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OB/GYN > Contraception > Flashcards

Contraception Flashcards

1
Q

What are factors to consider when choosing birth control method?

A

Efficacy
Convenience
Duration of actions
Reversibility (time to return to fertility)
Effects on uterine bleeding
Side effects/adverse effects
Affordability
Protection against STDs

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2
Q

Which type of male condom is the only one that protects from HIV virus?

A

latex

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3
Q

Perfect use of male condoms has a failure rate of what percentage?

A

2%

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4
Q

Typical male condom use has a failure rate of what percentage?

A

15%

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5
Q

What combination of male contraception has the same effectiveness of OCPs?

A

Condom plus contraceptive jelly/foam

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6
Q

Thin polyurethane material with two flexible rings at each end

One ring fits deep inside the vagina while the other remains outside

A

Female condom

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7
Q

Perfect use of female condoms has a failure rate of what percentage?

A

5%

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8
Q

Typical female condom use has a failure rate of what percentage?

A

21%

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9
Q

Mechanical barrier between the vagina and the cervical canal

Dome shaped, circular ring ranging from 50-105mm

Must be fitted by a healthcare provider and requires a prescription

Spermicidal jelly or cream must be placed between this and cervix

A

Diaphragm

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10
Q

How long must a diaphragm be left in post intercourse?

A

at least 6-8 hours afterwards

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11
Q

Typical diaphragm use has a failure rate of what percentage?

A

16%

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12
Q

Perfect use of diaphragm has a failure rate of what percentage?

A

6%

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13
Q

What are the side effects of diaphragm use?

A

Bladder irritation
Toxic shock if left too long
Hypersensitivity

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14
Q

The diaphragm can be inserted up to how many hours prior to intercourse?

A

6 hours

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15
Q

Cup-like silicone diaphragm placed over the cervix with spermicidal jelly

Held in place with suction

Must fit tightly – individualization is essential (fit by a clinician)

A

Cervical Cap

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16
Q

What is the most common cause of cervical cap failure?

A

getting dislodged during intercourse

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17
Q

How long must a cervical cap be left in post intercourse?

A

left in place 8-48 hours following intercourse

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18
Q

When does a diaphragm need to be replaced?

A

replaced with weight gain (~10lbs) or every two years

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19
Q

What are some disadvantages of the cervical cap?

A

Refitting after pregnancy or weight changes

Most women have a difficult time mastering placement

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20
Q

Act by disrupting the cell membrane of the spermatozoa

Also a mechanical barrier to the cervical canal

Comes in many forms 🡪 jellies, creams, gels, foam, vaginal sponges,
suppositories

A

Spermicides

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21
Q

What is the only spermicide available in the US?

A

Nonoxynol – 9

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22
Q

Spermicides are much more effective when combined with what?

A

barrier method

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23
Q

Typical spermicide use has a failure rate of what percentage?

A

29%

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24
Q

Perfect use of spermicide has a failure rate of what percentage?

A

18%

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25
Q

This oral contraceptive can be used during breastfeeding without affecting milk supply

A

Progestin only OCP (minipill)

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26
Q

This oral contraception has a slightly higher failure rate than combination OCPs

Not as effective

A

Progestin only OCP (minipill)

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27
Q

Continuous progestin therapy will result in what for most women after a year?

A

amenorrhea

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28
Q

This oral contraceptive MUST be taken at the same time every day – no pill-free or placebo pills

Need to take at these at the same time every day preferably within the hour (within 2-3 hours caution)

A

Progestin only OCP (minipill)

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29
Q

Patients using progestive only OCP pill need to use backup protection x 48 hours when the following happens?

A

Greater than 3 hours late on taking the pill

Pill is missed

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30
Q

What are the mechanisms of action for the progestin only OCP (minipill)?

A

Cervical mucus thickens - Hampers the transport of sperm
Endometrial activity is “out of phase” - Making implantation unlikely
Only suppresses ovulation

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31
Q

What are some disadvantages of the progestin only OCP (minipill)?

A

Not as effective as combined OCPs
Higher rate of breakthrough bleeding
Need to take at same time every day
Acne
Irritability

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32
Q

What is the most popular form of contraception?

A

Combination OCPs

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33
Q

What are the two forms of combination OCPs?

A

Monophasic
Multiphasic

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34
Q

What form of combination OCP is described below?

Continuous dose of estrogen and progesterone

Typically better: more regular, less changing around the body, improves acne and period pain

A

Monophasic

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35
Q

What form of combination OCP is described below?

Varying dose

Usually lower

Triphasic – gradually increasing progesterone

A

Multiphasic

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36
Q

In combination OCPs, what is the mechanism of action of the progesterone component?

A

No rise in FSH and LH during the follicular phase, plus no inhibition of midcycle rise in FSH and LH

Thickens cervical mucus

Thins endometrial lining

Alters tubal transport of ova and sperm 🡪 suppresses tubal peristalsis

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37
Q

In combination OCPs, what is the mechanism of action of the estrogenic component?

A

Inhibit ovulation by suppressing hypothalamic release of FSH and LH

Prevents maturation of follicles

Inhibit ovum implantation

Decrease time available for fertilization

Break down the corpus luteum

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38
Q

What are the four types of OCPs?

A

21-7
24-4 (Yaz)
84-7 (Seasonique)
Continuous (Lybrel)

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39
Q

Estrogen dose in combination OCPs typically fall within this range?

A

10 to 30 micrograms

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40
Q

What is the most common estrogen dose in combination OCPs?

A

25 micrograms most common

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41
Q

In combination OCPs, which component varies the most?

A

Progesterone

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42
Q

Which progesterone is the least androgenic?

A

Norgestimate

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43
Q

Which progesterone is the most androgenic?

A

Levonesterone

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44
Q

What are some advantages of combination OCPs?

A

High efficacy
Non-contraceptive benefits

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45
Q

What are some disadvantages of combination OCPs?

A

Must be taken daily

Multiple side effects

Can put patient in a hypercoagulable state

Increased risk for Cardiovascular complications, gallbladder disease, liver disease

Low dose estrogen – breakthrough bleeding

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46
Q

What are some non-contraceptive benefits of combination OCPs?

A

Reduction in: dysmenorrhea, menorrhagia, acne, Ovarian cysts, Ovarian cancer, Endometrial cancer

Relief of: PMS, PMDD symptoms (Yaz – the only pill approved for this)

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47
Q

Yaz is the only pill approved for this

A

Relief of PMDD symptoms

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48
Q

Perfect use of combination OCPs has a failure rate of how many births?

A

1/300 births

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49
Q

Typical use of combination OCPs has a failure rate of how many births?

A

1/12 births

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50
Q

What is the plan of care if a patient misses a combination OCP?

A

If you miss one day, still protected, double up the next day

If you miss two days, not protected, and need backup protection for 7 days

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51
Q

Initiation of combination OCPs: Describe the Quick Start method

A

Start the day the Rx is given as long as pregnancy is reasonably excluded

Back up protection needed for 7 days

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52
Q

Initiation of combination OCPs: Describe the Sunday Start

A

Start the first Sunday after next period

Back up protection needed for 7 days

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53
Q

Initiation of combination oral OCPs: Describe the First Day Start

A

Start on the first day of menses

Maximum contraceptive effect 🡪 backup is not required

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54
Q

List the absolute contraindications of combination oral contraceptives?

A

Previous thromboembolic event or thrombophlebitis (DVT/PE, CVA, Afib)

Thrombogenic mutations

Known or suspected breast cancer (history of estrogen-dependent tumor)

Liver disease (metabolized in liver)

Known or suspected pregnancy

Though inadvertent use during early pregnancy has not been associated with any risk of congenital anomalies

Undiagnosed abnormal uterine bleeding

Cerebral vascular or coronary artery disease

Women over 35 who smoke (>15 cigarettes a day)

Congenital hyperlipidemia

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55
Q

List the cautions of combination oral contraceptives?

A

Women with hypertension 🡪 especially poorly controlled

Women receiving certain anticonvulsants (decreases effectiveness)

Migraine headaches (Especially classic migraines with auras, increased risk of stroke)

Diabetes mellitus (not recommended in young diabetics – can progress/worsen CAD, vasculitis)

Antibiotics (may make OCPs less effective)

Lupus (SLE)

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56
Q

5cm vaginal ring which releases a constant level of ethinyl estradiol
and etonogesterel

Designed to be left in place during intercourse

A

Nuvaring

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57
Q

How long can the Nuvaring be removed?

A

Can be taken out for up to 3 hours

58
Q

How is the Nuvaring used?

A

Ring is worn in the vaginal x 3 weeks, followed by one ring-free week

59
Q

Transdermal birth control

Applied to buttock, lower abdomen, upper outer arm

Due to elevated estrogen component, consider thromboembolic
potential of patient

Caution in women weighing over 198 pounds

A

The Patch – Ortho Evra

60
Q

How to use the Patch?

A

The patch lasts 7 days, then replaced twice

One patch weekly x 3 weeks, then one week off (when period occurs)

61
Q

What are some of the advantages of the Patch birth control?

A

Easy to use

Don’t have to remember to take daily

Just as effective as oral combo contraceptives

62
Q

What are some of the disadvantages of the Patch birth control?

A

Lower effectiveness in obesity

Skin irritation

CV events

63
Q

Medroxyprogesterone acetate (DMPA) is also called what?

A

Depo-Provera
The Depo Shot

64
Q

What is the mechanism of action of Depo-Provera?

A

Suppresses ovulation by suppressing the surge of FSH and LH

Thickens cervical mucus

Thins endometrium making it not suitable for implantation

65
Q

What is the only injectable contraceptive available in the US?

A

Depo-Provera

66
Q

What is the dose and injection schedule for Depo-Provera?

A

150mg IM q 3 months

67
Q

Depo-Provera recommends caution in adolescents – why is this?

A

It can decrease bone mineral density and their bones are still forming

68
Q

How long can a patient use Depo-Provera?

A

Can only use two years at a time – need a break

69
Q

When given on time, the theoretical failure rate of Depo-Provera is what percentage?

A

0.3%

70
Q

When given on time, the actual failure rate of Depo-Provera is what percentage?

A

3%

71
Q

What are some of the advantages of Depo-Provera birth control?

A

Easy to adhere and parent can control

Amenorrhea

Cheap

Can be used effectively

Good for a forgetful or non-compliant patient

Improves symptoms of endometriosis

Progesterone only

72
Q

What are some of the disadvantages of Depo-Provera birth control?

A

Some patients don’t like getting shots

Irregular bleeding when first starting

Weight gain

Decreased bone mineral density

Mood changes and depression

Slow return to fertility

73
Q

How long does it take to return to fertility after being on Depo-Provera birth control?

A

6-18 months

74
Q

Single rod progesterone (Etonogesterol) implant

40 x 2mm semi-rigid rod (matchstick)

A

Implanon/Nexplanon

75
Q

What is the mechanism of action for Implanon/Nexplanon?

A

Suppresses ovulation

Altered endometrium

Increases cervical mucus

76
Q

What are some of the advantages of the Implanon/Nexplanon birth control?

A

Easy to adhere and parent can control

Can be used effectively

Good for a forgetful or non-compliant patient

Progesterone only

Not associated with osteoporosis

Good for diabetics

77
Q

How long is the Implanon/Nexplanon effective?

A

Effective for three years

78
Q

What are some of the disadvantages of the Implanon/Nexplanon birth control?

A

Unscheduled bleeding

Bleeding and hematoma formation at insertion site

Headache

Weight gain (less than Depo)

Acne

Breast tenderness

Emotional lability

79
Q

What is the discontinuation rate of the Implanon/Nexplanon birth control due to unscheduled bleeding?

A

14.8% discontinuation rate in the US

80
Q

When is the Implanon/Nexplanon birth control effective after implantation?

A

Effective within 24 hours of placement

However, still recommend condoms for 3-4 weeks

81
Q

The perfect patient for this is at low risk for STI, parous, and in a
monogamous relationship

Mechanism of action not completely understood

A

IUDs

82
Q

IUDs DO NOT act as abortifacients but if you get pregnant with an
IUD your risk for spontaneous abortion goes up what percentage?

A

50%

83
Q

What are the indications for IUDs?

A

Low risk for STDs

Desire long-term, reversible contraception

84
Q

Women with what conditions for which IUD may be optimal?

A

Diabetes

Menorrhagia/dysmenorrhea

Thromboembolism

Breastfeeding

Breast cancer

Liver disease

85
Q

What are the contraindications of IUDs?

A

Pregnancy

PID (Current or within the past 3 months)

Current STDs

Puerperal or postabortion sepsis (Current or within the last 3 months)

Purulent cervicitis

Undiagnosed abnormal vaginal bleeding

Malignancy of genital tract

Uterine anomalies or fibroids distorting cavity in way incompatible to IUD insertion

Allergy to any component of the IUD or Wilson disease

86
Q

What are some issues with IUDs?

A

Risk of PID (associated with insertion, not the string)

Does not increase the risk of tubal pregnancy, but if pregnancy is
discovered while having an IUD, high risk for tubal pregnancy

Expulsion of IUD

Perforation during insertion (rare)

Migration through myometrium (very rare)

87
Q

Which type of IUD is described below?

Single rod Levonorgesterel-releasing implant

T shaped device with progestin in the middle of the main shaft of the device

Two monofilament strings are attached to the vertical arm to allow easy removal and patient to check for placement during the course of usage

Good for 5 years

A

Mirena IUD

88
Q

How long is the Mirena IUD effective?

A

Good for 5 years

89
Q

What is the expulsion rate for Mirena IUD?

A

1-5%

90
Q

What is the mechanism of action for the Mirena IUD?

A

Thickens cervical mucus 🡪 impedes sperm ascent

Alters uterotubal fluid 🡪 interfere with sperm migration

Thins endometrium 🡪 implantation unlikely

91
Q

If pregnancy was to occur, testing should be done to rule out what?

A

ectopic as 50% are in the tube

92
Q

After Mirena IUD insertion, can be accompanied by irregular bleeding for typically how long after insertion?

A

the first 3 months

93
Q

What percentage of patients with a Mirena IUD become amenorrheic?

A

20-25%

94
Q

What is the efficacy of the Mirena IUD?

A

0.2 pregnancies/100 women

95
Q

What are the advantages of the Mirena IUD?

A

Quick return to fertility

Improves spontaneity of intercourse

Decreased bleeding

Can be used as a treatment option for menorrhagia

96
Q

What are the disadvantages of the Mirena IUD?

A

High initial cost

Requires office procedure for insertion

Risk of ectopic pregnancy if do become pregnant on IUD

97
Q

T380A

Copper IUD – containing 380mm² of copper attached to the arms and
wound around the body

Two monofilament strings are attached to the vertical arm to allow easy removal and patient to check for placement during the course of usage

A

Paragard IUD

98
Q

The Paragard IUD is approved for up to how long?

A

Approved for up to 10 years

99
Q

Which IUD can be used as emergency contraceptive if placed within 72 hours of unprotected sex?

A

Paragard IUD

100
Q

How soon after birth can the Paragard IUD be placed?

A

Placement typically done at the 6 week post partum visit but can be
placed within 10 minutes of delivery of placenta

101
Q

What is the mechanism of action of the Paragard IUD?

A

Interference with ova fertilization or implantation

Activity on the endometrium that may promote phagocytosis of sperm
(promotes inflammation)

102
Q

What is the efficacy of the Paragard IUD?

A

0.5-0.8 pregnancies per 100 women

103
Q

What are the advantages of the Paragard IUD?

A

Duration of usage

Can be used as emergent contraception

Option for patients who have difficulty with hormonal-based contraception

104
Q

What are the disadvantages of the Paragard IUD?

A

High initial cost

Office procedure for insertion

Does not help with bleeding issues

May increase dysmenorrhea

5-10% have increased bleeding

105
Q

Mirena strings should be cut longer than Paragard strings. Why is this?

A

Mirena pulls itself higher into the uterine cavity

106
Q

Therapy to reduce high rates of unintended pregnancy and abortion
after unprotected intercourse or after a failure of a contraceptive
barrier method

A

Emergency Contraception

107
Q

What is the efficacy of emergency contraception?

A

Reduce number of pregnancies by at least 75%

108
Q

Which emergency contraception is described below?

1500 ug levonorgestrel

Alters tubal transport of ova and/or sperm preventing ovulation or
fertilization, alter endometrium possibly preventing implantation

Does NOT terminate an existing pregnancy

Must be given within 72 hours

A

Plan B One Step

109
Q

What is the failure rate of the emergency contraceptive Plan B One Step?

A

Failure rate of 11%

110
Q

What is the most common side effect of Plan B One Step?

A

nausea and vomiting

111
Q

What is the time frame in which Plan B One Step must be taken?

A

within 72 hours

112
Q

What is the failure rate of the emergency contraceptive Paragard IUD?

A

Failure rate 0.1%

113
Q

What is the time frame in which Paragard IUD must be inserted for emergency contraception?

A

May be inserted within 7 days

114
Q

What is the time frame in which the emergency contraceptive Ulipristal (Ella) must be taken?

A

Must be used within 5 days

115
Q

What is the mechanism of action of the emergency contraceptive Ulipristal (Ella)?

A

Classified as a SPRM

Essentially causes delay in ovulation

116
Q

Used for 1st trimester abortion in the US

Not available in the US as a form of emergency contraceptive though
trails suggest 99% effectiveness rate

A

Mifepristone (RU 486)

117
Q

What is the mechanism of action of lactation as a contraceptive?

A

Women who breastfeed have a delay in resumption of ovulation
postpartum due to prolactin-induced inhibition of pulsatile GnRH

118
Q

To make lactation an option for contraception, what conditions must be met?

A

Breastfeeding should be all that the infant receives

you have to do it continuously in order for prolactin levels to remain elevated

119
Q

Why is lactation as a form of contraception troublesome?

A

May be anovulatory for up to six months post partum

Ovulation can occur as early as five weeks post partum

Important – ovulation return occurs before return of menses!

120
Q

Periodic abstinence

Coitus is avoided during the time of the cycle when a fertilizable ovum and motile sperm could meet in the oviduct

Accurate predictions of ovulation are essential

A

Natural Family Planning

121
Q

In order for Natural Family Planning to be an option, what condition must be met?

A

Women must have regular clockwork menses

122
Q

What percentage of fertile women have enough variability in their cycle to make reliable predictions unlikely in natural family planning?

A

20%

123
Q

Which method is the least reliable method of natural family planning?

A

Calendar Method

124
Q

What are the failure rates of the calendar method?

A

failure rates of 5-35%

125
Q

Which method of natural family planning is described below?

Evidence of ovulation is obtained by taking first morning basal body
temperature vaginally or rectally and charting the value

A

Temperature Method (natural family planning)

126
Q

With ovulation, the temperature abruptly rises how many degrees and remains at that plateau until menses?

A

0.5-1.0 F

127
Q

Which day following temperature rise is considered the end of the fertile period?

A

the third day

128
Q

Which method of natural family planning is described below?

Evaluated daily

Uses changes in cervical mucus secretions as affected by hormonal changes to predict ovulation

A

Cervical Mucus Method

129
Q

Which method of natural family planning is described below?

Tracking fertility by counting days

Ovulation ordinarily occurs 14 days before the first day of the next menstrual cycle

Luteal phase is a relatively constant 14 days for normal women

Requires regular monthly intervals between menses

Fertile interval lasts from days 10-17

A

Calendar Method

130
Q

Several days prior to ovulation, mucus becomes what consistency?

A

thin and watery
“egg white” consistency

131
Q

What is the major disadvantage of the cervical mucus method?

A

Difficulty in interpreting changes

132
Q

Which method of natural family planning is described below?

Measure urine LH daily

Typically start around day 10 and look for spike in LH

Turns positive just like a urine pregnancy test

A

Ovulation Predictor Kit

133
Q

What are the disadvantages of the Ovulation Predictor Kit?

A

Expensive and impractical for birth control

134
Q

When is the Ovulation Predictor Kit the most useful?

A

Useful in infertility

135
Q

What is the failure rate of female sterilization?

A

0.4%-1.8% failure rate

136
Q

Which type of female sterilization is described below?

Small metallic implant placed into the fallopian tubes

Induces scar tissue to form over implant, blocking the tubes

A

Essure (non-surgical)

137
Q

How long does it take for Essure to become effective?

A

Takes 3 months to scar down

138
Q

Essure carries a high incidence of what if they become pregnant?

A

ectopic pregnancies

139
Q

If the Essure fails, what is the next step?

A

If it fails, usually go ahead and do tubal ligation

140
Q

Which type of female sterilization is described below?

Outpatient surgery done under local or general anesthesia

Effective immediately

Not quite permanent, but reversal rates are poor

A

Bilateral Tubal Ligation

141
Q

Bilateral Tubal Ligation carries a high incidence of what if they become pregnant?

A

ectopic pregnancies

OB/GYN (14 decks)

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