Contraception Flashcards
How long do you need to use back up method after placement of Nexplanon or Mirena IUD?
7 days unless placed within 5 days of menses (or immediately following birth, abortion, or discontinuing another method)
Mirena IUD now considered effective emergency contraception, don’t need back up method of, effective immediately upon insertion
Smaller IUDs - need back up!!
Back up needed after ParaGard placement?
None! Regardless of when it is placed in the menstrual cycle
MOA of ParaGard?
Inhibition of sperm migration and viability
MOA of Levonorgestrel IUD?
Inhibition of sperm migration and viability
Endometrial Suppression
Altered cervical mucus
How long is a levonorgestrel IUD good for?
Skyla (13.5 mg)- 3 years
Kyleena (19.5 mg) - 5 years
- lower rates of amenorrhea
Mirena/Liletta (52 mg) - 8 years
Contraindications to IUDs?
- Severe cavity distortion
- Known or suspected pregnancy
- Active infection/PID
- Undiagnosed vaginal bleeding
- Genital tract malignancy
- Wilson’s disease (paragard)
- Breast cancer (LNG)
- If in past 3 months: PP endometritis, septic abortion, PID
How can you be reasonably sure a woman is not pregnant?
- no intercourse since last menses
- has been on reliable birth control/using consistently
- Within 7 days of LMP
- Within 4 weeks postpartum
- Within 7 days of miscarriage
- Breastfeeding, amenorrhoeic and is less than 6 months postpartum
Additional non-contraceptive benefits to OCPs?
Regular menses
Decreased blood loss
Decreased pain
Decreased incidence of endometrial and ovarian cancer
Decreased functional ovarian cysts
Decreased benign breast disease
Treatment for Endo
Treatment for hyperandrogenism (hirsutism, acne)
What is in the O-pill?
0.075 mg norgestrel
Options for EMERGENCY contraception within 3 days of unprotected intercourse?
- Combined OCP (100 mcg estrogen, 0.5 mg levonorgestrel) x 2 doses 12 hours apart
- Plan B = levonorgestrel 1.5 mg single dose (more effective and less side effects)
Options for EMERGENCY contraception within 5 days of unprotected intercourse?
- Copper IUD
- 52 mg LNG IUD
- Ulipristal (Ella) 30 mg single dose - prevents progestin binding to receptor, delays ovulation, alters endometrium to impair implantation
What can increase a patients risk of regret following tubal ligation?
Age younger than 30
Short time between delivery and sterilization
Poor access to information about sterilization procedures and alternatives
Social factors - not partnered, children not healthy, prematurity, neonatal death
What is PMDD?
Symptoms occur during the luteal phase of menstrual cycle
Symptoms subside around, or shortly after menstrual cycle
Symptoms interfere with ability to function
Treatment for PMDD?
Exercise
Calcium supplementation
Acupuncture
SSR
CBT
OCPs
NSAIDs
GnRH
BSO (only if very refractory)
Diagnostic criteria for migraine with aura?
At least 5 attacks
Duration 4-72 hours
3 or more of the following:
- Reversible aura symptoms (usually visual, sensory or motor symptoms)
- Aura developing over > 4 mins and lasts 5-60 minus
- Headache follows aura with symptom free interval of < 60 mins
