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EndoRepro 2 Exam 1 > Clin: Contraception, Sterilization - Wootton > Flashcards

Clin: Contraception, Sterilization - Wootton Flashcards

1
Q

what are the two general contraceptive mechanisms?

A
  1. inhibit the formation and release of the egg

2. impose a mechanical, chemical, or temporal barrier between the sperm and egg

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2
Q

suppression of hypothalamic gonadotropin-releasing factors with subsequent suppression of pituitary production of FSH and LH

  • progesterone component is major player suppressing LH and therefore ovulation (also thickens cervical mucus)
  • estrogen component mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
A

combination estrogen and progesterone pills

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3
Q

MOA: primarily thickens cervical mucus, making it impermeable

  • ovulation continues in 40% of users
  • mainly used in breastfeeding women and women who have a contraindication to estrogen
A

progestin only

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4
Q

why must progestin only pills be taken at the same time every day?

A

because the low dose!

- if pt is more than 3 hrs late taking the pills, then need to use a backup method for 48 hours

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5
Q

what are the benefits of hormonal oral contraceptives?

A
  • menstrual cycle regularity
  • improve dysmenorrhea
  • decrease risk of iron def anemia (shorter, less heavy cycles)
  • lower incidence of endometrial and ovarian cancers, benign breast and ovarian disease
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6
Q

what are the minor side effects of oral contraceptives?

A
  • breakthrough bleeding
  • amenorrhea
  • bloating
  • weight gain
  • breast tenderness
  • nausea
  • fatigue
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7
Q

what are the serious side effects of oral contraceptives?

A
  • venous thrombosis
  • pulmonary embolism
  • cholestasis and gallbladder disease
  • stroke and MI
  • hepatic tumors
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8
Q

estrogen and progesterone

  • applied for 3 weeks
  • caution with women >198lbs
  • same SA as oral contraceptives, but increased risk of thrombosis
A

transdermal patch

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9
Q

estrogen and progesterone

  • associated with greater compliance d/t once a month use (insert in vagina for 3 weeks)
  • can be removed up to 3 hrs without affecting efficacy
  • better tolerated since not going through GI tract
  • less breakthrough bleeding
A

vaginal ring (Nuvaring)

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10
Q

new vaginal ring: segesterone acetate and ethinyl estradiol

  • 13 months, 1 reusable ring
  • place in vagina for 21 days, remove for 7, reuse
  • same indications/SA/contraindications as other combination products
  • has not been studied in women w/BMI >29
A

annovera vaginal ring

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11
Q

who CANNOT use oral contraceptives?

A
  • women over 35 who smoke
  • hx of thromboembolic event
  • hx of CAD, cerebral vascular dz, congestive heart failure or migraine with aura, uncontrolled HTN
  • diabetes, chronic HTN, SLE
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12
Q

IM injection every 11-13 weeks

  • maintains level of progestin for 14 weeks
  • preferred to be given w/in first 5 days of menses (if not, use a backup method for 2 weeks)
  • efficacy is roughly equivalent to sterilization, NOT altered by weight
A

Depot medroxyprogesterone acetate (depot provera)

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13
Q

what is the MOA of depot provera?

A
  • thickening cervical mucus
  • decidualization of the endometrium
  • blocks LH surge and ovulation
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14
Q

what is the main concern with depot provera?

A
  • alteration of bone metabolism associated with increased estrogen levels
  • particular concern for adolescents
  • reversible after discontinuation
  • FDA BLACK BOX warning: should consider alternate method after 2 years
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15
Q

what are the side effects of depo-provera?

A
  • irregular bleeding (decreases with use, up to 80% become amenorrheic after 5 years)
  • weight gain
  • exacerbation of depression
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16
Q

what are the indications for depot-provera?

A
  • can use when estrogen is contraindicated
  • seizure disorders
  • sickle cell anemia (decreased number of crisis)
  • anemia secondary to menorrhagia
  • endometriosis
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17
Q

what are the contraindications of depot-provera?

A
  • known or suspected pregnancy
  • unevaluated vaginal bleeding
  • known/suspected malignancy of breast
  • active thrombophlebitis, or hx of thromboembolic events, or cerebrovascular disease
  • liver dysfunction/disease
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18
Q

single, radiopaque, rod-shaped implant containing 68mg estonogestrel 4cm long and 2mm in diameter
- use for 3 years (preferred insert in first 5 days of menses, if not -> backup method for 7 days)

A

nexplanon

- can be used in breast feeding pt

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19
Q

what is the mOA of nexplanon?

A
  • thickens cervical mucus

- inhibits ovulation

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20
Q

what are the side effects of nexplanon?

A
  • irregularly irregular bleeding
  • headache
  • vaginitis
  • weight increase
  • acne
  • breast pain
21
Q

what are the contraindications of nexplanon?

A
  • known/suspected pregnancy
  • current/past hx thrombosis
  • liver tumors or active liver dz
  • undiagnosed abnormal bleeding
  • known/suspected breast cancer (only absolute)
22
Q

what are the risks with IUDs?

A
  • increased risk of infection within first 20 days
  • increased risk ectopic pregnancy
  • if becomes pregnant, should be offered removal if the strings are visible (decreases risk of spontaneous abortion d/t IUD)
  • risk of uterine perforation at time of insertion requiring laparoscopy for removal
  • risk of malposition and necessitating hysteroscopy for removal
23
Q

what are the contraindications for IUD’s?

A
  • breast cancer (levonorgestrel ones only)
  • recent puerperal sepsis
  • recent septic abortion
  • active cervical infection
  • Wilson’s dz (copper only)
  • uterine malformations (uterine septums/firoids/significantly enlarged uterus (>10cm)
24
Q

how long are Mirena/Kyleena good for?

A

5 years

25
Q

how long is Liletta good for?

A

3 years

26
Q

how long is Skyla good for, and who was it designed for?

A

3 years

- made for nulliparous women (smaller uterus)

27
Q

what are the benefits of IUD?

A
  • decrease in menstrual blood loss
  • less dysmenorrhea
  • protection of endometrial lining from unopposed estrogen
28
Q

how long is paragard good for?

A

10 years

29
Q

what is the MOA of paragard?

A

copper interferes with sperm transport or fertilization and prevention of implantation

30
Q

vaginal liner that is recommended to be left in 6-8 hours after intercourse
- 3% breakage rate

A

female condom

NOTE: diaphragms must be left in for 6-8 hrs also (but MUST be used with spermicide!)

31
Q

women who use diaphragms are at an increased risk for what?

A

UTI

- d/t urinary stasis from pressure on the urethra and altered vaginal flora from spermicide

32
Q

smaller version of diaphragm

  • applied to cervix itself - high risk of displacement and TSS
  • used with spermicide
  • left in place for 6 hours after intercourse, no more than 48
A

cervical cap (FemCap)

33
Q

small, pillow shaped, contains spermicide

  • dimple in middle fits over the cervix/opposite end has elastic loop for removal
  • 1 size
  • more effective in nulliparous women
  • left in place for 6 hours, no more than 30 (increased risk TSS)
A

sponge

34
Q

when a woman assesses her cervical mucus and notes changes around ovulation (spinnbarkeit)
- avoid sex for 4 days after peak

A

cervical mucus method

35
Q

combines cervical mucus and basal body temp methods

- awareness of other signs of ovulation: cramping, breast tenderness, changes in position or firmness of cervix

A

symptothermal method

36
Q

what is the Yuzpe method?

A

emergency contraception

- combined oral regimen of tablets within 72 hours of unprotected sex

37
Q

progestin only (levonorgestrel)

  • 2 pills taken 12 hrs apart
  • OTC for women over 17
  • must be used within 120hrs of unprotected sex
  • failure rate is 1.1% (worsens after 72 hrs)
A

plan B

38
Q

ulipristal acetate 30mg

  • indicated for up to 5 days after unprotected sex
  • postpones follicular rupture, inhibits/delays ovulation
A

Ella

39
Q

what is the most frequently used birth control method in the US?

A

sterilization

  • 1 in 3 married couples use
  • should be considered permanent
40
Q

what are the post-op complications of a vasectomy?

A
  • bleeding
  • hematomas
  • acute/chronic pain
  • local skin infection

NOTE: not immediately effective (complete azoospermia obtained w/in 10 weeks)

41
Q

how is female sterilization performed?

A

laparoscopy, mini-laparotomy, hysteroscopy, or at time of c-section

42
Q

small incision, low rate of complications

- occlude the fallopian tubes via: electrocautery, clips, bands, or salpingectomy

A

laparoscopy

43
Q

fast, increase risk of thermal injury to surrounding tissues, poor reversibility, greater risk of ectopic pregnancy if failure occurs

A

electrocautery

44
Q

most reversible method (little tissue damage), but greatest failure rate (>1%)

A

hulka clips

45
Q

lower failure rate than hulka because of larger diameter

A

filshie clips

46
Q

intermediate reversibility and failure rate, higher incidence of post-op pain, increased risk of bleeding

A

bands (fallope rings)

47
Q

removal of entire fallopian tube

- increasing in use d/t recent literature regarding decrease in ovarian cancer risk

A

salpingectomy

48
Q

what is the most common female sterilization methods world-wide?

A

mini-laparotomy

- use small infra-umbilical incision in postpartum period or suprapubic incision as an interval procedure

49
Q

transcervical approach to tubal ligations

  • 99.8% effective
  • 3.6cm stainless steel inner coil and nickel titanium outer coil placed into fallopian tube with aide of hysteroscope
  • must use backup method for 3 months, and then have an hysterosalpingogram (HSG) to document complete sterilization
A

hysteroscopy

- good for obese patients

EndoRepro 2 Exam 1 (25 decks)

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