrier between sperm and egg

Answer 11

Alter the ability of the fertilized egg to implant and grow
Intrauterine device (IUD) may be used in emergency contraception

Question 12

Give examples of hormonal contraceptives

Answer 12

-Implantable rod*
-IUD-intrauterine device*
-Copper=non-hormonal
-Injectables/shot*
-Pills
-Combination▫
-Progestin only
-Patches▫
-Rings▫

Question 13

Why are LARCs a good contraceptive?

Answer 13

1) Reversible
2) Ideal for timing and spacing of pregnancies
3) Few contraindications/side effects

Question 14

Describe the nexplanon implant

Answer 14

1) SubQ; Radiopaque
2) Placed 1st 5 days of menses
3) Steady low dose of progestin suppressing ovulation & changing cervical mucous
4) Patient must feel for it daily.

Question 15

1) Are OCPs or IUDs more common?
2) When are IUDs inserted?
3) What are the risks of IUDs?
4) What can IUDs treat?

Answer 15

1) In the USA birth control pills are more common (despite efficacy)
2) Can be inserted anytime in the cycle (as long as not pregnant)
3) Risk of expulsion, perforation
4) Treats both metrorrhagia/menorrhagia

Question 16

1) What do hormonal IUDs contain?
2) Which one can last up to 5 years? Who can use it?
2) Which one lasts up to 3 years? Who can use it?
3) Are there any others?

Answer 16

1) Levonorgestrel IUD: (0.2/0.2%) (progestin)
2) Mirena: up to 5 years, parous and nulliparous women
3) Kyleena: nulliparous, up to 3 years
4) There are others, with various years of efficacy

Question 17

1) What do non-hormonal IUDs contain?
2) How long does the most common bran last?
3) Will the patient menstruate?

Answer 17

1) Copper IUD: (0.8/0.6%)
2) Paragard up to 10 years
3) Patient will still have cycle

Question 18

What is the MOA of IUDs with progestin?

Answer 18

1) Thickens the mucus of the cervix, which makes it harder for sperm to get to the egg.
2) Thins the uterine lining – So, if fertilization occurs, no implantation

Question 19

IUDs with Progestin:
1) What are the side effects?
2) What are the risks?
3) What are the benefits?

Answer 19

1) Irregular bleeding, cramping, amenorrhea, abdominal/pelvic pain
2) PID, infection, ectopic pregnancy, uterine perforation, expulsion, ovarian cysts, clots
3) Decrease menstrual blood loss (up to 50%) and severity of dysmenorrhea

Question 20

IUD with progestin: Local progesterone effect is used to relieve pain related to what 2 things?

Answer 20

Endometriosis and adenomyosis

Question 21

Copper IUD (Paragard):
1) Are there hormones?
2) How long does it last?
3) Can pts have CTs/MRIs?

Answer 21

1) No hormones; still ovulate
2) Effective for at least 10-12yrs
3) Can have CT/MRI

Question 22

What are the risks/ benefits of the copper IUD?

Answer 22

Same as hormonal IUDs except:
Does not help with dysmenorrhea, menorrhagia and metrorrhagia and may make periods heavier and more painful

Question 23

IUDs:
1) When is infection risk highest?
2) Which pts may benefit from STD screening before insertion? Can an IUD remain in place if there’s an STD?
3) How are IUDs removed?

Answer 23

1) First 20 days after insertion
2) High risk patients may benefit from STD screening prior to insertion
IUD may remain in place on long as no signs of spread to endometrium or fallopian tubes if +STD
3) Speculum and pull on string
Can become imbedded in uterine wall and require hysteroscopy for removal

Question 24

List 4 absolute contraindications to IUD placement

Answer 24

1) Active pelvic infection
2) Cervical or uterine CA
3) Distortion or abnormality of the body of the uterus
4) Uterine cavity that is not of sufficient depth to support the device (6-9cm)

Question 25

COCs/COCPs 1) What happens during a placebo week? Why is it important? 2) Is this required?

Answer 25

1) During placebo week, estrogen/progesterone levels fall, triggering a fake period This bleed is reassuring to the woman that she is NOT pregnant 2) This bleed is NOT required for birth control; extended cycle pills

Question 26

What are the benefits of COCs?

Answer 26

1) More predictable, shorter periods 2) Decrease painful periods (dysmenorrhea), acne, symptoms of PCOS 3) Protect bone health 4) Decreased androgenic symptoms 5) Reduce ovarian cysts 6) Reduce risk of ovarian cancer

Question 27

COC/COCP types: Describe Monophasic and give examples

Answer 27

1) Contain a constant amount of estrogen and progestin in each active pill.  2) Examples: Yasmin, Sorintec, Estarylla, Previfem,Jolessa Portia *Classic regimen is 21 days active pill and 7 days placebo

Question 28

COC/COCP types: Describe Biphasic and give examples

Answer 28

1) Deliver the same amount of estrogen each day while progestin dose is increased halfway through cycle. 2) Examples: LoSeasonique, Camrese L, Daysee, Mircette

Question 29

COC/COCP types: Describe Triphasic and give examples. What is one unique downside and one unique use?

Answer 29

1) 3 different doses of progestin and estrogen that change approximately every 7 days. 2) Examples: TriSprintec, Trivora, TriNessa, Cyclessa 3) *Associated with breakthrough bleeding *Used for acne treatment

Question 30

What 3 reasons are extended cycle pills best for? (i.e. No placebo week (week 4))

Answer 30

1) Menorrhagia 2) Dysmenorrhea 3) Endometriosis

Question 31

Continuous regiments (extended cycle): What are they? Give an example

Answer 31

1) Formulation specifically extends the cycle to every 3 months 2) Seasonale, Seasonique

Question 32

What is an alternative to a continuous regimen? Describe

Answer 32

1) Give patient 3 monthly packs and have them skip the placebo week and go immediately into the next pack a) Shorter and less frequent menses b) Higher rate of breakthrough bleeding that is worse in the first 12 weeks cycle c) *Hepatic adenomas

Question 33

List 5 positives of oral contraceptives

Answer 33

1) Predictable, shorter, and less painful periods 2) Reduce the risk of iron-deficiency anemia 3) Lower incidence of endometrial and ovarian cancers 4) Decrease risk of ectopic pregnancy 5) Reduced undesired pregnancy

Question 34

What are the absolute contraindications to COCPs?

Answer 34

-Pregnancy -Current breast cancer/ hormone-sensitive CA -Migraine (w aura) -B/P >160/90 -Ischemic heart disease/CHF/CVA -Liver cirrhosis, active hepatitis, or hepatic tumors -Postpartum and breastfeeding before 6 weeks -Smoking after age 35 -Hx DVT -AUB

Question 35

List the pros of the pill

Answer 35

1) Regulate fertility/cycle 2) Lifestyle-career etc. 3) Predictability 4) Inexpensive 5) Noninvasive 6) Decrease risk of endometrial, ovarian, colorectal CA

Question 36

List the cons of the pill

Answer 36

-CVA & MI -DVT/PE -Breast, cervical CA risk -Can decrease libido (esp progestin) -Breakthrough bleeding -Amenorrhea -HTN -Gallstones/cholestasis -HA/weight gain/breast tenderness* *estrogen component

Question 37

List and describe the 3 ways to start an OCP

Answer 37

1) First day start: Provides the maximum contraceptive effect in the first cycle -No back up form needed 2) Sunday start: Start first Sunday after menses onset -Use secondary form for first 7 days 3) Quick start: Started on the day it is prescribed, better compliance -Confirm patient not pregnant -Back-up form is needed for the first 7 days

Question 38

Progestin Only Pill (POP) OCPs: 1) What is it also called? 2) Who is it the pill of choice for? 3) What is the main perk of this form?

Answer 38

1) Aka “mini-pill” 2) Pill of choice for nursing mothers 3) Less risk of adverse effects

Question 39

Give 3 examples of women who can't take pills with estrogen

Answer 39

Breastfeeding mothers, women with a hx of blood clots, women with SEs on combined pills

Question 40

Emergency contraception: 1) What is unnecessary? 2) Do you need a pregnancy test?

Answer 40

1) Physical exam or laboratory tests unnecessary for the oral medication 2) No pregnancy test (unless suspect based on cycle history or symptoms)

Question 41

Plan B 1) Is it Rx or OTC? 2) What may pts need? 3) Is it safe for all ppl?

Answer 41

1) OTC 2) May need an antiemetic 3) Believed to be safe even if woman has absolute contraindications to routine OCP use

Question 42

Patches: Estrogen/Progestin combination (OrthoEvra) 1) Are the SEs, contraindications, effectiveness different from combo OCPs? 2) Are there any increased risks?

Answer 42

1) All the same 2) *Release more than 60% more estrogen than OCPs higher risk of estrogen-related complications ie. DVT

Question 43

1) When can you use Ella? Do you need an Rx? 2) Describe Paragard IUD as an emergency contraceptive

Answer 43

1) Up to 12ohrs (5d); need Rx 2) Within 5 days; <1% failure rate; needs Rx and appt.

Question 44

Estrogen/Progestin combination (OrthoEvra) patch: 1) When do you start it? How long is it effective? When do you change patches? 2) Where do you place it? 3) What are 2 downsides?

Answer 44

1) Start: first 5d of period -Effective x 1 week; replace weekly x 3 weeks -4th week: patch-free 2) Clean, dry skin of buttocks, upper outer arm, lower abdomen 3) Skin irritant for some; no regular swimming

Question 45

Depo-Provera: 1) What is the method of use? How often is it given? 2) What hormone(s) is/are in it? 3) Do you ovulate? 4) What is there a risk of?

Answer 45

1) “The shot”; IM injection q three months (arm or glutes) 2) Progestin only (Medroxyprogesterone acetate) 3) Depo-Provera typically suppresses ovulation, keeping your ovaries from releasing an egg thickens cervical mucus to keep sperm from reaching the egg 4) *Risk of osteoporosis; limit to 2 years of use

Question 46

List the efficacies of: 1) NuvaRing (combined estrogen/progestin) 2) Cervical cap 3) Diaphragm 4) Female condom 5) Male condom

Answer 46

1) 91% 2) 68% 3) 78% 4) 79% 5) 82% Films, foams, Jellies – 72%

Question 47

Nuvaring: 1) What does it release/ when? 2) When is it placed into the vagina?

Answer 47

1) Releases sustained amount of estrogen and progestin daily 2) At beginning of menses by the patient

Question 48

Nuvaring: 1) How long do you leave it in? 2) What does it look like? 3) Are the effects only local?

Answer 48

1) Left in place for 3 weeks *Can be take out for up to 3 hours, without altering efficacy 2) Colorless, odorless, 2-inch diameter 3) Metabolism still occurs in the liver

Question 49

1) What is the oldest and most widely used contraception? 2) Does it protect against STIs? Explain. 3) What is a downside?

Answer 49

1) Condoms 2) STD protection; only latex condoms protect against HIV 3) Subject to higher failure rate due to inconsistent, incorrect use, or damage to the barrier material