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Women's Health Exam 1 (A,S,L) > Birth Control 👼🔜🗑 (Lauren) > Flashcards

Birth Control 👼🔜🗑 (Lauren) Flashcards

1
Q

What question do you need to ask every female pt age 15-55?

A

“What are your plans for pregnancy in the next year?’

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2
Q

What are your options if you have unprotected sex with a loser and you dont want to get pregancy ?!?! (Aka emergency contraceptives)

A

Oral tablets- Plan B, taking a bunch of birth control pills (72 hrs)

Paragard insertion within 5 days

Ulipristal Acetate (Ella) within 5 days

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3
Q

What does Uripristal Acetate (Ella) do?

A

It is a selective Progesterone Recpetor Modulator (SPRM) that prevents implantation. Used as emergency contraception within 5 days of unprotected intercourse

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4
Q

How long after having unprotected sex do you have to take Emergency contraception?

A

Plan B/pills- 72 hours

Paragard- 5 days

Ella- 5 days

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5
Q

What are the 4 types of short acting/frequent use contraception

A

“The Pill”

Nuva Ring

OrthoEvra patch “The Patch”

Depo Provera “The Shot”

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6
Q

Methods that require increased frequency of use have (better/worse) efficacy

A

Worse

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7
Q

Who are the best candidates for short acting/frequent use contraception methods?

A

Woman who might want to get pregnant in the next 1-2 years (NOT Depo provera shot though)

Woman not looking for long term pregnancy prevention

Woman using it for non-contraceptive benefits (acne, etc)

Uninsured poor woman (short acting are cheap)

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8
Q

What are the 3 ways oral contraceptives prevent pregnancy?

A

Suppress ovulation

Thickening cervical mucus

Thinning the endometrial lining

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9
Q

Why are progestin-only pills/“mini pills” less effective than combined oral contraceptive?

A

They are less likely to consistently suppress ovulation. (They will still thicken mucus and thin lining though)

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10
Q

What makes all the different Combined oral contraceptives different from each other

A

The type of progestin used

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11
Q

What are monophasic birth control pills?

A

Every pill in the pack has the same amount of estrogen and progestin except for the placebo pills

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12
Q

What are triphasic birth control pills?

A

The level of estrogen and progestin throughout the pack of pills changes to try to be more physiologic

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13
Q

Which has a higher total dose of estrogen per month: monophasic or triphasic pills

A

Monophasic

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14
Q

What are continuous birth control pills?

A

Birth control packs that have 3 straight months of active pills and 1 week of placebo pills
(Monophasic)

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15
Q

Who do you need to be CAUTIOUS with when giving them combined hormonal contraceptives (including ring and patch)?

A

Diabetics (well controlled)

HTN (well controlled)

Smoking under age 35

Common Migraines (without aura)

Liver disease

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16
Q

Who can you NEVER give Combined hormonal contraceptives to?

A

Uncontrolled diabetes

Uncontrolled HTN

CAD

Complex Migraine (with aura)

History of thromboembolism

Hormone sensitive cancers

Smoker over age 35

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17
Q

Why would we ever give the progesterone only pill/POP/“mini pill?”

A

Patients who can not take estrogen. (Usually postpartum moms who are breastfeeding since estrogen will suppress milk)

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18
Q

Why do progesterone only pills suck?

A

More breakthrough bleeding due to no estrogen

More likely to fail if not taken properly (ovulation doesnt get suppressed)

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19
Q

What are the contraindications to estrogen?

A

Immediately postpartum (VTE risk)

Early lactation can be suppressed

Thromboembolism history

CAD

Smoker over 35

Classic migraines (?) Thought this was just a caution but whatever

Liver dysfunction

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20
Q

What are the Non-Contraceptive benefits of OCPs?

A

Cycle regulation

Treatment of heavy menses

Acne caused by androgenic excess

Dysmenorrhea treatment

Preventing functional ovarian cysts

Preventing ovarian, colon, and endometrial cancers

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21
Q

When you give a patient a new form of contraception, when can she start it?

A

As long as you have ruled out pregnancy, she can start it right away

22
Q

What are the six different situations that would make you assume a woman is not pregnant?

A
  1. She hasn’t had sex since her last period
  2. She has been correctly and consistently using a reliable method of contraception
  3. She is within the first 7 days after her period
  4. She is within 4 weeks postpartum
  5. She is within the first 7 days post abortion or miscarriage
  6. she is breastfeeding, amenorrhea can, and less than 6 months postpartum
23
Q

How does the Depo-provera shot prevent preganncy?

A

Suppresses ovulation, thins the lining, and thickens cx mucus

24
Q

Which hormone(s) are in the depo-provera shot?

A

Progesterone only

25
Q

What are the side effects of depo provera?

A

Irregular cycles/breakthrough bleeding***

Amenorrhea

Loss of bone mineral density**

26
Q

What is the black box warning for depo-provera, and how long can a patient be on it due to this?

A

Loss of bone mineral density. Women should only use it for 2 years.

27
Q

When starting depo-provera, how long must a woman use back-up contraception?

A

If started during menses, no backup method needed

If started >7 days after menses, use backup method for 7 days

28
Q

What hormones are in the patch and nuva ring?

A

Estrogen and progesterone

29
Q

What are the failure rates of the patch and the ring?

A

Low (user-dependent)

30
Q

When starting a patient on any sort of combined estrogen+progestin contraception, how long does she need to use a backup form of contraception?

A

If started during period, no backup needed 👍

If started >5 days after menses, use backup for 7 days

31
Q

What is backup contraception?

A

Barrier methods (condom, diaphragm, cervical caps, cervical sponge)

32
Q

What is the failure rate of barrier methods?

A

High (highly user-dependednt, many compliance issues)

33
Q

What is the only contraindication for barrier methods?

A

Sensivitirgy to material

34
Q

Do barrier methods have any Non-contraceptive benefits?

A

Lower risk of STD transmission with condoms***

35
Q

What does LARC stand for?

A

Long Acting Reversible Contraceptives

36
Q

What are the 2 forms of LARCs?

A

Sub-dermal implants (Nexplanon)

IUDs

37
Q

Which hormone is in sub-dermal implants and hormonal IUDs?

A

Progestin only (irregular bleeding)

38
Q

What is the only contraindication to subdermal impants?

A

Allergy to material

39
Q

What are the contraindications to IUDs?

A

Active infection

Copper sensitivity

Uterine anomaly (risk of perforation)

Untreated cervical disease

40
Q

Which IUD is the only one with FDA approval to treat menorrhagia?

A

Mirena

41
Q

Which IUDs contain hormones, and which one has no hormones, but is copper?

A

Progestin: Mirena, Skyla, Liletta

Copper: Paragard

42
Q

What non-contraceptive benefits do hormonal IUDs have?

A

Mirena treats menorrhagia

Reduction of menstrual blood flow

43
Q

Women spend more than three-quarters of their reproductive lives ______________

A

Trying to avoid unintended pregnancy

44
Q

Why are LARCs the best contraception?

A

Eliminate need for user input (no doses/refills/etc)

Hormone levels are maintained at constant levels which further decreases chance of ovulation

No frequent doctor visits

One less thing for mom to remember

Allows for mothers to plan their pregnancies better

45
Q

What are the 3 surgical approaches for female sterilization?

A

Laparoscopic (most common)

Postpartum

Transcervical (Essure- off-market)

46
Q

What is a possible non-contraceptive benefit of sterilization?

A

Decreased risk of ovarian cancer

47
Q

Can laparoscopic sterilization be performed under sedation or local anesthesia?

A

No, requires ventilation, so should only be performed under general anesthesia

48
Q

What is the best form of contraception for a married 40 year old G2P2 woman with earl controlled HTN and an ACE inhibitor?

A. OCP

B. IUD

C. Contraceptive patch

A

IUD.

No effect on HTN, no effect on thromboembolism, and due to her age and parity, she probably would like the long term effect

49
Q

What is the best contraception for a 14 yr old G0 non-sexually active girl with irregular menses?

A. OCP

B. IUD

C. Depo Provera

A

OCP.

Shes not sexually active, so she doesn’t need to prevent pregnancy. Depo provera does not regulate menses

50
Q

What is the best contraception for a 30 yr old G2P2 breastfeeding twins at 3 moths post -partum?

A. OCP

B. IUD

C. Depo provera

A

IUD.

An OCP requires her to remember daily pills, and a combined pill will suppress milk.
Depo provera requires her to come in to the office every 12 weeks for injections, which is probably hard when she has new twins.

Women's Health Exam 1 (A,S,L) (3 decks)

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