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TN Gyneco > 8. Contraceptions > Flashcards

8. Contraceptions Flashcards

1
Q

Name types of contraceptive methods (6)

A
  • Physiological
  • Barrier methods
  • Hormonal
  • Copper IUD
  • Surgical
  • Emergency Postcoital Contraception (EPC)
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2
Q

Name Physiological contraceptive methods (5)

A
  • Withdrawal/coitus interruptus
  • Rhythm method/calendar/mucus/symptothermal
  • Lactational amenorrhea
  • Chance – no method used
  • Abstinence of all sexual activity
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3
Q

Name barrier contraceptive methods (6)

A
  • Condom alone
  • Spermicide alone
  • Sponge – Parous - Nulliparous
  • Diaphragm with spermicide
  • Female condom
  • Cervical cap – Parous - Nulliparous
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4
Q

Name hormonal contraceptive methods (7)

A
  • OCP
  • Nuva Ring®
  • Transdermal (Ortho Evra®)
  • Depo-Provera®
  • Progestin-only pill (Micronor®)
  • Mirena® interauterine system (IUS)
  • Jaydess® interauterine system (IUS)
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5
Q

Name surgical contraceptive methods (2)

A
  • Tubal ligation
  • Vasectomy
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6
Q

Name Emergency Postcoital Contraception (EPC) (4)

A
  • Yuzpe® method
  • “Plan B” levonorgestrel only
  • Postcoital interauterine system IUD
  • Ella
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7
Q

Name: Combined Oral Contraceptive Pills (5)

A
  • progestin
  • estrogen
  • most contain low dose ethinyl estradiol (20-35 µg) plus progestin (norethinedrone, norgestrel, levonorgestrel, desogestrel, norgestimate, drospirenone)
  • failure rate (0.3% to 8%) depending on compliance
  • monophasic or triphasic formulations (varying amount of progestin throughout cycle)
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8
Q

Describe action of progestin as Combined Oral Contraceptive Pills (5)

A
  • prevents LH surge
  • suppresses ovulation
  • thickens cervical mucus
  • decreases tubal motility
  • decidualizes endometrium
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9
Q

Describe action of estrogen as Combined Oral Contraceptive Pills (2)

A
  • suppresses FSH and follicular development
  • causes endometrial proliferation
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10
Q

Describe: Transdermal (Ortho Evra®) (6)

A
  • continuous release of 6 mg norelgestromin and 0.60 mg ethinyl estradiol into bloodstream
  • applied to lower abdomen, back, upper arm, buttocks, NOT breast
  • worn for 3 consecutive weeks (changed every wk) with 1 wk off to allow for menstruation
  • as effective as OCP in preventing pregnancy (>99% with perfect use)
  • may be less effective in women >90 kg
  • may not be covered by drug plans
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11
Q

Describe: Contraceptive Ring (Nuva Ring®) (6)

A
  • thin flexible plastic ring
  • releases etonogestrel 120 µg/d and estradiol 15 µg/d
  • works for 3 wk then removed for 1 wk to allow for menstruation
  • as effective as OCP in preventing pregnancy (98%)
  • side effects: vaginal infections/irritation, vaginal discharge
  • may have better cycle control; i.e. decreased breakthrough bleeding
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12
Q

Describe Starting Hormonal Contraceptives (4)

A
  • thorough history and physical exam, including blood pressure and breast exam
  • can start at any time during cycle but ideal if within 5 d of last menstrual period (LMP)
  • follow-up visit 6 wk after hormonal contraceptives prescribed
  • pelvic exam not required as STI screening can be done by urine and pap smear screening does not start until >21 yr
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13
Q

Name advantages: Combined Estrogen and Progestin Contraceptive Methods (10)

A
  • Highly effective
  • Reversible
  • Cycle regulation
  • Decreased dysmenorrhea and heavy menstrual bleeding (less anemia)
  • Decreased benign breast disease and ovarian cyst development
  • Decreased risk of ovarian and endometrial cancer
  • Increased cervical mucus which may lower risk of STIs
  • Decreased PMS symptoms
  • Improved acne
  • Osteoporosis protection (possibly)
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14
Q

Name estrogen-related side effects: Combined Estrogen and Progestin Contraceptive Methods (8)

A
  • Nausea
  • Breast changes (tenderness, enlargement)
  • Fluid retention/bloating/edema
  • Weight gain (rare)
  • Migraine, headaches
  • Thromboembolic events
  • Liver adenoma (rare)
  • Breakthrough bleeding (low estradiol levels)
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15
Q

Name Progestin-related side effects: Combined Estrogen and Progestin Contraceptive Methods (9)

A
  • Amenorrhea/breakthrough bleeding
  • Headaches
  • Breast tenderness
  • Increased appetite
  • Decreased libido
  • Mood changes
  • HTN
  • Acne/oily skin*
  • Hirsutism*
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16
Q

How can androgenic side effects of progestin-related contraceptive method may be minimized? (4)

A

by prescribing formulations containing

  • desogestrel
  • norgestimate
  • drospirenone
  • or cyproterone acetate
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17
Q

Name absolute contraindications: Combined Estrogen and Progestin Contraceptive Methods (9)

A
  • Known/suspected pregnancy
  • Undiagnosed abnormal vaginal bleeding
  • Prior thromboembolic events, thromboembolic disorders (Factor V Leiden mutation; protein C or S, or antithrombin III deficiency), active thrombophlebitis Cerebrovascular or coronary artery disease
  • Estrogen-dependent tumours (breast, uterus)
  • Impaired liver function associated with acute liver disease
  • Congenital hypertriglyceridemia
  • Smoker age >35 yr
  • Migraines with focal neurological symptoms (excluding aura)
  • Uncontrolled HTN
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18
Q

Name relative contraindications: Combined Estrogen and Progestin Contraceptive Methods (7)

A
  • Migraines (non-focal with aura <1 h)
  • DM complicated by vascular disease
  • SLE
  • Controlled HTN
  • Hyperlipidemia
  • Sickle cell anemia
  • Gallbladder disease
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19
Q

What can decrease efficacy of combined estrogen and progestin contraceptive method, requiring use of back-up method? (6)

A
  • Rifampin
  • phenobarbital
  • phenytoin
  • griseofulvin
  • primidone
  • St. John’s wort
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20
Q

Describe: Fetal abnormalities if conceived on OCP (1)

A

No evidence of fetal abnormalities if conceived on OCP

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21
Q

Describe use of oral contraceptive pill and nursing infant and breastfeeding (3)

A
  • No evidence that OCP is harmful to nursing infant
  • but may decrease milk production;
  • not recommended until 6 wk postpartum in breastfeeding and non-breastfeeding moms, ideally ≥3 mo postpartum if BF
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22
Q

Describe link between irregular breakthrough bleeding and OCP (2)

A
  • Irregular breakthrough bleeding often occurs in the first few months after starting OCP
  • usually resolves after three cycles
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23
Q

Name Active Compounds (estriol and progestin derivative): Alesse® (2)

A
  • 20 µg ethinyl estradiol
  • 0.5 mg levonorgestrel
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24
Q

Name advantages: Alesse® (2)

A
  • Low dose (20 µg) OCP
  • Less estrogen side effects
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25
Q

Name disadvantages: Alesse® (2)

A
  • Low-dose pills can often result in breakthrough bleeding
  • If this persists for longer than 3 mo, patient should be switched to an OCP with higher estrogen content
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26
Q

Name Active Compounds (estriol and progestin derivative): Tri-cyclen® (3)

A
  • 35 µg ethinyl estradiol
  • 0.180/0.215/0.250 mg norgestimate
  • Triphasic oral contraceptive (graduated levels of progesterone)
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27
Q

Name advantages: Tri-cyclen® (1)

A

Low androgenic activity can help with acne

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28
Q

Name disadvantages: Tri-cyclen® (1)

A

Triphasic OCPs not ideal for continuous use >3 wk in a row (unlike monophasic formulation)

29
Q

Name Active Compounds (estriol and progestin derivative): Yasmin® and Yaz® (3)

A
  • Yasmin®: 30 µg ethinyl estradiol
    • 3 mg drospirenone (a new progestin) Yaz®: 20 µg ethinyl estradiol + 3 mg drospirenone – 24/4-d pill (4 d pill free interval)
  • Drospirenone has antimineralocorticoid activity and antiandrogenic effects
30
Q

Name advantages: Yasmin® and Yaz® (3)

A
  • Decreased perception of cyclic weight gain/bloating
  • Fewer PMS symptoms
  • Improved acne
31
Q

Name disadvantages: Yasmin® and Yaz® (3)

A
  • Hyperkalemia (rare, contraindicated in renal and adrenal insufficiency)
  • Check potassium if patient also on ACEI, ARB, K+-sparing diuretic, heparin
  • Continue use of spironolactone
32
Q

Name indications: Progestin Only Contraceptive Methods (3)

A
  • Suitable for postpartum women (does not affect breast milk supply)
  • Women with contraindications to combined OCP (e.g. thromboembolic or myocardial disease)
  • Women intolerant of estrogenic side effects of combined OCPs
33
Q

Describe mechanism of action: Progestin Only Contraceptive Methods (5)

A
  • Progestin prevents LH surge
  • Thickening of cervical mucus
  • Decrease tubal motility
  • Endometrial decidualization
  • Ovulation suppression – oral progestins (not IM) do not consistently suppress compared to combined OCPs
34
Q

Name side effects: Progestin Only Contraceptive Methods (8)

A
  • Irregular menstrual bleeding
  • Weight gain
  • Headache
  • Breast tenderness
  • Mood changes
  • Functional ovarian cysts
  • Acne/oily skin
  • Hirsutism
35
Q

True or false

Progestin only contraceptives must be taken at the same time every day

A

True

36
Q

What to do with combined OCP if miss 1 pill in <24h (1)

A
  • Take 1 pill ASAP, and the next pill at the usual time
37
Q

What to do with combined OCP if miss _>_1 pill in a row in 1st wk (2)

A
  • Take 1 pill ASAP, and continue taking one pill daily until the end of the pack
  • Use back-up contraception for 7 d; emergency postcoital contraception EPC
38
Q

What to do with combined OCP if miss <3 pills in 2nd or 3rd wk of cycle (4)

A
  • Take 1 pill ASAP, and continue taking one pill daily until the end of the pack
  • Do not take placebo (28-d packs) or do not take a hormone free interval (21-d packs)
  • Start the next pack immediately after finishing the previous one
  • No need for back-up contraception
39
Q

What to do with combined OCP if miss ≥3 pills during the 2nd or 3rd wk (4)

A
  • Take 1 pill ASAP, and continue taking one pill daily until the end of the pack
  • Do ot take placebo (28-d packs) or do not take a hormone free interval (21-d packs)
  • Start the next pack immediately after finishing the previous one
  • Use back-up contraception for 7 d; EPC may be necessary
40
Q

Name: SELECTED EXAMPLES OF PROGESTIN-ONLY METHODs (2)

A
  • Progestin-Only Pill (“minipill”): Micronor® 0.35 mg norethindrone
  • Depo-Provera®
41
Q

Describe: Progestin-Only Pill (“minipill”) (6)

A
  • Micronor® 0.35 mg norethindrone
  • must be taken daily at same time of day to ensure reliable effect; no pill free interval
  • higher failure rate (1.1-13% with typical use, 0.51% with perfect use) than other hormonal methods
  • ovulation inhibited only in 60% of women; most have regular cycles (but may cause oligo/amenorrhea)
  • highly effective if also post-partum breastfeeding, or if >35 yr
  • relies on the progestin effects on the cervical mucous and endometrial lining
42
Q

Describe: Depo-Provera® (8)

A
  • injectable depot medroxyprogesterone acetate
  • dose 150 mg IM q12-14wk (convenient dosing)
  • initiate ideally within 5 d of beginning of normal menses, immediately postpartum in breastfeeding and non-breastfeeding women. Can consider quick start
  • irregular spotting progresses to complete amenorrhea in 70% of women (after 1-2 yr of use)
  • highly effective 99%; failure rate 0.3%
  • suppresses ovulation very effectively
  • side effect: decreased bone density (may be reversible) and weight gain
  • disadvantage: restoration of fertility may take up to 9 mo
43
Q

What to do if: Missed Progestin-Only Pills >3 h (1)

A

Use back-up contraceptive method for at least 48 h; continue to take remainder of pills as prescribed

44
Q

What to do if Missed Depo-Provera:If last injection given 13-14 wk prior (1)

A

give next injection immediately

45
Q

What to do if Missed Depo-Provera: If >14 wk prior

A
  • do β-hCG
    • If β-hCG is positive, give EPC and no injection
    • If β-hCG is negative, give next injection right away and:
      • Intercourse occurred in last 5 d: give EPC, use back-up contraception for 7 d ; repeat β-hCG in 3 wk
      • Intercourse occurred >5 d ago but within the last 14 d: use back-up contraception for 7 d; repeat β-hCG in 3 wk
      • Intercourse occurred >14 d ago: use back- up contraception for 7 d
    • No evidence of fetal abnormalities if conceived on DMPA
46
Q

Name: interauterine system (IUS)/intrauterine device (IUD) Contraceptive Methods (2)

A
  • Copper-Containing IUD (Nova-T®)
  • Progesterone-Releasing IUS (MirenaV, Kyleena®, Jaydess®):
47
Q

Describe mechanism of action: Copper-Containing IUD (Nova-T®) (2)

A
  • mild foreign body reaction in endometrium
  • toxic to sperm and alters sperm motility
48
Q

Describe mechanism of action: Progesterone-Releasing IUS (MirenaV, Kyleena®, Jaydess®) (2)

A
  • decidualization of endometrium and thickening of cervical mucus;
  • minimal effect on ovulation
49
Q

IUS/IUD Contraceptive Methods last how long? (1)

A

5 year

50
Q

Name side effects of IUS/IUD Contraceptive Methods (9)

A
  • Both Copper and Progesterone IUD
    • Breakthrough bleeding
    • Expulsion (5% in the 1st yr, greatest in 1st mo and in nulliparous women)
    • Uterine wall perforation (1/1000) on insertion
    • If pregnancy occurs with an IUD, increased risk of ectopic
    • Increased risk of PID (within first 10 d of insertion only)
  • Copper IUD:
    • increased blood loss and duration of menses
    • dysmenorrhea
  • Progesterone IUD:
    • bloating
    • headache
51
Q

Name absolute contraindications: Both Copper and Progesterone IUD (4)

A
  • Known or suspected pregnancy
  • Undiagnosed genital tract bleeding
  • Acute or chronic PID
  • Lifestyle risk for STIs*
52
Q

Name absolute contraindications: Copper IUD (2)

A
  • Known allergy to copper
  • Wilson’s disease
53
Q

Name relative contraindications: Both Copper and Progesterone IUD (6)

A
  • Valvular heart disease
  • Past history of PID or ectopic pregnancy
  • Presence of prosthesis
  • Abnormalities of uterine cavity, intracavitary fibroids
  • Cervical stenosis
  • Immunosuppressed individuals (e.g. HIV)
54
Q

Name relative contraindications: Copper IUD (1)

A

Severe dysmenorrhea or heavy menstrual bleeding

55
Q

Name: Emergency Contraceptive Methods (4)

A
  • Hormonal:
    • Yuzpe Method
    • Plan B
    • Ulipristal
  • Non-hormonal: Postcoital IUD (Copper)
56
Q

Describe usage of Yuzpe method (5)

A
  • Used within 72 h of unprotected intercourse; limited evidence of benefit up to 5 d
  • Ovral® 2 tablets then repeat in 12 h (ethinyl estradiol 100 µg/ levonorgestrel 500 µg)
  • Can substitute with any OCP as long as same dose of estrogen used
  • 2% overall risk of pregnancy
  • Efficacy decreased with time (e.g. less effective at 72 h than 24 h)
57
Q

Describe mechanism of action: Yuzpe method (4)

A

Unknown; theories include:

  • Suppresses ovulation or causes
  • deficient luteal phase
  • Alters endometrium to prevent implantation
  • Affects sperm/ova transport
58
Q

Name side effects: Yuzpe method (2)

A
  • Nausea (due to estrogen; treat with Gravol®)
  • Irregular spotting
59
Q

Name contraindications: Yuzpe method (2)

A
  • Pre-existing pregnancy (although not teratogenic)
  • Caution in women with contraindications to OCP (although NO absolute contraindications)
60
Q

Describe usage: Plan B (5)

A
  • Consists of levonorgestrel 750 µg q12h for 2 doses (can also take 2 doses together); taken within 72 h of intercourse.
  • Can be taken up to 5 d
  • Greater efficacy (75-95% if used within 24 h) and better side effect profile than Yuzpe method but efficacy decreases with time; 1st line if >24 h
  • No estrogen thus very few contraindications/side effects (less nausea)
  • Less effective in overweight individuals (>75 kg less effective, >80 kg not recommended)
61
Q

Describe mechanism of action: Plan B (3)

A

Same as Yuzpe method -> Unknown; theories include:

  • Suppresses ovulation or causes deficient luteal phase
  • Alters endometrium to prevent implantation
  • Affects sperm/ova transport
62
Q

Name Side Effects: Plan B (2)

A

Same as Yuzpe method

  • Nausea (due to estrogen; treat with Gravol®)
  • Irregular spotting
63
Q

Name Side Effects: Plan B (1)

A

Pre-existing pregnancy (although not teratogenic)

64
Q

Describe dosage: Ulipristal (1)

A

30 mg PO within 5 d

65
Q

Describe mechanism of action: Ulipristal (2)

A
  • Selective Progesterone
  • Receptor Modulator (SPERM) with primarily antiprogestin activity: may delay ovulation by up to 5 d
66
Q

Name side effects: Ulipristal (5)

A
  • Headache
  • hot flashes
  • constipation
  • vertigo
  • endometrial thickening
67
Q

Name contraindications: Ulipristal (1)

A

Pre-existing pregnancy (although not teratogenic)

68
Q

Describe follow-up of emergency postcoital contraception (2)

A
  • 3-4 wk post treatment to confirm efficacy (confirmed by spontaneous menses or pregnancy test)
  • contraception counselling

TN Gyneco (20 decks)

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