Women's health lecture 2 Flashcards
(129 cards)
1
Q
How many pregnancies in US are unplanned?
A
More than 50%
2
Q
Two general MOA for contraception
A
- Inhibit the development and release of egg
- imposing a mechanical, chemical or temporal barrier between the sperm and egg
3
Q
What is considered a barrier between sperm and egg (not expected)
A
intrauterine contraception
4
Q
Secondary mechanism
A
alter the ability of the fertilized egg to implant and grow
5
Q
What is provider’s obligation?
A
Knowledge of all agents and ability to explain to patient in language they can understand
6
Q
Pearl Index of contraception
A
the measure of unintended pregnancies from 100 women during 1 year of contraceptive use
7
Q
The most effective contraceptive
A
implant at 0.05 then IUS at 0.2-0.8
8
Q
Contraindications to hormonal contraceptives in general
A
- known or suspected pregnancy
- thrombosis disorder
-hepatic tumor or active liver disease
-undiagnosed abnormal genital bleeding
-breast cancer
-allergy
9
Q
What are considered LARC
A
Nexplanon, IUD, injectable Depro
10
Q
When to switch out the Nexplanon?
A
3 years
11
Q
MOA of Nexplanon
A
thickening of the cervical mucus and inhibiting ovulation
12
Q
what hormone is in Nexplanon?
A
Progestin (etonogestrel)
13
Q
Can Nexplanon be inserted after delivery?
A
Yes
14
Q
SE of Nexaplanon
A
Irregular bleeding, weight gain, HA, mood swing, acne
does NOT affect bone mineral density
15
Q
Risk of Nexaplanon
A
complications associated with implantation and removal, can travel, be careful of the neural vascular bundle
16
Q
Hormonal IUD for bigger diameter
A
Mirena and Liletta
17
Q
Hormonal IUD with smaller diameter
A
Kyleena and Skyla
18
Q
Non hormonal IUD
A
Copper T IUD
19
Q
How long does the copper IUD last for
A
10 years
19
Q
How long does the copper IUD last for
A
10 years
20
Q
MOA for copper IUD
A
acts as a spermicide
21
Q
SE of copper IUD
A
heavier, longer periods, spotting in between, cramping
22
Q
Risk of copper IUD
A
Pelvic inflammatory disease, ectopic pregnancy, uterine perforation, expulsion
23
Q
Contraindication for copper IUD
A
Wilson’s disease
24
IUD with progestin MOA
may thicken the mucus of the cervix, thinking of the uterine lining
25
Which IUD can be used for 8 years
Mirena and Liletta
26
Which IUD can be used for 5 years
Kyleena
27
Which IUD can be used for 3 years
Skyla
28
SE of hormonal IUD
Irregular bleeding, amenorrhea, abdominal/pelvic pain
29
Risk of hormonal IUD
PID, severe infection, ectopic pregnancy, uterine perforation, expulsion, ovarian cyst
30
Benefits associated with hormonal IUD
decrease menstrual blood loss and severity of dysmenorrhea
31
When is the best time for IUD insertion
when the patient is menstruating
32
What do you need to confirm before IUD insertion?
Pregnancy and negative STD
33
Can IUD be inserted immediately postpartum?
Yes, 10 minutes of placenta delivery
34
When is the expulsion rate highest for IUD
done immediately postpartum
35
How to remove IUD if it is imbedded in the uterine wall?
Hysteroscopy
36
How to remove the IUD if it perforates
laparoscopic removal
37
Risks associated with IUD
Infection is likely in the first 20 days after insertion
38
Do you need to remove the IUD if the patient acquires STD while it is in place?
No, as long as there aren't any signs of spreading to the endometrium or fallopian tube
39
Do you need to remove the IUD if the patient acquires STD while it is in place?
No, as long as there aren't any signs of spreading to the endometrium or fallopian tube
40
When is expulsion the greatest with IUD
first few months of use
41
How long does injectable hormonal contraceptive last
13 weeks up to 15 weeks
42
When do you give the injectable
within first 5 days of the current menstrual period
43
Is the injectable a sustained release of progestin?
No, higher peaks and then sustained levels of progestin
44
MOA for injectable
inhibits the secretion of LH which prevents follicular maturation and ovulation cause cervical mucus to thicken
45
the concern about injectable effectiveness
not as effective with ovulation suppression as OCP since it cannot suppress the FSH
46
indication for injectables
breastfeeding, smokers, HTN, >35 y/o, seizure disorders
47
contraindication of injectables
unevaluated vaginal bleeding, suspected pregnancy, malignancy of the breast, sensitivity to DMPA ingredients
48
SE of injectables
Measurable weight gain, irregular bleeding, amenorrhea, BONE LOSS due to suppression of estradiol
49
Benefits of injectables
decrease the risk of endometrial carcinoma and IDA, improves pain associated with endometriosis
50
COC of hormonal contraceptive
ethinyl estradiol or estradiol valerate with 19-nortesterones or spironolactone derivative
51
Monophasic
The same goes in each pill each day of the month
52
Monophasic
The same does in each pill each day of the month
53
Biphasic
deliver the same amount of estrogen each day while progestin does is increased halfway
54
Triphasic
Three varying doses of hormones in the pill pack
55
Which physic regimen is associated with breakthrough bleeding
triphasic
56
Continuous regimens benefits
shorter and less frequent menses
57
Continuous regimens SE
higher rate of breakthrough bleeding
- worse the first 12 weeks cycle
58
estrogen specific side effect
bloating and weight gain, breast tenderness, nausea, fatigue, headache, HTN
59
COC contraindication
-35 y/o who smokes >15 cigarettes/day
-history of CAD, CHF, or cerebral vascular disease
- history of thromboembolic disease
- undiagnosed abnormal vaginal bleeding
- known breast cancer
60
POP MOA
makes the mucus thick and relatively impermeable, thins endometrium
61
who are ideal patient for POP
lactating women, women over age 40, women with contraindication to estrogen component
62
Disadvantage of POP
-> 3 hours late, need backup method
- start on the first day of menus
-poor cycle control
-continuous regimen
63
Oral contraceptive SE
- breakthrough bleeding
- amenorrhea and post pill amenorrhea
-venus thrombosis
-PE
-stroke
64
Advantages of oral contraceptive
*predictable, shorter and less painful periods
* reduce the risk of iron deficiency
* lower incidences of endometrial and ovarian cancer
* lower incidence of benign breast and ovarian disease
* decrease the risk of ectopic pregnancy
65
Oral contraceptive disadvantages
* may interact with other medications
* antibiotics may alter the intestinal flora and thought to interfere with absorption, but efficacy is not reduced
66
First day start with OCP
*provides maximum contraceptive effect
* no back up form is needed
67
Sunday start with OCP
*use secondary form for first 7 days
68
Quick start with OCP
*back up is needed for the first 7 days
69
Transdermal patch usage
*Start during the first 5 days of period
* replace every 3 weeks
*4th week is patch free
* place on the buttocks, upper outer arm, or lower abdomen
70
What hormones does transdermal patch contains?
Estrogen and progestin (xulane)
71
Do not used ________ if BMI is >30
transdermal patch
72
What hormones does contraceptive vaginal ring contains?
Estrogen and progestin
73
When to change the vaginal ring
change once a month, 3 weeks in and 1 week out
74
How long can you take out the vaginal ring for without altering the efficacy
up to 3 hours
75
Advantage of thing ring
*less breakthrough bleeding than OCP
* Less GI SE and medication interactions
76
Is the ring temperature sensitive?
Yes, store at room temp
77
Condoms is __________
Only reliable, nonpermanent method of contraception available to men
78
concerns with natural membrane condom
*Does not block HIV and other STDs
*damaged by oil based lubricants
79
When to seek emergency contraceptive if there was breakage or slippage of the condom
Within 120 hours
80
Slippage and breakage rate of male condom
5-8%
81
Slippage and breakage rate of female condoms
3%
82
What is placed on the diaphragm?
Spermicide
83
What does the diaphragm covers?
Anterior vaginal wall and cervix
84
How to tell if the diaphragm is placed correctly?
If the cervix can be felt through the dome of the diagphragm
85
When to insert the diaphragm
up to 6 hours before intercourse
86
How long do you leave the diaphragm in for?
6-8 hours after, max is 24 hours
87
What to do if additional intercourse is desired during the 6-8 hour window?
Apply additional spermicide without removing the diaphragm
88
Oil lubricants can damage _______
Diaphragm, cervical cap, condom
89
What is the common size of the diaphragm?
75mm
90
Diaphragm usage is twice likely to have_____
UTI
91
How long is the cervical cap left in place for?
6 hours after, max 48 hours
92
______is not necessary for repeated intercourse when using cervical cap
additional spermicide
93
How long can the contraceptive sponge used for repeated intercourse
24 hour period
94
How long is the contraceptive sponge left in for?
6 hours after intercourse, up to 30 hours
95
What is the most common ingredient in spermicides
Nonoxynol- 9
96
When do you place the spermicide?
10-30 minutes before each act of intercourse
97
How long is the spermicide effective for?
no more than 1 hour
98
How long do you need to chart when using the calendar methods
6 months
99
How is the fertile period determined
subtracting 18 days from the total length of the shortest cycle
100
How to determine the last day of fertile period
subtract 11 days from the total length of the longest cycle
101
When do you check the basal body temperature
immediately upon awakening
102
What temperature and pattern determines ovulation
Biphasic pattern with rise of 0.5-1F
103
When looking at the mucus, when are you most fertile?
watery, thin, "stretchy" (EWCM - egg white cervical mucus)
104
Lactational amenorrhea MOA
suckling = elevated prolactin level which suppresses GnRH from hypothalamus
105
Does emergency contraceptive cause abortion?
No, it only prevents the fertilized egg from implantation
106
Which emergency contraception can be used regardless of weight or BMI?
IUD
107
When is the copper EC inserted?
Within 5 days of unprotected intercourse
108
Liletta and Mirene use in EC (off label)
* inserted within 5 days
* reduces menstrual bleeding and discomfort
109
Antiprogestin commercial names
Ella, ellaOne, fibristal
110
MOA of antiprogestin
selective progestin receptor modulator
*more effective than progestins*
111
When can you take Ella?
within 5 days of UPI
112
Levonoregestrel or plan B contains what hormone?
Progestin
113
When to take the plan B?
within 72 hours of UPI
114
What is Yuzpe
EC pill that contains combined estrogen and LNG contraceptive pill
115
When do you need to take Yuzpe?
within 72 hours
116
SE of Yuzpe
severe nausea and vomiting
117
What can interfere with Ella?
progestin contraceptive
118
When can you take progestin contraceptive after taking Ella?
5 days after UPA administration
119
Concern with oral EC pills
efficacy decrease with increasing BMI
120
Are there contraindication with taking a second dose if you vomited 3 hours after taking it?
No
121
Which EC pill can you start contraceptive immediately?
LNG, levonoregestrel, also called Plan B
122
Risk indicator for regret about sterilization
*younger than 25
*minority status
*less access to information or support from other procedure
123
Is vasectomy immediate sterilization?
No
*multiple ejaculations are required before the collecting system is emptied of sperm
124
how is azoospermia confirmed?
Semen analysis
*may be checked at 8-10 weeks
125
Laparoscopy conducted
occlusion of Fallopian tube
126
is the most common surgical approach for tubal ligation in the world
Minilaparotomy
127
Essure
titanium-Dacron spring device places into the tubal Ostia bilaterally
128
Complication with essure
ectopic pregnancy, persistent pain, uterine perforation, prolonged heavy bleeding, migration of device
