021315 contraception

Question 1

what does LH surge cause?

Answer 1

resumption of meiosis in dominant oocyte

Question 2

when does follicular rupture occur after onset of LH surge?

Answer 2

32-44 hours after

Question 3

most reliable predictor of ovulation

Answer 3

onset of LH surge

Question 4

sperm are viable in the reproductive tract for up to how long

Answer 4

5 days

Question 5

3 forms of contraception

Answer 5

prevent ovulation
prevent fertilization
prevent implantation

Question 6

three formations for combined hormonal methods

Answer 6

pill
patch
vaginal ring

Question 7

MOA of combined hormonal methods

Answer 7

prevent ovulation

thicken cervical mucous

Question 8

combined contraceptive vaginal ring

Answer 8

single ring placed in vagina for 3 wks

removed for one week to allow withdrawal bleed

Question 9

combined transdermal patch

Answer 9

one patch per wk for 3 weeks then 1 week patch-free

less effective in women w BMI over 30

Question 10

combined hormonal contraceptives’ other effects

Answer 10

increase levels of pro-coagulant factors

decrease anticoagulant proteins

Question 11

contraindications to combined hormonal contraceptive

Answer 11

history of venous thromboembolic event
postpartum
history of coronary artery dis
cigarette smokers
complicated diabetes
severe HTN
migraine (risk of ischemic stroke)
severe active liver dis (the hormones are metabolized by liver)
breast or endometrial cancer
undiagnosed abnormal uterine bleeding
pregnancy

Question 12

post hysterectomy, what postmenopausal hormone therapy should you give

Answer 12

estrogen only

Question 13

MOA of progestin only pills

Answer 13

• suppress ovulation in 50% of cycles

- prevent fertilization by thickening cervical mucus and slowing ovum transport through decreased tubal motility

Question 14

DMPA

Answer 14

depot medroxyprogresteron acetate injection

• profound ovulation inhibition (slow return to baseline fertility)
• given every 3 months

Question 15

decreases frequency of seizures and sickle cell crises

Answer 15

DMPA

Question 16

contraceptive implant

Answer 16

MOA-inhibts ovulation
contains progestin etonogestrel
works for 3 years

Question 17

two types of IUDs

Answer 17

copper
progestin levonnorgestrel (5 yr and 3 yr)

Question 18

do IUDs increase risk for inferility?

Answer 18

no

Question 19

MOA of copper IUD

Answer 19

prevents normal fertilization (copper ions reduce motility and viability of sperm and is toxic to oocytes)

SECONDARY mechanism-inhibition of implantation esp if used for emergency contraception

Question 20

MOA of 5 yr levonorgestrel IUD

Answer 20

prevents fertilization by creating thick impenetrable cervical mucus, a sterile inflammatory rxn within uterus, and impaired sperm migration

Question 21

3 yr vs 5 yr levonorgestrel IUD

Answer 21

3 yr has lower dose of levonorgestrel and is designed for teens and nulliparous women

has lower rates of amenorrhea compared to 5 yr

Question 22

contraindications to IUD use

Answer 22

pregnancy
pelvic inflam dis
current STI
undiagnosed abnormal genital bleeding 
malignancy of genital tract
etc

Question 23

nonoxynol-9

Answer 23

spermicide

used ideally with a barrier method

Question 24

sponge

Answer 24

nonoxynol-9 impregnated

Question 25

diaphragm

Answer 25

used with spermicide

Question 26

cervical cap

Answer 26

use with spermicide

Question 27

hormonal emergency contraception

Answer 27

levonorgestrel
ulipristal acetate
copper IUD

Question 28

methods of sterilization

Answer 28

laparoscopy (tubal ligation)
mini laparotomy post partum (tubal ligation)
hysterocopy

Question 29

progestins at high doses can

Answer 29

inhibit LH surge and thus prevent ovulation

Question 30

most effective forms of reversible contraception

Answer 30

implant and IUDs