23. Contraception and Sterilization Flashcards
Hormonal Contraceptives are reversible and most effective, come as oral, injectable (depo) implantable (nexplanon), hormone containing IUD (mirena MC), contraceptive patches (orthoevra) and what?
COntraceptive rings like nuvaring and annovera
OCPs with combo of estrogen and progesterone suppress gonadotropin leading to suppression of FSH and LH, progesterone is the major player which supresses LH and increases mucosal thickness, estrogen mainly improves ?
cycle control- usually monphasic formulation
Progestin only OCPs primarily make cervical mucous thick and impermeable- used in breastfeeding women w contraindication to estrogen…
Benefits of hormonal OCP include mesntrual cycle regularity, improve painful periods, dec risk of iron def, and lower incidence of endometrial?
cancers
*less bleeding
SE of OCP include breakthrough bleeding in first 3 months, amenorrhea in first year, and mild bloating, weight gain, breast tenderness, nausea fatigue and ?
headache (d/t estrogen)
Serious SE of OCP include venous thrombosis, pulm embolism, cholestasis and GB disease, stroke and MI, and hepatic tumors….. The transdermal patch is also offered which is once weekly for 3 weeks with same SE except greater risk of thrombosis- cannot be used in someone over how many pounds?
198
Vaginal ring is both E and P, greater compliance because once a month insertion for 3 weeks, less breakthrough bleeding- same indications and SE… Who cant use combination therapy? 35+ smokers, women w hx of thrombembolic event, liver disease, migraine with aura and?
hypertension
Depo-Provera is injectable (medroxyprogesterone acetate), IM injection every 11-13 weeks, contraception for 14 weeks, MOA- thick mucous, decidualization of endomet, block LH surge and ovulation, BLACK BOX warning in adolescents for what side effect?
Bone metabolism due to dec estrogen levels when used more than 2 years
SE of Depo injectible is irregular bleeding, weight gain and exacerbation of depression, indications include needing a better compliance, breastfeeding, estrogen contraindicated, women w seizures, sickle cell, endometriosis, *dec risk of endometrial?
Hyperplasia
- used in fluffy patients with postmenopausal
- contra: pregnant, vag bleeding, malig of breast, active thrombophlebitis, liver dysfunction
Long acting reversible contraceptives = Implants/IUDs… Nexplanon rod into arm for 3 years, MOA thickens cervical mucus and inhibits ovulation- implant- SE include irregular bleeding, headache, weight increase, acne*, indicated for convenient effective contraception or breastfeeding pts, contraind w pregnancy, current thrombosis, liver tumors, AUB ** and the only ABSOLUTE contra is?
Breast cancer
*complications include infection, bruise, deep insertion, migration and persistent pain/paraesthesia
IUDs are either copper T(Paragard) or leveonorgestrel releasing (mirena), risks include infection, inc risk of ectopic, if preg should remove, uterine perforation.. Contraind: breast cancer (levonorgestrel only!), pueperal sepsis,septic abortion, cervical infection, uterine malformations and wilson’s disease for which device?
Copper T
Levonorgesterel IUDs for 5/3 years, benefits include bec menstrual blood loss, less pain, protection of endometrial lining, convenient/long term, Copper T length is 10 years and interferes with sperm transport or fertilization, same contraindications as?
Levorgestrel IUDs
To know if youre fertile- keep a calender, body temperature rises by 0.5-1 at time of ovulation- avoid sex 3 days after, check cervical mucus or sympotothermal method which combines mucus and temperature…
WTF
Emergency contraception has no contraindications, Plan B 2 pills taken twelve hours apart use within 120 hours*, Ella- indicated for up to how many days?
5 days
Sterilization is PERMANENT- male is done via vasectomy, and for females is mini-laparotomy.
DONE
