Contraception Flashcards
MOA of copper IUD and how to use it for emergency contraception
Copper IUD Mechanism: induces sterile inflammatory reaction. biochemical/morphological changes in endometrium affect sperm transport
Use: emergency contraception (most effective, up to 7d post-coitus) and as pregnancy prevention (especially BMI >30) Efficacy: 0.01% pregnancy rate
T/F copper IUD isn’t as good as an emergency contraceptive for those with BMI >30
false.
Copper use: Use: emergency contraception (most effective, up to 7d post-coitus) and as pregnancy prevention (especially BMI >30)
levonorgestrel is only good if BMI is below 25– it is less effective if BMI >25. What is a hormal alternative as an emergency contraceptive?
• Levonorgestrel: 1-3% pregnancy rate (less effective in BMI >25)
• Ulipristal Acetate: 1-2% pregnancy rate (less effective in BMI >35)
• Yuzpe Method: 3% pregnancy rate (more side effects)
after emergency contraception: Conduct a pregnancy test if there is no menstrual bleeding by___ days, or by ___days if cycle control was initiated.
Conduct a pregnancy test if there is no menstrual bleeding by 21 days, or by 28 days if cycle control (normal hormonal BC) was initiated.
Contraindications to IUDS
Pregnancy
Current PID or purulent cervicitis
Puerperal sepsis
Immediately after septic abortion
Known distorted uterine cavity
Pelvic tuberculosis
Abnormal vaginal bleeding
cervical /endometrial cancer awaiting treatment
Malignant GTD with elevated B HCG
Current PR+ breast cancer (LNG-IUS)
mechanism, requirements for lactational amenorrhea as a form of BC
Mechanism: supress HPO axis because of elevated prolactin–> anovulation
Requirements: <6mo post-partum, fully BF, remains amenorrheic Efficacy: 2% pregnancy rate for 6mo
Combined Estrogen-Progestrin Pills Mechanisms:
• Suppression of hypothalamic GnRH releasing factors–> prevents ____ release–> inhibits __
• Progesterone thickens __ __–>inhibits sperm migration • Progesterone renders endometrium __–> unfavourable for
implantation
• ¯secretion + peristalsis within fallopian tube–>interferes with ovum- sperm interaction
Combined Estrogen-Progestrin Pills Mechanisms:
• Suppression of hypothalamic GnRH releasing factors–> prevents FSH/LH release–> inhibits ovulation
• Progesterone thickens cervical mucous–>inhibits sperm migration • Progesterone renders endometrium atrophic–> unfavourable for
implantation
• ¯secretion + peristalsis within fallopian tube–>interferes with ovum- sperm interaction
key contraindications fo oral COC pill
- smoker
- previous DVT
- breast cancer
- migraine with aura
had major surgery
mechanism of progestin-only contraception
progesterone maintains the uterine lining and negatively feedsback to the gnrh axis to prevent follicular development– thus it prevents ovulation of the next egg.
recall: The combined birth control pill prevents ovulation by maintaining more consistent hormone levels. Without a peak in estrogen, the ovary doesn’t get the signal to release an egg, which eliminates the possibility of fertilization and pregnancy.
is depoprovera progestin only or combo
progestin only.
DepoProvera MOA: inhibition ovulation. 0.2% perfect use, 6% typical use.
Pros: compliance, amenorrhea, safe with breastfeeding
Cons: irregular bleeding, delayed return to fertility, loss of bone mineral density (reversible), weight gain.
progesterone-only contraindication
Progestin contraindications: current breast cancer, previous Hx of BC, severe cirrhosis, hepatocellular adenoma, malignant liver tumor, unexplained vaginal bleeding prior to investigation.
