Contraception Flashcards

Question

lactational amenorrhea method (LAM)

Answer 1

-About 90% of patients have resumed menstruation by 13 weeks postpartum -It is possible to delay menses up to 6 months via LAM due to suppression of the increased production of estradiol and the cyclical secretion of LH from breastfeeding -Patients should breastfeed (not pump) at least every 4 hours during the day and every 6 hours at night -When menses have resumed, LAM should no longer be used for contraception -It is costly in terms of the time and effort required

Answer 2

-The progestin etonorgestrel is a metabolite of desogestrel, a progestin that is contained in numerous OCs -Though the manufacturer states that the device must be removed by the end of the 3rd year, ACOG states it is effective for at least 4 years -Insertion may be performed at any time in the menstrual cycle as long as pregnancy can be ruled out -Clinicians must be trained and certified in insertion and removal of the implant by the manufacturer -The device should be placed: -Subdermally in the nondominant upper arm -Under the skin overlying the triceps muscle -About 8-10 cm from the medial epicondyle of the humerus and 3-5 cm posterior to the sulcus between the biceps and triceps muscle -Insertion usually takes about 1 minute -At the conclusion of the procedure, the device should be readily palpable

Answer 3

-Deep insertion -Locate device with high frequency linear ultrasound, MRI -If the radiologist is inexperienced in identification of these devices, obtain plain film, CT or fluoroscopy after administration of barium -Then attempt removal by clinician experienced with deeply inserted devices -Skin infection -Hematoma formation -Oligomenorrhea or amenorrhea -Menorrhagia or menometrorrhagia -Increased risk of ectopic gestation if patient becomes pregnant -MIGRATION TO PULMONARY ARTERY- RARE

Answer 4

-Rule out pregnancy -Prescribe NSAIDs for 5-7 days -If unsuccessful, treat with low dose COCs for 2 weeks if there are no contraindications

Answer 5

-5 are currently available in the United States -4 levonorgestrel containing IUDs -One copper IUD -May be used in nulliparous or adolescent females -No other tests required prior to insertion (Pap, GC/CT, etc.) -Use with caution in patients in non-monogamous relationships or whose partners are known or suspected of being non-monogamous -ADR: -Perforation -Expulsion -PID- MC occurs at the time of insertion -Unclear association with bacterial vaginosis

Answer 6

-Increase production and viscosity of cervical mucus -Currently, there is no evidence that they are abortifacients -All are associated with increased risk of amenorrhea -However, ovulation usually occurs -Other adverse effects include effects of LNG: -Ovarian cysts -Headache -Breast tenderness -Weight gain

Answer 7

-Copper causes inhibition of sperm transport -Currently, there is no evidence that it is an abortifacient -May be used for emergency contraception -Patients with copper allergy or Wilson’s disease should not use this type of IUD -Adverse effects include menorrhagia, longer menses, and dysmenorrhea

Answer 8

-Any of these devices can be inserted at any time during the menstrual cycle as long as pregnancy has been ruled out -May use paracervical block to reduce pain -May use ultrasound during insertion if desired and available

Answer 9

-Prescription only -Contains lactic acid and citric acid -5 gm inserted intravaginally within 60 minutes of having intercourse -Repeat in 1 hour if additional intercourse is desired -Normally, the vaginal pH ranges from 3.5-4.5 but increases during sex to 7-8 to be tolerable for sperm -The contraceptive gel maintains the normal pH during relations -Also provides a barrier preventing sperm from penetrating the cervix -About 86% effective with typical use -ADRs: -Vulvovaginal irritation (18%) -Vulvovaginal pruritus (14.5%) -Vulvovaginal mycotic infection (9.1%) -Bacterial vaginosis (8.4%) -Mild burning, pruritus, or pain experienced by male partner (9.8%)

Answer 10

-47% of married couples rely on sterilization -Tubal occlusion (30.2%) -Vasectomy (17.1%)

Answer 11

-May be accomplished via: -Laparoscopy -Minilaparotomy or laparotomy -Methods include: -Dissection of portion of tube -Salpingectomy -Electrocautery -Clips or rings applied to tube -Insertion of Essure® into tubal ostia (formerly available) -Generally, there is a 1% failure rate -Associated with an increased risk of ectopic gestation -Complications: -Bleeding -Infection -Formation of pelvic adhesions: Chronic pelvic pain and Increased risk of ectopic gestation -Failure

Answer 12

Sterilization by laparotomy: modified Pomeroy method

Answer 13

Sterilization by laparotomy: Parkland method

Answer 14

-Transcervical sterilization -Device was inserted via hysteroscopy into tubal ostia -No longer available due to discontinuation by manufacturer

Answer 15

-Originally termed the Yupze method, based on 50 mcg COCs, to be given after sexual assault to prevent pregnancy -2 50 mcg COC pills PO now and 2 12 hrs later -Prevents ovulation

Answer 16

-Prevents ovulation -No nausea (due to progestin-only preparation) -Single dose for convenience -Must be given within 72 hrs to achieve >90% efficacy

Answer 17

-May use copper T380A IUD (Paragard®) within 5 days of unprotected sex -It is the most effective method of emergency contraception

Answer 18

-Like mifepristone, it is a selective progesterone receptor modulator (SPRM) -Prevents ovulation -May also interfere with implantation -May act as an abortifacient at higher doses -Acts for 5 days -Efficacy is undiminished over 5 days -Rx only for all patients