B8-012 Contraception Flashcards
progestin inhibits ovulation by […] suppression
LH
[…] thickens the cervical mucus, preventing sperm transport
progestin
what type of contraception is contraindicated in patients who experience migraine with aura?
combined hormonal contraception (CHC)
(vision changes, numbness, parasthesias)
what schedule of combined oral contraceptive pills have been shown to have improved efficacy?
shortened hormone free week
(24 days on 4 days off)
what would an ideal OCP look like?
30 mcg EE + levonorgestrel
shortened/erased placebo week
monophasic
CHC patches may have lower efficacy in what patient populations?
obese patients
NuvaRing lasts […] month(s)
one
*new ring every month
Annovera (contraceptive ring) lasts […] month(s)
12
*same ring for 12 months, in for 24 days out for 4
what forms of CHC can be used continuously?
ring and pill
what forms of CHC cannot be used continuously?
patch
breast cancer in CHC users usually occurs in women in what age range?
40s
(RR of breast cancer due to CHC use is very low)
patients who use estrogen containing contraception have lower rates of what cancers? [3]
ovarian
colon
endometrial
there is a known causal link between estrogen and what chronic disease?
hypertension
CHCs raise systolic BP by […] mmhg and diastolic by […]mmhg
CHCs raise systolic BP by [8] mmhg and diastolic by [6]mmhg
what type of contraception is contraindicated in patients with hypertension?
CHC
(increased risk of MI, ischemic stroke)
do progestin only contraceptives still carry risk of VTE?
no
(suitable option for women with hx/risk factors of VTE)
progestin only pills (POPs) [2]
norethindrone (micronor)
drospirenon (slynd)
[norethindrone vs drospirenon]
primary mechanism: cervical mucus thickening
norethindrone (POP)
[norethindrone vs drospirenon]
primary mechanism: inhibits ovulation
drospirenon (POP)
[norethindrone vs drospirenon]
requires extremely punctual dosing
if the dosing is more than 3 hrs late, need to use a backup for 48 hrs
norethindrone (POP)
[norethindrone vs drospirenon]
window for missed pill is 24 hours
drospirenon (POP)
how can you be “reasonably sure” a patient is not pregnant?
actively menstruating
hasn’t had sex since last period
reliably using a form of birth control
within 7 days of spontaneous or induced abortion
4 weeks postpartum
fully or nearly fully breastfeeding
what are the risks of giving progesterone/estrogen in pregnancy?
none
(so can start any form of hormonal contraception and do a pregnancy test in 2-4 weeks if unsure a patient is pregnant; cannot use IUD though)
why are women with obesity are at a higher risk of endometrial cancer? [2]
increased peripheral conversion of estrogen
higher rates of anovulation
(contraception offsets risk)
IUDs decrease the risk of […] cancer
endometrial
what type of IUD actually reverses 90% of benign endometrial hyperplasia?
LNG-IUD
52 mg LNG IUD (mirena) is now approved for […] years of use
8
20% of patients with the 52 mg LNG IUD (mirena) experience […] at one year
amenorrhea
recent data supports the copper IUD is effective for […] years
12
data suggests the copper IUD is effective through menopause if placed after age […]
35
most common reasons patients stop using progestin implant (Nexplanon)
irregular bleeding
bleeding with the progestin implant (nexplanon) is highest in the […] months
first three
(decreases over the first year, plateaus in year 2/3)
most effective form of reversible, prescription contraceptive
progestin implant (nexplanon)
injection (depo-provera) is administered every […] weeks
12-13
grace period up to 15
side effect of depo is delayed fertility. it may take […] months for fertility to return
9-10
patients who use depo-provera experience a bone mineral density loss of 1-2% per year. Because of this, the FDA recommends use is limited to […]
2 years
(BUT: ACOG and WHO disagree, no evidence of increased fx risk and reverses within 12 months)
MOA spermicidal
copper IUD
MOA changes cervical mucus [2]
LNG IUD
northindrone (POP)
MOA inhibits ovulation [4]
implant (nexplanon)
DMPA (depo-provera)
drospirenon (POP)
CHC (pill/patch/ring)
common side effect is heavier menses
copper IUD
common side effect is light/rare/absent menses
LNG IUD
common side effect is light/rare/absent menses/ irregular bleeding
progestin implant
nexplanon
common side effect is light/rare/absent menses/ irregular bleeding and possible weight gain
DMPA (depo-provera)
common side effect is lighter menses
POP
common side effect is lighter menses, HA, nausea, breast tenderness
CHC (pill/patch/ring)
good up to 10 years (FDA), 12 yrs (evidence)
copper IUD
good 3-8 years (FDA)
LNG IUD
good for up to 3 yrs (FDA), 5 yrs (evidence)
progestin implant
nexplanon
taken every 3 months
DMPA (depo-provera)
taken daily [2]
POPs
CHC pill
taken weekly
CHC patch
taken monthly
CHC ring
minimum exam requirements for IUD placement
pelvic exam, exclude pregnancy
minimum exam requirements before prescribing any contraceptive with estrogen
blood pressure
CHC can be used to treat what medical symptoms/problems? [4]
menorrhagia
dysmenorrhea
acne/hirsutism
endometriosis
common side effects of estrogen containing contraception [3]
headache
nausea
breast tenderness
when do the common side effects of estrogen containing contraception typically resolve?
after 1-2 cycles
[…] will improve acne, decrease menstrual flow, and regulate menstrual cycles
CHC
CHC […] will result in lighter menses, but continuous use is not recommended so the patient will have a monthly period
patch
what method of contraception is most consistently associated with weight gain?
depot
(5-6 kg over 3-5 years)
weight gain within the first […] months of use has been shown to predict future weight gain with depot
6 months
if the CHC patch falls off, what should the patient do?
replace the patch
hormones are delivered through the adhesive
the patch is NOT recommended to be placed where on the body?
breasts
can be on back, abdomen, buttocks
hypertension is a direct contraindication to what types of contraception?
estrogen containing
associated with delay in return to fertility, 9-10 months after stopping
DMPA
(related to IM route of administration)
DMPA is administered every […]
12-13 weeks
grace period through 15 weeks
in evaluating risk of contraceptive methods for a patient, it is important to weight the risks of the method against […]
pregnancy
