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Women's Health Exam 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the most common contraindications to prescribing OCP?

A
  • HTN
  • smoker
  • age
  • hx of migraines with aura
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2
Q

Use of the USMLE Medical Eligibility Criteria for Contraceptive Use

A

Helps determine which birth control is right for individual pt factors; Counsel pt and make decision together.

Grade 1: no restrictions
Grade 2: benefits generally outweigh risks
Grade 3: risks usually outweigh benefits
Grade 4: risk too high, do not use

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3
Q

Pros of OCPs?

A
  • regulate menses
  • decrease heavy bleeding/cramps
  • decrease ovarian cyst formation
  • decrease acne
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4
Q

Cons of OCPs?

A
  • sore breasts
  • nausea
  • spotting
  • decreased sex drive
  • slight increased risk of DVT (but risk is higher with pregnancy)
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5
Q

Efficacy of OCPs?

A

perfect use = 99.7% effective

typical use = 93% effective

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6
Q

Two types of progestin-only pills and their pros/cons

A
  • Micronor (norethindrone): 28 active pills; higher likelihood of irregular bleeding
  • Slynd (drospirenone): 24 active pills, 4 inert pills; lesser likelihood of irregular bleeding
  • compared to combo pills, POPs still have higher risk of irregular bleeding.
  • ovulation is not consistently suppressed and about half still ovulate
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7
Q

How do progestin-only pills work?

A

thicken cervical mucus, inhibit sperm migration, suppress ovulation

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8
Q

Combined pill MOAs? (5)

A
  • suppress ovulation by inhibiting GnRH and LH/FSH, preventing folliculogenesis
  • stabilize endometrium production to maintain a regular withdrawal bleeding pattern (cycle control)
  • thickens cervical mucus
  • impairs normal tubal motility and peristalsis
  • endometrial decidualization and eventual atrophy
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9
Q

Combined pill dosing

A
  • ethinyl estradiol dose is most commonly 20mcg/day or 35mcg/day
  • 8 different progestins available
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10
Q

monophasic vs biphasic vs triphasic vs continuous combined pills

A
  • monophasic: same does x3wks, then 1 placebo wk
  • biphasic: lower ratio of E/P dudring first 2wks, then higher dose during last 2 wks of cycle
  • triphasic: dose changes q 7days
  • continuous: same dose daily (for 91 day cycle or 365 days)

No pill is superior to another; all equally efficacious

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11
Q

what is the biggest disadvantage of continuous pills?

A

unpredictable bleeding or spotting are more frequent due to atrophic, thin endometrium (thus, some extended cycle regimens have 7 days breaks q 84days to decrease breakthrough bleeding)

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12
Q

examples of continous/extended pills available

A
  • Seasonique/Lo Seasonique (91 day cycle)
  • Amethyst/Lybrel (365 day use)
  • technically could use any OCP continuously and skip placebos
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13
Q

How do you pick the right pill for your pt?

A
  • consider pt’s goals and side effects
  • consider pt’s PMHx
  • discuss bleeding pattern variation of the different pill types (more likely to have breathru bleed w/ lower dose hormones and continuous pills)
  • dosing will change if pt misses a pill, dependent on type of pill
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14
Q

The Patch (aka OrthoEvra) - dosing and usage info

A

150mcg norelgestromin/20mcg ethinyl estradiol qd

  • changed weekly x3 weeks, and off for 1wk. use in different areas to decrease skin irritation.
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15
Q

The Ring - Nuva Ring (dose and usage)

A

0.120mg etonogestrel/0.015mg ethinyl estradiol qd.

lasts up to 5wks (typical use is place for 3wks and remove for 1wk)

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16
Q

The Ring - Annovera (dose and usage)

A

0.15mg segesterone acetate/0.013mg ethinyl estradiol qd.

lasts for 1yr (place for 3 wks and remove for 1wk)

17
Q

Depo Provera shot

A

-injectable depot medroxyprogesterone acetate (progestin-only)
- two forms - subQ injection or IM injection
- given q 13wks (3 months)
- self administration has been effective with higher rates of continuation

18
Q

Pros of depo provera?

A
  • less blood loss/anemia, fewer corpus luteum cysts
  • decreases cramps, pain, ovulation pain
  • improvement in endometriosis
  • decreased seizures frequency
19
Q

Cons of depo provera?

A
  • progressive weight gain possible
  • irregular bleeding
  • frequency of return visits
  • slow return to baseline fertility (10 months)
  • may cause loss of bone mineral density
20
Q

Nexplanon implant (hormone, duration of use, efficacy)

A
  • etonogestrel (progestin only) implant placed in inner upper arm.
  • 3 yrs of use
  • 99.95% effective; has lower failure rate than a tubal ligation
21
Q

MOA of Nexplanon implant?

A

works by changing cervical mucus and decreasing tubal motility and inhibits gonadotropin secretion

22
Q

most common side effect of nexplanon implant?

A
  • changes in bleeding pattern/spotting; also most common reason for discontinuation
    -(there have been some cases of the device migrating to lungs)
23
Q

Ernst Grafenburg tested IUDs made of _______ because he believed it ___________. What was the problem with the design?

A

tested silk/silver intrauterine rings;
believed it prevented blastocyst formation.
Problem was difficulty removing the ring without a string attached.

24
Q

in 1969, Howard Tatum worked to do what with IUDs?

A
  • improve side effects and decrease size of IUD
  • minimize expulsion rates
  • developed the ‘T’ shape
  • added copper wire
25
Q

who developed the ‘T’ shape IUD and added a copper wire?

A

Howard Tatum in 1969

26
Q

in 1970, Dr. Antonio Scommegna devised what kind of IUD?

A

a ‘T’ shaped device using progesterone in a semi-permeable capsule

27
Q

what was the Dalkon shield?

A

IUD with soft sheath, thick woven nylon filaments. But had ill-designed removal string that increased PID, sepsis, and infertility.

28
Q

Paragard IUD (approved duration, MOA, pros/cons)

A
  • approved for 10 yrs
  • 99% effective
  • works primarily as spermicide where copper inhibits sperm motility and acrosomal enzyme reaction
  • prevents implantation
  • NO HORMONES
  • pro: effective, easy to use
  • con: heavier menstrual cycles
29
Q

which IUD on the market is approved for abnormal uterine bleeding?

A

Mirena/Liletta IUD

30
Q

Mirena/Liletta IUD (hormone, approved duration, MOA)

A
  • levonorgestrol (progestin-only)
  • approved for 8 yrs (5yrs for AUB)
  • thickens cervical mucus and prevents implantation by altering endometrium
  • changes uterotubal fluid impairs sperm/ovum migration
31
Q

Pros/Cons of Mirena/Liletta IUD

A

pros: decreased bleeding with menstrual cycles*, approved for AUB, 20% amenorrhea rate at 1yr, may reduce risk of cervical/ovarian cancer

cons: irregular bleeding/spotting for 3-6months; risk of expulsion 3-6% in first yr; possible malposition or uterine perforation

32
Q

contraindications to IUD

A
  • anatomic abnormality of uterus
  • pregnancy***
  • current PID or recent postpartum endometritis
  • vaginal bleeding of unknown cause
  • GYN malignancy
33
Q

Skyla and Kyleena IUDs

A
  • smaller and have less hormone than Mirena IUD
    (thus, less hormone = less rates of amenorrhea(
  • last for fewer years (5yr and 3yr)
  • similar side effects to Mirena but NOT approved for AUB

Women's Health Exam 2 (7 decks)

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