9-Family Planning

Question 1

What is the rhythm method?

Answer 1

Periodic abstinence to avoid pregnancy using different methods such as calendar or cervical mucus method
Require significant will power
Failure rate is as low as 9% with perfect use
Typical use is 20.5% in a year

Question 2

What is post coital method?

Answer 2

Use of high dose steroids to prevent pregnancy and delay ovulation

Question 3

What is the effectiveness of post coital contraception

Answer 3

Combined oral contraceptives decrease possibility of pregnancy by 75% and levonorgesterol by 85%

Question 4

What are the types of IUD available in the USA?

Answer 4

Progesterone releasing IUD- inhibits sperm capacitation, atrophy of endometrial glands
Copper IUD- non hormonal, sterile inflammatory response caused by the release of free copper ions

Question 5

What are the characteristics of the IUD?

Answer 5

Not abortifacient, inhibits fertilization
Not recommended for those with fibroids that distort uterine cavity
Best for those in monogamous relationship
Pregnancy rate is 0.2%-0.5% in the first year after placement of progesterone and copper IUD respectively

Question 6

What are the adverse reactions of IUD?

Answer 6

Pain, cramping, bleeding irregularities
Increased amount of bleeding with copper IUD
Irregular bleeding initially with progesterone IUD

Question 7

What are the contraindications of IUD?

Answer 7

Active or recent pelvic infection
Wilsons disease
Abnormal endometrial cavity
History of an ectopic pregnancy

Question 8

What are the effectiveness of the condom?

Answer 8

Male - 2% pregnancy rate /year
Typical use is 17.4% pregnancy /year
Female-5% pregnancy rate/year
Typical use- 21% pregnancy rate/year

Question 9

What are the injectable progestins?

Answer 9

Progestin subdermal implant-3 years
Depo-Provera injection every 3 months
Both have high rate of menstrual abnormalities
May take up to 9 months to achieve pregnancy after discontinuation
Recommend oral calcium for bones

Question 10

What are the expected effectiveness?

Answer 10

Implant expected effectiveness 0.05% Pregnancy rate/year, typical use: 1% pregnancy rate /year
Depo- Provera expected effectiveness is 0.3% pregnancy rate/year

Question 11

What are the major side effects?

Answer 11

Breakthrough bleeding
Weight gain
Affective side effects

Question 12

What are the types of sterilization?

Answer 12

Intended to be permanent, not reversible
Vasectomy-safest
Tubal ligation
cornual ablation with silicon plugs- not effective until after 3 months after placement
Failure rate is dependent of what technique used

Question 13

What are the general aspects of oral contraceptives?

Answer 13

Composed of synthetic estrogen and progestin

Estrogen suppresses FSH, Progesterone suppresses LH and thickens cervical mucus

Question 14

What are the risk and benefits of oral contraceptives?

Answer 14

No contraception has greater mortality rate than pregnancy itself among patients younger than 35
Cardiovascular disease
Estrogen has a tendency to form clots
Most vascular disease morbidity occurs in high risk patients such as smokers, diabetics, lupus

Question 15

What are the non contraceptive benefits of OCP?

Answer 15

Decreased incidence of benign diseases of the breast and ovary
Less iron deficiency anemia
Lower incidence of uterine and ovarian cancers
Decreased risk of pelvic infections

Question 16

What is the risk of cancer associated will OCP?

Answer 16

Breast cancer-may have some risk
Ovarian cancer- reduces the risk of epithelial. Relative risk of 0.2 after 10 years of OCP use
Cervical cancer-use greater than 5 years may increase risk, HPV effect
Endometrial cancer- reduce risk by 50%

Question 17

What are other informations associated with OCPs?

Answer 17

OCPS do not cause infertility
Decreased risk of PID and moderate symptomatic endometriosis
Start with low dose
Progesterone only pills are less effective but great for breastfeeding moms

Question 18

What are the absolute contraindications of OCPs?

Answer 18

History of thromboembolic disorder
Coronary artery disease
Breast cancer or estrogen dependent neoplasia
Liver tumor or impairment
Congenital hyperlipidemia
Smoker over the age of 35
Migraine with aura
Any migraine over the age of 35

Question 19

What are the relative contraindications of OCPs?

Answer 19

Migraine without aura
HTN
diabetes
Active gallbladder disease
Older than 30 and smoker

Question 20

What are the early pill danger signs?

Answer 20

A- abdominal pain (severe)
C-chest pain ( severe, cough, shortness of breath)
H- headache (severe)
E- eye problems (blurring, speech problems)
S- severe leg pain ( calf or thigh)

Question 21

What are the side effects of OCPs?

Answer 21

Breakthrough bleeding- 30% of women during the first month after OCP start
Amenorrhea
Nausea
Affective symptoms