Chapter 47: Contraception & Infertility Flashcards
When is day one of the menstrual cycle counted
The start of menses (bleeding)
What is the follicular phase of the menstrual cycle
Surge in estrogen, which causes LH and FSH to increase
What is the ovulatory phase in the menstrual cycle
The LH surge triggers ovulation
Once the egg (oocyte) is released after the LH surge, the egg lives for how long
24 hrs
A person wishing to conceive can use a kit to detect LH. When should this person have intercourse
When the LH surge is detected and for the following 2 days
Which hormone indicates pregnancy
hCG
What time of day is the hCG level the highest & is the best time to use a pregnancy test
in the morning
Folic acid should be taken to help prevent birth defects of the brain and ____
spinal cord (neural tube defects)
The only reversible contraceptive method that has a delay in return to fertility is
the medroxyprogesterone injection
Barrier methods of contraception include
Condoms, diaphragms
Which form of contraceptive can protect against many STDs
condoms (only if latex or synthetic)
What are the only types of lubricants to recommend to use with condoms to make them less likely to break
water or silicone-based (NOT OIL)
Foams, film, creams, suppositories, sponges and jelly contraceptives contain which spermicide
Nonoxynol-9
Hormonal contraceptives inhibit the production of which hormones
FSH and LH (which prevents ovulation)
Estrogen/progestin combination pills are called ___ and non-oral contraceptives that contain estrogen & progestin are called ___
COCs
CHCs
The FDA requires ___ to be dispensed with oral contraceptives
Patient Package Insert (PPI)
What are monophasic COCs
they have the same dose of E and P throughout the pill pack
What are biphasic, triphasic, and quadriphasic pill packs
they mimic the E and P levels during a menstrual cycle. The type of formulation (e.g., triphasic) refers to the number of times the amounts of the hormone change
COCs can be used for other indications besides pregnancy, such as
dysmenorrhea (menstrual cramps), PMS, acne in females, anemia, etc
What is the first line treatment for PCOS to regulate menses
COCs
What is first-line treatment for endometriosis
COCs
Which COC is a mild potassium-sparing diuretic which decreases bloating, PMS symptoms, and weight gain and also is associated with less acne
Drosperinone
POPs prevent pregnancy by suppressing ___
ovulation; this thickens the cervical mucous to inhibit sperm penetration and thinning the endometrium
POPs are primarily used in which patients
breastfeeding
What decreases milk production in lactating women
estrogen (which is why POPs are used)
POPs require
good adherence!!! the pill must be taken within 3 hours of the scheduled time
POPs are sometimes used for
migraine with aura ppx
The contraceptive patch should NOT be used in patients with
clotting risk factors since it has higher systemic estrogen exposure (do not use in women > 35 years who smoke)
Xulane patch is less effective in women > __ lbs
198
Depo-Provea is given IM or SC every ____
3 months
During week 4 of using COCs, what occurs
menses
Extended cycle COCs have __ days of active hormone pill
84 (bleeding occurs every 3 months)
Which brand of COCs is approved for suppressing menses altogether by taking continuous contraception
Amethyst
What is a common SE with continuous contraception?
Patients should be counseled that this typically resolves after how long
spotting (breakthrough bleeding)
Resolves after 3-6 months
Lo in the name of a COC indicates = __ mcg E
35
low E causes less estrogenic SE
“24” in the name of a COC indicates:
a shorter placebo time: 24 active + 4 placebo
Which brand of COC is an extended cycle formulation
Seasonique
period occurs every 3 months, so one period per season
Which COCs contain drosperinone
Yasmin and Yaz
Which brands of contraception are POPs
Errin, Camilla, Nora-BE
Side effects of estrogen
nausea, breast tenderness/fullness, bloating, weight gain, elevated BP
COC formulations with less estrogen can lead to
breakthrough bleeding
It is recommended to wait __ monthly cycles before changing the dose to see if spotting resolves with COCs
3
Boxed warning for ALL estrogen-containing products (pills, ring, patch)
Do not use in women > 35 years old who smoke due to risk of serious CV events
Boxed warning for estrogen + progestin transdermal patch
increased risk for VTE (DVT/PE) compared to COCs
Boxed warning for Depo-Provera shot
Loss of bone mineral density with long-term use
Do NOT use estrogen with these conditions
- DVT/PE, stroke, CAD
- History of breast, ovarian, or liver cancer, migraines with aura
If a patient experiences early or mid-cycle spotting, the dose of ___ should be increased & if they experience late-cycle spotting, the dose of ___ needs to be increased
Estrogen
Progestin
Drosperinone can cause:
higher clotting risk
increased potassium - do not use with kidney, liver, or adrenal gland disease
Patients taking Depo-Provera injection should be taking adequate
Calcium and vitamin D
What are the common symptoms of a DVT/PE
Remember ACHES:
- Abdominal pain that is severe
- Chest pain
- Headaches
- Eye problems
- Swelling or sudden leg pain
If a patient has a concern for acne, which birth control should be selected
COC with lower androgenic activity (e.g., Sprintec) or no androgenic activity (i.e., Yaz, Yazmin)
If a patient is breastfeeding, which birth control should be selected
POPs or non-hormonal method
If a patient has migraine with aura, which birth control should be selected?
What about without aura?
- With: POPs or non-hormonal
- Without: any method
If a patient has fluid retention, which birth control should be selected
drosperinone containing COC
If a patient has heavy menstrual bleeding, which birth control should be selected
Natazia or IUD Mirena
If a patient has HTN, which birth control should be selected
POP or non-hormonal method
If a patient has a mood disorder, which birth control should be selected
monophasic COC - extended cycle or continuous with drosperinone is preferred
If a patient has nausea, which birth control should be selected
can decrease E dose
If a patient is overweight, which birth control should NOT be used
DMPA (can cause weight gain)
If a patient is postpartum, which birth control should be selected
POPs or nonhormonal medthod
If a patient has PMDD, which birth control should be selected
Yaz or antidepressant
Which birth control does NOT have drug interactions
injection (DMPA)
Which drugs can DECREASE hormonal contraception efficacy
- Antibiotics (rifampin, rifabutin) - backup method with rifampin for 6 weeks after rifampin is d/c
- Anticonvulsants: carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate, lamotrigine
- St. John’s Wort
- Smoking
- Ritonavir
Which drugs cannot be used with any formulation containing EE due to risk of liver toxicity
Hep C treatments - Technivie & Viekira Pak
The “Start Today” method is the bet practice recommendation for starting COC & requires non-hormonal backup for ___ days
7
The Sunday Start method starts the Sunday after onset on menstruation & is used if the pt prefers that menstruation occur during the week and is complete before the following weekend. It requires non-hormonal backup for ___ days
7
T/F: If COC is started within 5 days after the start of period, non-hormonal backup is required for 7 days
False - no back-up method is needed
When can POPs be started
Any time
If more than ___ COC pills are missed, backup contraception is required for 7 days
1
If 2 COCs are missed during week 3 of cycle, what should the patient do
Omit hormone-free week & start next pack of pills
If patient misses a dose of POP and it has been > __ hours past the scheduled time, backup contraception is required for how long
3 hours
48 hours
What is the brand name for the IUD
Mirena
What is the brand name for the copper-T UD
Paragard
The copper-T IUD can be used for:
Emergency contraception &/or regular birth control
What is the birth control implant brand name
Nexplanon
The birth control implant releases which hormone for how many years
etonogestrel for 3 years
What is the most effective form of emergency contraception
copper IUD (Paragard)
What are the 2 oral options of EC
levonorgestrel (Plan B One-Step) Ulipristal acetate (Ella)
The oral options for EC can be used within __ days
5
What is the dose of Plan B
one 1.5 mg tab of levonorgestrel
Plan B reduces the risk of pregnancy by up to 89% when started within __ hours after unprotected sex
72
What is the MOA of plan B
prevents or delays ovulation and thickens cervical mucus
If a patient vomits within __ hours of taking Plan B, the dose should be repeated
2
Which EC requires a prescription
Ulipristal (Ella) - it is a chemical cousin to mifepristone aka the “abortion pill”
Ulipristal is indicated for up to __ days after unprotected intercourse
5
Where can the contraceptive patch be placed
butt, stomach, upper arm or upper torso
What days can the contraceptive patch be started
On day 1 or Sunday
How long is NuvaRing kept in place
3 weeks & taken out for one week
If NuvaRing is kept in place > __ weeks, backup contraception is needed
4
Infertility is defined as not being able to get pregnant for how long after unprotected sex
1 year
What is the first-line treatment for a woman with irregular or absent menstrual cycles
Clomiphene
Clomiphene drug class
SERM
Drugs that are SERMs act as ___ agonists in some tissues and ___ antagonists in other tissues
estrogen; estrogen
The surge in LH from clomiphene triggers ovulation & commonly causes ___
hot flashes
SERMs have a risk for
clotting
Gonadotropins trigger ovulation by acting similar to __ & __
FSH and LH
Infertility drugs are good in that they trigger ovulation, but they also have the risk of causing
release of multiple eggs and ↑ risk of multiple births
Gonadotropin formulations
SC or IM
