Contraception Flashcards
What are the phases of the menstrual cycle?
- Follicular phase
- Ovulation
- Luteal phase
- Menses
The menstrual cycle is a recurring series of physiological changes that prepare the body for potential pregnancy.
What are the factors to consider when selecting contraception?
- Effectiveness (Theoretical, Actual)
- Importance of not being pregnant
- Likelihood and ability to adhere
- Frequency of intercourse
- Age may affect adherence or adverse effect risks
- Cost and ability to pay
- Adverse effects
- Perceptions, misperceptions, risk-benefit
- Concomitant drug use
- Health status and habits
- Patient preference
- Cultural preferences
- Religious influences
These factors help patients and healthcare providers make informed choices about contraceptive methods.
What are some methods of birth control?
- Abstinence
- Male or female sterilization
- Natural family planning
- Spermicides
- Barrier methods (e.g., diaphragm, condom, female condom, sponge)
- Hormonal contraception (e.g., combined contraceptives, progestin-only)
- Intrauterine device (IUD) or intrauterine system (IUS)
- Lactic acid, citric acid, and potassium bitartrate vaginal gel
- Emergency contraception
Each method has its own mechanism of action and suitability depending on individual circumstances.
What are the indications for combined hormonal contraceptives?
- Prevent pregnancy
- Acne
- Premenstrual dysphoric disorder
These uses are FDA-approved and indicate the versatility of hormonal contraceptives.
What are the types of estrogens available in contraceptive products?
- Ethinyl estradiol
- Estradiol valerate
- Estetrol
- Mestranol
These estrogens are used in various contraceptive methods to achieve desired effects.
What are some adverse effects attributed to estrogen?
- Nausea, vomiting
- Bloating, edema
- Irritability
- Cyclic weight gain
- Cyclic headache
- Hypertension
- Breast fullness, tenderness
Understanding these side effects can help manage patient expectations and treatment plans.
What are the pharmacologic actions of estrogen in contraceptives?
- Feeds back to the pituitary, inhibiting FSH and ovulation
- Increases aldosterone concentrations, resulting in increased sodium and water retention
- Increases sex hormone-binding globulin, which may result in clearing up hormone-mediated acne and hirsutism
These actions are crucial for the contraceptive efficacy of estrogen-containing methods.
What are the types of progestins available in contraceptive products?
- Norethindrone
- Norethindrone acetate
- Ethynodiol diacetate
- Norgestrel
- Levonorgestrel
- Desogestrel
- Norgestimate
- Etonogestrel
- Drospirenone
- Dienogest
- Segesterone acetate
Progestins play a significant role in contraceptive effectiveness and can have varying side effects.
What are some adverse effects caused by progestin?
- Headaches
- Increased appetite
- Increased weight gain
- Depression, fatigue
- Changes in libido
- Androgenic adverse effects (e.g., hair loss, hirsutism, acne)
Awareness of these effects is important for patient counseling and management.
What are category 4 contraindications for combined hormonal contraceptives?
- Less than 21 days postpartum for women with no risk factors for DVT
- Smoker (15 cigarettes or more per day) and/or 35 and older
- Blood pressure greater than 160/100 mm Hg
- Vascular disease
- Current DVT or pulmonary embolism or history of DVT or pulmonary embolism
- Complicated diabetes showing nephropathy, neuropathy, or retinopathy
- Major surgery with prolonged immobilization
- Known thrombogenic mutations
- Current or history of ischemic heart disease
- Stroke (history of cerebrovascular accident)
- Migraine headache with aura
- Current breast cancer
- Systemic lupus erythematosus with positive or unknown antiphospholipid antibodies
These contraindications highlight patients who should avoid combined hormonal contraceptives due to increased health risks.
What are the common drug interactions with hormonal contraception?
- Broad-spectrum antibiotics
- Other antibiotics (e.g., tetracycline, minocycline, erythromycin, penicillins, cephalosporins)
While broad-spectrum antibiotics generally do not require alternative contraception, caution is advised with other antibiotics.
What are the proposed mechanisms of drug interactions with hormonal contraceptives?
- Interference of absorption
- Liver enzyme induction (e.g., rifampin and griseofulvin)
Understanding these mechanisms is critical for managing contraceptive effectiveness during concurrent medication use.
What are the advantages of combined oral contraceptives (COCs)?
- Effective
- Easy to use
- Reversible
- Regular menstrual cycle
- Reduction of several cancers
These advantages contribute to the popularity of COCs among various contraceptive options.
What are the disadvantages of combined oral contraceptives (COCs)?
- No HIV or STI protection
- Patient adherence
- Expensive
- Adverse effects
These disadvantages must be communicated to patients when discussing contraceptive options.
What are the advantages of combined oral
contraceptive methods?
- Effective
- Easy to use
- Reversible
- Regular menstrual cycle
- Reduction of several cancers
- Decreased risk of benign breast tumors
- Improves acne
- Sexual enjoyment
- Emergency contraception
- Transition therapy for perimenopause
None
What are the disadvantages of combined oral contraceptive methods?
- No HIV or STI protection
- Patient adherence
- Expensive
- Adverse effects
- Circulatory complications
- Menstrual cycle changes
- Sexual and psychological effects
- Hepatocellular adenoma
- Gallbladder disease
- Drug interactions
None
What should be done if two or more doses are missed?
- Take most recent doses as soon as possible
- Continue taking remaining doses at the usual time
- Use a backup method (BUM) or avoid intercourse until 7 active tablets have been taken for 7 consecutive days
- Use emergency contraception (EC) if unprotected intercourse occurred in the previous 5 days
None
What is the proper use of a transdermal patch?
- Place patch on a dry, hairless area of upper arm, shoulder, abdomen, or buttocks
- Rotate site of patch each week
- One patch per week for 3 weeks; week 4 is patch-free
None
What is the effectiveness of the transdermal patch?
- Similar to pills (7% failure rate for typical use, 0.3% for perfect use)
- Less effective in women weighing more than 198 lb (90 kg)
None
What should be done if the transdermal patch is off for less than 24 hours?
- Reapply the patch; no backup method needed
None
What should be done if the transdermal patch is off for more than 24 hours?
- Open a new patch, start a new cycle
- Use a backup method for the first week of the new cycle
None
What are the advantages of the transdermal patch?
- Efficacy
- Adherence
- User controlled
- Readily reversible
None
What are the disadvantages of the transdermal patch?
- Site reactions
- Patch detachment
- Appearance, less privacy
- Breast discomfort
- Dysmenorrhea
- Headache
- Nausea
- Should not be used in women > 90 kg
None
What is the mechanism of action of progestin-only contraceptives?
- Thickens cervical mucus, prevents sperm movement
- Thins uterus lining
- Suppresses mid-cycle peak of LH and FSH, inhibits ovulation
None
What are the indications for progestin-only contraceptives?
- History of or current MI, stroke, DVT, CVD
- Atrial fibrillation
- Blood pressure 160/100 mm Hg
- Smoker age 35 or older
- Active, symptomatic liver disease
- Migraine headache with neurologic impairment or aura
- Retinopathy or neuropathy because of diabetes
- Surgery within the past 4 weeks
- Breastfeeding (estrogen may decrease breast milk production)
None
What are the types of progestin-only contraceptives?
- Oral (Norethindrone 0.35 mg)
- Depot medroxyprogesterone acetate (DMPA)
None
What is the effectiveness of oral progestin-only contraceptives?
- 7% failure rate (typical)
- 0.3% failure (perfect use)
None
What are the contraindications for progestin-only contraceptives?
- Suspected or demonstrated pregnancy
- Active hepatitis, hepatic failure, jaundice
- Inability to absorb sex steroids from GI tract
- Concurrently taking medications that increase hepatic clearance
- Taking an antibiotic such as rifampin or rifabutin
None
What are the adverse effects of depot medroxyprogesterone acetate (DMPA)?
- Progestin related
- Progressive significant weight gain
- Severe depression (rare)
- Loss of bone density (BMD)
None
What should be done if the DMPA injection is missed?
- Return in 11–13 weeks for next injection
- Use a backup method if more than 13 weeks have passed
None
What are the contraindications specific to copper IUD?
- Pregnancy
- Current or recent sexually transmitted infection (STI)
- Uterus less than 6 cm or greater than 9 cm
- Undiagnosed abnormal vaginal bleeding
- Active cervicitis or active pelvic infection
- Known symptomatic actinomycosis
- Recent endometritis (past 3 months)
- Allergy to copper; Wilson’s disease
None
What is the primary action of a spermicidal?
Prevention of sperm motility and acrosomal enzyme activation
This action inhibits sperm from reaching the fallopian tube and fertilizing the ovum.
What are some contraindications for the use of Copper IUDs?
- Active cervicitis or pelvic infection
- Known symptomatic actinomycosis
- Recent endometritis (past 3 months)
- Allergy to copper or Wilson’s disease
- Uterine distortion or pathology affecting placement
- Known or suspected uterine or cervical cancer
- Unresolved abnormal Papanicolaou (Pap) test
- Severe anemia (relative contraindication)
These conditions may affect the safety and effectiveness of Copper IUDs.
What is the perfect use failure rate of Copper IUDs?
0.6%
The typical use failure rate is 0.8%.
What are the advantages of using a Copper IUD?
- Long-term efficacy (up to 10 years)
- Easy adherence
- Allows spontaneous sexual activity
- Readily reversible
- Cost-effective
- High patient satisfaction
These advantages make Copper IUDs a popular choice for long-term contraception.
What are the disadvantages of using a Copper IUD?
- Increased monthly blood loss (about 35%)
- Dysmenorrhea
- Spotting and cramping
- Risk of expulsion
- Potential for increased risk of infection for 20 days after insertion
- Considered a foreign body
These disadvantages may affect user experience.
What is the mechanism of action for Progestin IUS (levonorgestrel)?
- Prevents implantation as a foreign object in the uterus
- Thickens cervical mucus
- Thins endometrium
- Inhibits sperm motion
This mechanism provides a highly effective method of preventing pregnancy.
What are some contraindications for Progestin IUS?
- Pregnancy or suspicion of pregnancy
- Congenital or acquired uterine anomaly
- Acute or history of PID
- Postpartum endometritis or infected abortion (past 3 months)
- Known or suspected uterine or cervical neoplasia
- Unresolved abnormal Papanicolaou (Pap) test
- Genital bleeding of unknown etiology
- Untreated acute cervicitis or vaginitis
- Acute liver disease or liver tumor
- History of ectopic pregnancy
These contraindications must be considered before insertion.
What does the acronym PAINS stand for in patient counseling for IUDs?
- P: Period late, abnormal spotting or bleeding
- A: Abdominal pain, pain with intercourse
- I: Infection exposure (STI); abnormal vaginal discharge
- N: Not feeling well, fever, chills
- S: String missing, shorter, or longer
This acronym helps patients remember warning signs to watch for after IUD insertion.
What is the effectiveness of the implant for pregnancy prevention?
99% effective for up to 3 years
The implant releases progestin etonogestrel to prevent pregnancy.
What is the mechanism of action of lactic acid, citric acid, and potassium bitartrate vaginal gel (Phexxi)?
Lowers pH of the vagina and decreases motility of sperm
It is not a spermicide and must be used before each session of sex.
What is the definition of emergency contraception?
A therapy used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse
This definition is provided by ACOG.
What is the recommended timing for emergency contraception after unprotected intercourse?
Within 120 hours
While some products state 72 hours, studies suggest effectiveness can extend up to 120 hours.
What is the effectiveness range of emergency contraception?
57%–85%
Effectiveness may vary based on timing and method used.
What are the adverse effects of ulipristal acetate?
- Headache
- Nausea
- Abdominal pain
- Dysmenorrhea
- Menstrual changes
These effects may vary in intensity among users.
What is the recommended action regarding breastfeeding after taking ulipristal acetate?
Not recommended within 24 hours of taking ulipristal
High concentrations of ulipristal can be present in milk during the first 24 hours.
What is the recommendation for emergency contraception in individuals with a BMI greater than 25 kg/m²?
Use ulipristal acetate or the copper IUD
Progestin-only emergency contraceptive pills are not as effective for those with higher BMI.
What is the Yuzpe method?
High-dose estrogen plus progestin using available COC products
This method is not frequently utilized clinically due to its side effects.
