Contraception

Question 1

Mechanism of OCP

Answer 1

prevents ovulation, implantation and sperm transportation

Question 2

Factors that decrease efficacy

Answer 2

delayed initiation of method, illness, meds, lubricants

Question 3

Risks of OCP

Answer 3

VTE, breast cancer, MI, CVA

Question 4

Benefits

Answer 4

cycle regulation, reduced flow, improvement of anemia, increased BMD, reduced dysmenorrhea, reduced acne, reduced PMS, reduced hirsutism, reduced endometrial + ovarian cancer

Question 5

SE

Answer 5

irregular bleeding, nausea, wt gain, breast tenderness, headaches

Question 6

CI to OCP

Answer 6

<4w postpartum + breastfeeding or <3w postpartum
Severe liver cirrhosis or hepatocellular carcinoma
Undiagnosed Vaginal Bleeding
Estrogen Dependent Cancers (Breast/Uterus)
Thromboembolic Events/Disorders
Age >35 and Smoking
Pregnancy
Cerebrovascular Disease
Coronary Artery Disease
Migraine w/ aura
Uncontrolled Hypertension
Congenital Hypertriglyceridemia

Question 7

SE from excess estrogen

Answer 7

Nausea
Breast Tenderness/Enlargement
Weight Gain
Bloating
Edema
Migraines/Headaches
Thromboembolic Events
Menorrhagia/Spotting

Question 8

SE from excess progesterone

Answer 8

Amenorrhea
Headaches
Breast Tenderness
Weight Gain
Increased Appetite
Mood Lability
Hypertension

Question 9

SE + how to respond with estrogen, progesterone + androgen
Acne
Breakthrough bleeding
Absent menses
Depression/ mood swings
HA
Breast tenderness
Weight gain
Menstrual cramps
Endometriosis

Answer 9

Acne = higher estrogen, lower androgen
Breakthrough bleeding = higher estrogen, higher progestin, lower androgen
Absent menses = higher estrogen, lower progestin
Depression/ mood swings = lower progestin
HA = lower estrogen, lower progestin
Breast tenderness = lower estrogen, lower progestin
Weight gain = lower estrogen, lower progestin
Menstrual cramps = higher progestin
Endometriosis = lower estrogen, higher progestin, higher androgen

Question 10

Mechanism of POP

Answer 10

alters cervical mucus, partial ovulation suppression

Question 11

CI to POP

Answer 11

unexplained vaginal bleeding, breast Ca, cirrhosis, active viral hepatitis, hepatic adenoma

Question 12

Risks of POP

Answer 12

delayed fertility, reduced BMD

Question 13

Benefits of POP

Answer 13

amenorrhea, reduced risk of endometrial cancer, reduced dysmenorrhea

Question 14

SE of POP

Answer 14

menstrual disturbance, wt gain, mood

Question 15

how to manage irregular bleeding with POP

Answer 15

add NSAID, change to OCP or supplement with estrogen

Question 16

how to manage irregular bleeding with depo

Answer 16

800mg ibuprofen BID x 5/7, add OCP, TXA 500mg BID x5/7

Question 17

What to counsel pts on with depo

Answer 17

Vit D + calcium supplementation
Wt bearing exercises

Question 18

CI to IUD

Answer 18

pregnancy, PID, STI, unexplained vaginal bleeding, cervical/ endometrial cancer

Question 19

Benefits of IUD

Answer 19

reduced flow + pain, reduced endometrial cancer risk

Question 20

SE to IUD

Answer 20

irregular bleeding, pain, progesterone SE, ovarian cysts

Question 21

Risks of IUD

Answer 21

perforation, PID, expulsion, failure (ectopic)

Question 22

Emergency contraception options + when they need to be given (SE + CI)

Answer 22

Ulipristal 30mg or Levonorgestrel 1.5mg
Not effective if on day of ovulation
Within 72hrs
SE: N/V, dizziness

Copper IUD Insertion
7 days
CI: pergnancy, PID, STI
Complications: pelvic pain, perforation, bleeding, infection, expulsion