Contraception Flashcards
Contraceptive method that prevents ovulation
COCPs
POPs
Lactational Amenorrhea
Contraceptive method that prevents sperms reaching the oocyte
Sterilization
Contraceptive method that prevents embryo implantation in the uterus
IUDs
LNG-IUS
Contraceptive method that allows sprem in the vagina but prevent further passage
Vaginal diaphragm
Cup
Contraceptive method that prevents sperm in the vagina
Condom
Contraceptive method that kills the sperm
Spermicidal agents
Medical Eligibility criteria (MEC) levels
MEC Category I - No restriction
MEC Category II - Benefits > Risk
MEC Category III - Risks > Benefits
MEC Category IV - Unacceptable health risk
What are the absolute contraindications of CHCs?
HTN
CVA
DVT
MI
BCA
Migraine w/ Aura
Age >35
Smoker
Liver tumors
Estrogen-dependent tumor
What is the MOA of CHCs?
It inhibits ovulation by stopping negative feedback (decreases FSH and LH)
CHCs different forms
Pills
Patch
Ring
Pills has
low dose estrogen and progestin
Women who get symptomatic during pill free period, what will you advise?
Take pill continuously without the 7 day pill-free period
Patch has ____________ and _______________ and used for 21 days
ethinylestradiol
norelgestromin
Where is the patch applied?
Any skin area - lower abdomen, arm, buttocks
Site CTD -Breast
Ring has _____________ and _______________
ethinylestradiol
etonorgestrel
If 1 pill is missed OR if the pill taken 24-48 hours late
Take the last missed mill
Continue the pack as usual
Leave the earlier missed pill
NO CONTRACEPTION NEEDED
If >2 pills are missed OR if pill taken >48 hours late then
Take the last missed mill
Continue the pack as usual
Leave the earlier missed pill
If 1st week → Use emergency CTC
If 2nd week → No need
If 3rd week → Directly start a new pack after the 21th pill WITHOUT 7 pill free days
If Patch is missed for ______then emergency ctc is needed
48 hours
If ring is missed for ________ then emergency ctc is needed
3 hours
Risk of venous thromboembolism is greatest during ________ year of use of COCPs
1st year
To prevent venous thromboembolism when prolonged immobility >3hrs
Exercise and Graded compression stockings
COCPs use decrease the risk of __________ cancers
Colorectal
Endometrial
Ovarian
COCP use increases the risk of ____________ cancers
Breast
Cervical
POPs are extremely safe to use if a woman has _______________ risk factors
Cardiovascular risk factors
Low dose progesterone inhibits ovulation ____________
inconsistently
POPs are ideal for a woman who ___________________
wants pills but can’t use COCPs
POPs are used in women with
Breastfeeding
Old age
CVDs
Diabetes
SCD
Disadvantages of POP
Irregular menses
Functional ovarian cysts
Breast tenderness
Mood swings
Acne
Headache
If a POP pill is missed
- take missed POP, use condom and have emergency ctc
Injectable IM
- Depo provera (medroxyprogesterone)
Injectable SC
Sayana press (medroxyprogesterone)
Progesterone injection frequency -
12-14 weeks
Injectables are a type of ________ ctc
long term
Injectables Progesterones are used to treat ______________
Dysmenorrhea or Heavy periods
Injectables have _______ return in fertility while Subdermal implants have _________ return in fertility
delayed
rapid
Injectables are not for those who wish for _________ ctc
short term
There is increased risk of HIV by using ____________
Depo provera
Subdermal implants are inserted in ____________ under LA
Non dominant arm
8cm above medial epicondyle
Nexplanon - 1 rod - _______________ - 3 yr CTC
etonorgestrel
(nExplanon - 2nd letter is E and it has 1 L in it)
Uniplant - 1 rod - ________________- 1 year CTC
nomgesterol (uNiplant - 2nd letter is N and it has 1 L in it) Uniplant - uni means 1 so single rod
Jedelle - 2 rod - _________________ - 3-5 years
Levonorgestrel (jedeLLe - it has 2 Ls and 2 Ls also mean 2 rods so it is longer)
_______________ - 1 rod - etonorgestrel - 3 yr CTC
___________- 1 rod - nomgesterol - 1 year CTC
__________ - 2 rods - levonorgesterel - 3-5 yrs CTC
Nexplanon
Uniplant
Jedelle
Subdermal implants are for those who _____________
Who forget to take pills
Progesterone releasing IUD (LNG-IUD) types
Mirena
Jaydess or Skyla
Mirena - ___ years
Jaydess/ Skyla - ____ years
Mirena - 5 years
Jaydess/ Skyla - 3 years
MOA of LNG-IUD -
Makes the endometrium unfavorable for implantation and thickens the cervical mucus
LNG-IUDs are used for tx of
HMB, dysmenorrhea, pelvic pain (endometriosis and adenomyosis) and prevents endometrial hyperplasia
Risk of teratogenicity if pregnancy occurs -
LNG-IUD
Persistent spotting and irregular bleeding when using early
LNG-IUD
IUDs are used in ___________
long term contraception where regular compliance is not needed
IUD ctc duration
3-10 years
Copper IUD used in women _________ so left in place until menopause
> 40 year
If hormone IUD is used in women __________ so left in place until menopause
> 45 year
CTD of IUD
Pregnancy, PID, Ectopic preg hx, malformation of uterus, copper allergy
IUD types
Copper IUD
Hormonal LNG-IUD
MOA of Copper IUD -
Inflty rxn around uterine lining and inhibits sperm motility
Side effects of IUD -
Increased menstrual blood loss
Increased dysmenorrhea
IUD expulsion
pregnancy (remove IUD within 12 weeks)
Pelvic infxn (Actinomyces like organism)
Uterine perforation
Positive ALO in symptomatic patients -
penicillin + remove IUD
Tx of IUD complications -
Laparoscopy
Laparotomy
IUD decrease the risk of __________________
Ectopic Pregnancy
LARC -
Cu-IUD
LNG-IUD
Progesterone Implants
____________ is the most effective contraceptive method
LARC
What is LARC
Long acting reversible contraception
Most common barrier method is ________
condom
Failure rate of condom is _________
24%
Vaginal diaphragm is placed between ________________ and ________________
the posterior vaginal fornix and the pubic symphysis
Vaginal diaphragm failure rate is _________
18%
Vaginal diaphragm has ______________ as a spermicidal agent
Nonoxynol N-9
Fitting by a trained person is required in ____________ (condom/diaphragm)
diaphragm
Diaphragm is inserted 1 hour prior to intercourse and removed after _________ hours
6 hours
Emergency CTC is AKA
morning after pill
Post coital ctc
Two types of Emergency CTC -
Hormonal and Copper bearing IUD
_______________ is the most effective emergency CTC
Copper IUD
Copper bearing IUD - MOA
inhibit implantation if fertilization has occured
Hormonal Emergency Pills - Levonorgestrel (____ hours) Ulipristal acetate (____ hours)
Levo - 96 hours
Ulipristal - 120 hours
Hormonal Emergency ctc - MOA
delay ovulation and sperms lose the ability to fertilize
Sterilization is ideal for relatively ______________________
older couples
Semen analysis should be done at ______ weeks after vasectomy to see if any sperm are still present
12
Tubal ligation is done by -
Laparoscopy, Laparotomy, Hysteroscopy
Laparotomy is done during
C-section
Laparoscopy - Under ____ Use alternative ctc unti ______________
GA
menstruation occurs
________________ is suitable for patients who cannot tolerate surgery (obese, previous surgery)
Hysteroscopy
Hysteroscopy uses ______________ and confirmed by Xray or US
Micro-inserts
What is post-tubal ligation syndrome?
Increased menstrual bleeding
What are some Miscellaneous Techniques?
Calendar method (8-18 days)
Temparature method
Lactational amenorrhea <6months