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MI Internal Medicine and Infectious Disease > Contraception > Flashcards

Contraception Flashcards

1
Q

Phases of ovarian cycle + day ranges

A

Follicular (0-13)

Luteal (14-28)

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2
Q

Phases of uterine cycle + typical day range

A

Menses (0-6)
Proliferative (7-13)
Secretory (14-28)

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3
Q

Cycles of the menstrual cycle

A

Ovarian cycle

Uterine cycle

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4
Q

Steroid hormones of the ovarian cycle

A

Estrogen
Inhibin
Activin
Progesterone

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5
Q

Gonadotropins of the ovarian cycle

A 
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
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6
Q

Inhibin function in ovarian cycle

A

FSH suppression

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7
Q

Activin function in ovarian cycle

A

Enhances ovarian follicle FSH binding

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8
Q

Estrogen function in ovarian cycle

A

Ovarian follicle maturation; gonadotropin regulation

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9
Q

Progesterone function in ovarian cycle

A

Converts endometrium to secretory phase for implantation

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10
Q

Precipitant of normal menstrual bleeding

A

Progesterone-withdrawal

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11
Q

Inhibits uterine smooth muscle contractions (i.e. prevents preterm labor)

A

Progesterone

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12
Q

Inhibits preterm lactation

A

Progesterone

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13
Q

Fertile period (typical)

A

days 12-17

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14
Q

Endometrial thickening period (typical)

A

days 7-13

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15
Q

Endometrial slough period (typical)

A

days 0-6

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16
Q

Endometrial implantation and mucus thickening period (typical)

A

days 14-28

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17
Q

Ethinyl estradiol (EE)

A

Synthetic estrogen

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18
Q

Ethinyl group in ethinyl estradiol (EE)

A

Orally active

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19
Q

Estradiol valerate (EV)

A

Naturally occurring estrogen

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20
Q

Progestin

A

Synthetic progesterone

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21
Q

Progestin types

A

Levonogestrel
Drospirenone
Norethindrone

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22
Q

Progestin contraceptive mechanism

A 
Thickens cervical mucus 
Inhibit ovulation 
Thin endometrium
HPO axis interruption
Inhibits sperm capacitación
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23
Q

Progestin secondary effects

A

Reduced/eliminated menses, BP elevation, mood swings, depression, weight gain, increased appetite, fatigue, tender breasts, acne, hirsutism, nausea

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24
Q

Most prescribed progestin

A

Levonogestrel

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25
Q

Combined hormonal contraceptive (CHC) formats

A

Pill
Ring
Patch

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26
Q

CHC hormones

A

Estrogen

Progestin

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27
Q

CHC duration

A

Short-acting

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28
Q

Minipill

A

Progestin-only pill (POP)

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29
Q

Number of active/inactive pills in conventional COC packs

A

21 active / 7 inactive (28)

24 active / 4 inactive (28)

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30
Q

Bleeding period on convetional COC

A

Inactive pills

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31
Q

Number of active/inactive pills in extended cycle COC packs

A

84 active / 7 inactive (91)

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32
Q

Bleeding period on extended cycle COC

A

Inactive pills

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33
Q

Amethyst continuous COC pill hormones

A

Levonogestrel

Ethinyl estradiol

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34
Q

Number of active/inactive pills in continuous COC packs

A

365 active / 0 inactive

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35
Q

Continuous COC trade name

A

Amethyst

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36
Q

Bleeding period on continuous COC

A

Amenorrhea

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37
Q

Monophasic COC

A

Estrogen and progestin levels remain constant across follicular and luteal phases

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38
Q

Multiphasic COC

A

Estrogen and progestin levels vary by phase

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39
Q

First-year failure rate COC

A

3%

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40
Q

First-year failure rate COC < 22 years

A

4.7%

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41
Q

Gonadotropin(s) suppressed by estrogen

A 
Follicle stimulating hormone (FSH)
Luteinizing hormone (LH)
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42
Q

Number of annual menstrual bleeds on extended cycle COC packs

A

4x/year

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43
Q

Excessive estrogenic effects

A 
Dysmenorrhea
Nausea
Chloasma
CVA
DVT
VTE
PE
Telangectasias
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44
Q

Benefits of combined contraception

A 
Decreased cramping, pain
Oligo or amenorrhea 
Improved acne
Ovarian, endometrial cancer prevention
Reduced risk of ectopic pregnancy, ovarian cysts, endometriosis
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45
Q

Contraceptive ring trade name

A

NuvaRing

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46
Q

NuvaRing hormones

A

EE + etonogestrel

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47
Q

NuvaRing change interval

A

21 days/3 weeks, leave out for 1 week, replace

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48
Q

NuvaRing falls out

A

> 3 hours use backup contraception

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49
Q

CHC hormone responsible for most FSH suppression

A

Estrogen&raquo_space; progestin

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50
Q

COC contraindications

A

Progestin contraindications +
≥35 years, ≥15 cigarettes/day
HTN ≥160/100 (≥140/90, relative)
Thromboembolic d/o w/o anticoag

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51
Q

CHC hormone responsible for most FSH suppression

A

Estrogen&raquo_space; progestin

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52
Q

CHC hormone responsible for most FSH suppression

A

Estrogen&raquo_space; progestin

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53
Q

CHC hormone responsible for most FSH suppression

A

Estrogen&raquo_space; progestin

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54
Q

Contraception patch trade name

A

Xulane

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55
Q

Xulane hormones

A

EE + norelgestromin

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56
Q

Xulane failure rate

A

< 1 - 2%

57
Q

Xulane regimen

A

3 weeks on 1 week off (set change day)

58
Q

Xulane change interval

A

Once weekly

59
Q

Xulane contraindication

A

Same as COC
BMI ≥30
Certain HCV regimens

60
Q

Xulane detachment

A

> 24 hours back up method x 7 days

61
Q

Xulane placement

A

Not on the breasts

62
Q

Depo-Provera (DMPA) hormones

A

progestin only

63
Q

DMPA failure rate

A

< 1%

64
Q

DMPA time to return to fertility

A

1 year

65
Q

DMPA regimen interval

A

3 months

66
Q

DMPA PID, endometrial, cervical CA risk

A

Reduced risk

67
Q

DMPA long term risk

A

Bone density, lower HDL

68
Q

DMPA contraindications

A

Allergy
Abnormal uterine bleeding, undiagnosed
Pregnancy

69
Q

DMPA grace period

A

2 weeks

70
Q

DMPA back up method

A

1st 2 weeks after injection unless admin by DOC 5

71
Q

Contraceptive implant trade name

A

Nexplanon

72
Q

Nexplanon failure rate

A

0.01%

73
Q

Nexplanon hormone

A

Progestin

74
Q

Nexplanon regimen interval

A

3 years

75
Q

Nexplanon advantages

A 
LARC
No EE side effects
Few systemic SE
Scant/absent menses
Less anemia
Lower r/o endometrial CA
76
Q

Hormone IUD trade name

A

Mirena (most common)

77
Q

Non-hormone IUD trade name

A

ParaGard

78
Q

ParaGard MOA

A

Copper ions sterile inflammatory reaction toxic to sperm ova and impairs implantation

79
Q

Mirena MOA

A

LNg has progestin effects

80
Q

Mirena regimen interval

A

5 years

81
Q

ParaGard regimen interval

A

10-12 years

82
Q

LNg/Cu IUD contraindications

A 
Active pelvic infection (impedes resolution)
Severe structural abnormality
Pregnancy*
Cu allergy
Wilson's disease
Abnormal uterine bleeding, undiagnosed
83
Q

ParaGard noncontraceptive benefits

A

Continued menstrual cycle (b/c nonhormonal)
Reduced r/f cervical CA
Possible reduced r/f endometrial CA

84
Q

Mirena (etc) noncontraceptive benefits

A

Reduced menorrhagia, anemia, dysmenorrhea
Reduced endometriosis pain, hyperplasia
Reduced r/f PID, cervical/ovarian/endometrial CA

85
Q

ParaGard bleeding effects

A

Heavier, crampier bleeding first 6 months

86
Q

Mirena (etc) bleeding effects

A

Irregular, longer, or reduced bleeding first 6 months, increasing amenorrhea over years of use

87
Q

IUD danger signs

A

Abdominal pain, dyspareunia, fever, chills

88
Q

Diaphragm fit

A

Refit +/- 20 lbs or use universal diaphragm

89
Q

Diaphragm adjunct

A

spermicide should be used

90
Q

Diaphragm failure rate

A

18% (with spermicide!!)

91
Q

Diaphragm STD protection

A

physical barrier and spermicide provide protection

92
Q

Diaphragm contraindication

A

Occupied vaginal canal (tampon)

93
Q

Diaphragm proper use

A

Leave in 6 hours postcoitus

94
Q

Diaphragm continued use

A

Do not remove, instill more spermicide into vagina

95
Q

Vaginal sponge trade name

A

Today Sponge

96
Q

Today Sponge MOA

A

Physical barrier and spermicide

97
Q

Today Sponge pregnancy rate nulliparous

A

12%

98
Q

Today Sponge pregnancy rate multiparous

A

24%

99
Q

Today Sponge risk factor

A

Breaks apart, TSS (rare)

100
Q

Today Sponge proper insertion

A

Premoisten w/2 tbsp H2O to activate spermicide, insert to fully cover cervix

101
Q

Today Sponge interval/timeframe

A

Max 30 hours, 24 hours in advance, 6 hours postcoitus

102
Q

Today Sponge lifespan

A

Single use!

103
Q

Penile condom failure rate

A

12%/year

104
Q

Inserted condom failure rate

A

21%/year

105
Q

Emergency contraception (EC) hormone

A

LNg

106
Q

Hormonal EC trade name

A

Plan B, One Step, etc

107
Q

Hormonal EC timeframe

A

Earlier the better, 72 hours optimal, 120 hours (5 days) max

108
Q

Ella EC active ingredient

A

Ulipristal acetate

109
Q

Hormonal EC benefit

A

OTC

110
Q

Ella EC timeframe

A

Equal efficacy within 120 hours / 5 days

111
Q

IUD EC

A

ParaGard / Cu IUD

112
Q

ParaGard EC timeframe

A

120 hours / 5 days

113
Q

LNg EC effectiveness

A

≥89% within 72 hours

114
Q

ParaGard / Cu IUD EC effectiveness

A

≥99%

115
Q

Hormonal EC side effects

A

N/V/f/HA/dizziness/diarrhea/breast tenderness/edema/irregular menses

116
Q

Vasectomy failure rate

A

1:400

117
Q

Tubal ligation failure rate

A

1:600

118
Q

Family planning failure rate

A

20%/year

119
Q

Calendar method step 1

A

Record serial cycles x 6 months longest/shortest cycles

Mark day 1 of period then count days between day 1 of ea period

120
Q

Calendar method NOT appropriate

A

All cycles <27 days

121
Q

Calendar method step 2

A

Determine fertile period subtract 18 from shortest cycle (earliest day of fertility) and 11 from longest cycle (latest day of fertility)

122
Q

Calendar method Ex.: if shortest cycle = 26 days

A

26 - 18 = 8, if day 1 was on the 4th, then mark 11th as first fertile day

123
Q

Calendar method Ex.: if longest cycle = 30 days

A

30 - 11 = 19, if day 1 was on the 4th, then mark 22nd as last fertile day

124
Q

Calendar method principle

A

Abstain during calculated fertile period

125
Q

Basal body temp method step 1

A

Record BBT before getting out of bed daily x 3-4 months

126
Q

Basal body temp method step 2

A

Identify BBT drop, identify BBT rise

127
Q

Basal body temp method principle

A

Abstain 2-3 days prior to expected BBT drop and 3 days following BBT rise

128
Q

Basal body temp ____ ovulation

A

drops 12-24 hours before

129
Q

Basal body temp rises ____ ovulation

A

after (d/t progesterone)

130
Q

Billings test method

A

Cervical mucus test

131
Q

Billings test method step 1

A

Record changes in mucus 3-4 months noticing change in quality

132
Q

Billings test mucus quality

A

from scant and thick to thin with increasing Spinnbarkeit

133
Q

Billings test method (Spinnbarkeit defined)

A

stringy ellastic cervical mucus indicating fertility

134
Q

Billings test method step 2

A

Abstain from mucus change to 4 days after (mucus will return to thick, scant state)

135
Q

TwoDay method

A

Variation of Billings test, check mucus ≥BID, presence of mucus yesterday + today = fertile; dry/no mucus = less fertile

136
Q

Symptothermal method

A

Basal body temp method + Billings test method

137
Q

Lactation method

A

Postpartum, rely on breastfeeding to delay ovulation for up to 6 months

138
Q

Family planning method limitations

A

No STI/HIV protection
High failure rate, requires accuracy
No sex for ~25% of month

MI Internal Medicine and Infectious Disease (35 decks)

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