Contraception

Question 1

The Choice of Contraception Method
Depends On

Answer 1

• Importance of not being pregnant
• Age
• Adverse effects
• Concomitant drug use
• Health status
• Patient preference
• Ability to adhere
• Cost

Question 1

CHCs Drug Interactions

Answer 1

any drug that increases liver microsomal enzyme activity such as phenobarbital, phenytoin, griseofulvin, and rifampin.

Question 2

Factors for consideration of Pill Versus Other Progestin-Only Methods

Answer 2

Efficacy:
2. Dosing frequency and convenience:
3. Resumption of fertility
4. Need for procedure:

Question 3

If a patient is going to be receiving an interacting medication for more than 2 months, switch to

Answer 3

(DMPA) or an IUD
to avoid the interaction

Question 4

Treatment of mild vaginal symptoms

Answer 4

nonhormonal lubricants and moisturizers

Question 5

Side effects of POPS

Answer 5

• Irregular menses
• Ectopic pregnancy
• Acne
• Headache
• Nausea
• Libido changes.

Question 5

A variety of progestin-only contraceptive methods exists

Answer 5

There are two progestin-only oral products available, norethindrone
“mini-pills” and drospirenone ”Slynd”.
* Etonogestrel subdermal implant.
* Levonorgestrel-releasing intrauterine devices (IUDs)
* Depot medroxyprogesterone acetate (DMPA) IM, SC injections

Question 6

For individuals who cannot or prefer not to use estrogen-containing
contraception

Answer 6

estrogen-related side effects, hypertensive or
diabetic patients, smokers, older than 35, breastfeeding mothers, and
patient with history of DVT or CV complications)

Question 7

Treatment of moderate to severe menopausal genitourinary syndrome

Answer 7

low-dose vaginal estrogen (topical) rather than systemic estrogen.

Question 8

POPs need to be taken
injection
etonogestrel implant
levonorgestrel-releasing IUDs

Answer 8

daily and, ideally, at the same time of day
every 12-14 week
three to five years
three to six years

Question 8

associated with a rapid return of fertility after method discontinuation (typically within one cycle)

Answer 8

POPs, the etonogestrel implant, and IUDs

Question 9

Progestins provide most of the contraceptive effect by?

Answer 9

thickening cervical mucus to prevent sperm penetration, slowing tubal motility, delaying sperm transport, and inducing endometrial atrophy.

Progestins block the LH flow, to inhibit ovulation.
* Estrogens suppress FSH release from the pituitary, which may
contribute to blocking the LH flow to prevent ovulation.

Question 10

The return of fertility with the ——-injection may take 6-12
months.

Answer 10

DMPA

Question 11

The estrogen component in most combined hormonal contraceptives is

Answer 11

ethinyl estradiol

Question 12

COCS Contraindications

Answer 12

• Age ≥35 years
• Smoking ≥15 cigarettes per day
• Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
• Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
• Venous thromboembolism
• Known ischemic heart disease
• History of stroke
• Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
• Current breast cancer
• Severe (decompensated) cirrhosis
• Hepatocellular adenoma or malignant hepatoma
• Diabetes mellitus of >20 years duration or with nephropathy,
  retinopathy, or neuropathy

Question 13

Contraindications of POPS

Answer 13

• Known or suspected breast cancer.
• Undiagnosed abnormal uterine bleeding.

Question 13

Oral Progestin Only Tablets Drug Interactions

Answer 13

Medications that induce the P450
phenytoin, carbamazepine, oxcarbazepine, primidone, topiramate,
protease inhibitors, and St. John’s wort

increase potassium levels;
ACE inhibitors, potassium-sparing diuretics, and high-dose ibuprofen
contraindicate with drospirenone

Question 14

Risk of CHCS

Answer 14

• Increased blood pressure
• Increased risk for stroke and MI (especially if smokers and older than 35)
• Increased risk of thromboembolic disorders
• Increased risk of glucose intolerance
• Increased risk of gallbladder disease

Question 15

CHCs Common Side Effects

Answer 15

irregular bleeding
breast tenderness,

Question 16

Benefits of CHCS

Answer 16

• Very effective when used correctly
• Reduction ectopic pregnancy
• Reduction in symptoms associated with premenstrual syndrome
• Reduction breast disease
• Reduction in the development of new ovarian cysts
• Reduction in ovarian cancer
• Reduction in endometrial cancer
• Reduction acne
• Reduction hirsutism
• More regular menstrual cycles
• Fertility returns soon after stopping.

Question 17

For moderate to severe hot flashes

Answer 17

systemic estrogen is required

Question 18

estrogen/bazedoxifene) to prevent endometrial hyperplasia.

Answer 18

to prevent endometrial hyperplasia.

Question 19

Alternatives to estrogen for treatment of hot flashes include selective
serotonin reuptake inhibitors

Answer 19

aroxetine, fluoxetine, citalopram,
escitalopram), dual serotonin and norepinephrine reuptake inhibitors
(eg, venlafaxine, desvenlafaxine), clonidine, gabapentin, and pregabalin.

Question 20

In those who have undergone hysterectomy, estrogen therapy is given as

Answer 20

monotherapy