Contraception 2 Flashcards
1
Q
what days is menstruation in the menstrual cycle
A
days 1-7
2
Q
what days is follicular/proliferative phase in the menstrual cycle?
A
days 7-13
3
Q
what day is ovulation in the menstrual cycle?
A
day 14
4
Q
what day is luteal/secretory phase in the menstural cycle?
A
days 15-28
5
Q
what should every 18-50 y/o be asked?
A
do they want to get pregnant in the next year?
6
Q
what is efficacy and safety class 1?
A
no restriction
7
Q
what is efficacy and safety class 2?
A
benefits > risk
8
Q
what is efficacy and safety class 3?
A
risk > benefits
9
Q
what is efficacy and safety class 4?
A
don’t use
10
Q
what are the contraception options from most effective to least effective?
A
emergency contraception > sterilization > long-acting (LARC) > hormone contraception > mechanical barriers > periodic abstinence
11
Q
what are the 3 ways of preventing contraception?
A
preventing ovulation, preventing fertilization, preventing implantation
12
Q
what are the methods for preventing ovulation?
A
oral hormonal agents (combo, progestin only pills) vaginal insert, injectable, transdermal patch, nexplanon
13
Q
how do the combined OCPs work to prevent ovulation?
A
prevent ovulation by inhibiting gonadotropin secretion thru an effect on both pituitary and hypothalamic centers
14
Q
how does estrogen work in combined OCP?
A
suppresses FSH, which suppresses the development of a dominant follicle
15
Q
what is needed to potentiate action of progestin?
A
estrogen
16
Q
if there is less progestin, what occurs in the endometrium, the cervix, and the fallopian tubes?
A
atrophic glands in endometrium (thins uterus), thickens cervical mucus, impairs peristalsis in fallopian tubes
17
Q
what does estrogen do to the endometrium to prevent what?
A
stabilizes the endometrium to prevent BTB
18
Q
what dose of estrogen increases break BTB?
A
< 20
19
Q
what 4 changes does estrogen excess cause?
A
- breast cystic changes/tenderness
- dysmenorrhea
- chloasma (skin discoloration)
- HTN
20
Q
what 4 changes does estrogen deficiency cause?
A
- spotting days 1-9
- continuous bleeding and spotting
- hypomenorrhea
- atrophic vaginitis (menopause type sx’s)
21
Q
how does progestin work in combined OCP?
A
suppresses LH secretion
22
Q
what are the 1st generations of progestin?
A
norethindrone acetate, ethynodiol dictate, lynestrenol, noreethynodrel
23
Q
what are the 2nd generations of progestin?
A
di-norgestrel, levonorgestrel
24
Q
what are the 3rd generations of progestin?
A
desogestrel, gestodene, norgestimate
25
what are the unclassified progestins?
drospirenone, cyproterone acetate
26
what generation of progestin has the highest androgenic effect? what does this mean if patient has acne or hirsutism?
2nd generation (di-norgestrel, levonorgestrel)
means don't use 2nd gen progestins if pt has acne or hirsutism
27
what generation of progestin has the lowest androgenic effect? what does this mean if patient has PCOS or acne/hirsutism?
3rd generation (desogestrel, gestodene, norgestimate)
means 3rd gen is good for PCOS symptoms
28
what 5 changes does progestin excess cause?
- increased appetite
- depression
- fatigue
- libido decreased
- weight gain (non-cyclic)
29
what 4 changes does progestin deficiency cause?
- BTB days 10-21
- delayed withdrawal bleeding
- dysmenorrhea
- hypermenorrhea
30
what are the 6 formulations of combined OCPs?
monophasic, biphasic, triphasic, 4-phasic, monthly, continuous/extended formularities
31
what is the monophasic formulation of combined OCPs?
SAME dose of estrogen and progestin in active pills
32
what is the biphasic formulation of combined OCPs?
same amount of estrogen each day, progestin INCREASES HALFWAY through pack
33
what is the triphasic formulation of combined OCPs?
varying doses of estrogen +/- progestin every 7 days
34
what is the 4-phasic formulation of combined OCPs?
varying doses of estrogen AND progesterone throughout pack
35
are the biphasic, triphasic, and 4-phasic formulations of combined OCPs more/less effective than one another?
No, they are equally effective
36
what is the monthly formulation of combined OCPs?
21 days of hormones, 7 days of placebo
OR
24 days active, 4 days placebo
37
when do you get your period with the monthly formulation of combined OCPs?
every 28 days
38
what are the monthly formulation of combined OCPs names?
Yaz, Yasmin, loestrin-24, femcon
39
what effect does the monthly formulation of combined OCPs have?
decreases BTB and shorter period
40
what are the continuous/extended formulations of the combined OCPs? names?
longer active pills, less number of periods/year
Seasonale/Seasonique (4 periods/year)
Lybrel (full year of active pills -> NO PERIOD)
41
what are the continuous/extended formulations of the combined OCPs good for?
menorrhagia, anemia, dysmenorrhea, endometriosis, menstrual HA, PMDD
42
what formulation of combined OCP do you NOT get your period?
Lybrel (full year of active pills)
43
what formulation of combined OCP do you only get your period 4x/year?
seasonale/seasonique
44
what are adrs of combined OCPs?
VTE risk d/t estrogen, breast tenderness, nausea, bloating, BTB, DDI with phenytoin and Rifampin
45
what 2 medications interact with combined OCPs?
phenytoin and Rifampin
46
if patient has BTB on combined OCPs, what do you tell them?
it takes 90 days
47
how do you manage androgenic side effects hormonal OCPs?
select 3rd gen progestin, low dose norethindrone or ethynodiol dictate
48
how do you manage irregular, heavy, painful menses adr of hormonal OCPs?
increase progestin or decrease estrogen
49
how do you manage hirsutism or acne adr of hormonal OCPs?
increase estrogen or decrease androgen/progestin
50
how do you manage BTB, spotting (days 10-28) adr of hormonal OCPs?
increase progestin
51
how do you mange high risk thrombosis adr of hormonal OCPs?
decrease estrogen
52
how do you manage amenorrhea adr of hormonal OCPs?
increase estrogen
53
how do you manage breast tenderness/swelling adr of hormonal OCPs?
decrease estrogen
54
how do you manage BTB, spotting (days 1-9) adr of hormonal OCPs?
increase estrogen
55
how do you manage nausea adr of hormonal OCPs?
take with food at night or decrease estrogen or increase progestin
56
what are the 8 contraindications of combined OCPs?
(1) >35 and smoking
(2) multiple RF's for arterial CVD (older age, smoking, DM, HTN)
(3) HTN >160/100
(4) VTE, thrombogenic mutations, hx of stroke
(5) ischemic heart disease
(6) migraine w/aura at any age (increased risk of stroke)
(7) current breast cancer
(8) impaired liver fxn
57
what MUST you obtain from the patient before prescribing any combo OCPs?
BP and BMI (height and weight)
| also hx and pe
58
what are the 3 different ways to start combo OCPs?
quick start, Sunday start, first day start
59
what is the quick start method of combo OCPs?
most preferred, highest retention
start the same day you rx BUT reasonably exclude pregnancy
60
what is the most preferred/high retention way to start combo OCPs?
quick start method
61
for how many days must the pt use back up contraception when doing quick start for combo OCPs?
if >5 days from last period
62
what is the Sunday start method of combo OCPs? what are you avoiding in this method?
start Sunday after period begins
avoiding withdrawal bleed on weekend
63
for how many days must the pt use back up contraception when doing Sunday start method of combo OCPs?
backup for 7 days
64
what is the first day start method of combo OCPs?
start on 1st day of period, NO BACKUP
65
what must you always follow-up on with the pt when they are on combo OCPs?
BP, assess for changes in health, adrs
66
what are the progestin only pills?
pack of 28 active pills taken continuously
67
what is the MOA of the progestin only pills?
thickens cervical mucus, suppresses ovulation, thin endometrium
68
what is the ONLY formulation of the progestin only pills?
Norethindrone
69
what are the advantages of the progestin only pills?
- rapid acting
- back-up method for only 2 days
- common use postpartum period (good if pt is breastfeeding b/c no estrogen)
70
if pt is breastfeeding and want to be on OCP, which one should they be on?
progestin only pills
71
wha are the disadvantages of the progestin only pills?
short half-life -> MUST TAKE AT THE SAME TIME EVERY DAY w/in 1 HOUR!!!
irregular bleeding patterns, not effective at suppressing follicular cysts b/c no estrogen
72
when must the pt take their progestin only pills?
MUST TAKE AT THE SAME TIME EVERY DAY w/in 1 HOUR!!!
73
what cysts are the progestin only pills not effective at suppressing and why?
not effective at suppressing follicular cysts b/c no estrogen
74
what is the vaginal insert method for preventing ovulation? dosing?
nuvaring (ethinyl estradiol and etonogestrel)
dosing: monthly
- ring in for 3 weeks, ring free for 1 week (get period this time)
75
what are the advantages of the nuvaring?
start whenever, no daily pill, less BTB
76
if don't put nuvaring in on 1st day of period what may the pt need to use?
back up contraception
77
what is a disadvantage of the nuvaring?
increased vaginal discharge
78
what is the injectable method for preventing ovulation? dosing?
Depo-provera (medroxyprogesterone acetate)
dosing: every 90 days (2 week grace period)
79
what is the MOA of Depo-provera?
suppresses gonadotropins to inhibit ovulation
80
when can you start Depo? when must you use back up contraception?
start anytime BUT if >7 days from last period should use back up contraception
81
what is the advantage of Depo?
progestin only
82
what are disadvantages of Depo?
weight gain
return of fertility is delayed (6-12 months for period to return)
bone loss d/t the lack of estrogen
83
if adolescent pt is taking Depo as contraception, what should they also be taking with it and why?
should be taking vitamin D and calcium supplements b/c Depo lacks estrogen (it's only progestin)
84
what is the transdermal patch of preventing ovulation? dosing?
Ortho Evra (combo of estrogen and progestin)
weekly dosing
85
where can you put Ortho Evra (transdermal patch) on your body?
butt, abdomen, upper outer arm, upper torso
NOT BOOBS
86
what is the BBW for Ortho Evra?
BBW for smoking (increased clot risk)
87
disadvantages of Ortho Evra?
BBW for smoking (increase clot risk), less effective in obese women, skin irritation
88
what is Nexplanon? what's it's MOA?
long-acting reversible contraception (LARC)
MOA: suppresses ovulation and inhibits fertilization
89
how long does Nexplanon last?
3 years (slow release of progestin - etonogestrel)
90
disadvantages of Nexplanon?
irregular bleeding, scarring
91
what are 4 methods to prevent fertilization?
abstinence, periodic abstinence, barrier methods/mechanical barriers, sterilization
92
what is the only method of contraception that is 100% preventing BOTH pregnancy and STIs?
abstinence
93
what are the 3 methods of periodic abstinence?
coitus interruptus, fertility awareness based methods, lactational amenorrhea method
94
what is fertility awareness based method of periodic abstinence?
tracking cycle and avoiding intercourse during women's likely fertility
95
what are the 4 methods of fertility awareness based method of periodic abstinence?
(1) standard days method
(2) cervical mucus method (avoid when increased cervical mucus)
(3) basal body temp method
(4) symptothermal method
96
what days during standard days method is woman most fertile and thus should not have intercourse?
days 8-19
97
what is the basal body temp method?
basal body temp increases slightly during ovulation -> don't have intercourse during this time
98
what is the symptothermal method?
combo of basal body temp method and cervical mucus method
99
what is lactational amenorrhea method of periodic abstinence?
means have high prolactin levels when breastfeeding, which inhibits LH/follicular maturation -> no ovulation
100
what are the 3 requirements of anovulation (specifically if using lactational amenorrhea method of periodic abstinence as contraception)?
< 6 months post part, exclusively breastfeeding, amenorrhea
101
what are the most popular AND most effective forms against STIs?
male condoms
102
what are the barrier methods of contraception (prevent fertilization)
male condoms, female condoms, diaphragm, cervical cap, sponge, spermicides
103
when can a male not use male condoms?
latex allergy
104
when can female condoms be placed?
before intercourse
105
are female condoms latex free?
yes!!!
106
how does a diaphragm work?
covers cervix to prevent fertilization
107
what increases efficacy of diaphragm?
using spermicide with it
108
what is required to use diaphragm or cervical cap?
pelvic exam and measurement, must also refit after pregnancy
109
how long does diaphragm last?
up to 2 years
110
what barrier methods for contraception DON'T protect against STIs?
diaphragm, cervical cap, sponge, spermicides
111
what must you use with the cervical cap?
spermicide
112
what are advantages of the cervical cap?
reusable
113
what does the sponge contain?
spermicide
114
what is barrier method (besides female and male condoms) DOESN'T require pelvic exam/fitting?
sponge
115
disadvantages of the sponge?
SULFA ALLERGY, no STI prevention, ONE TIME USE
116
what barrier method has a sulfa allergy?
sponge
117
what are spermicides?
chemicals that stop sperm from moving
118
what are the 2 methods of female sterilization?
Essure and Tubal ligation
119
what is Essure?
female sterilization method
coils cause scarring of fallopian tubes
120
what is required after 3 months of Essure procedure?
HSG
121
when can tubal ligation (method of female sterilization) be done?
postpartum (right after giving birth)
122
what are the 3 ways of doing tubal ligation? which way is the M/C and most effective and which way has the highest risk of failure?
Electrocoagulation (M/C, most effective)
Tubal excision (salpingectomy)
Clips/rings (highest risk of failure)
123
what cancer does female sterilization protect against?
ovarian cancer
124
what are disadvantages of female sterilization?
permanent
if pregnancy happens, more likely to be ectopic
125
what is a difference b/w female and male sterilization?
male is reversible, female isn't
126
what must men get that got a vasectomy 3 months post procedure? and what do they need to use for these 3 months?
semen analysis (and need to use back up for 3 months)
127
what method prevent implantation?
intrauterine device (IUD)
128
what is the M/C worldwide long-acting reversible contraception (LARC)?
IUD
129
efficiency of IUDs are similar to what other form of contraception?
sterilization
130
what are misconceptions of IUDs?
risk of PID, ectopic pregnancy, infertility
131
what are 5 C/Is to IUDs?
(1) distortion of uterine cavity (didelphys)
(2) active infection
(3) undo uterine bleeding
(4) pregnancy
(5) postpartum sepsis
132
what are the 2 types of IUDs?
hormonal and non-hormonal (copper IUD)
133
what chemical is in the hormonal IUD?
levonorgestrel (progestin)
134
what are the names of the hormonal IUDs and how long do each of them last?
Skyla (3 years), Liletta (4 years), Mirena (5 years), Kyleena (5 years)
135
what is the MOA of Skyla, Liletta, Mirena, Kyleena (hormonal IUDs)?
prevent implantation
- cervical mucus change and endometrial atrophy
- inhibits binding of sperm and egg
136
what must be done before inserting Skyla, Liletta, Mirena, of Kyleena (hormonal IUDs)? at what time can they be put in?
bimanual and cervical inspection prior to implantation (make sure uterus isn't anteverted, retroverted)
make sure pt isn't pregnant
can be put in immediately postpartum
137
if Skyla, Liletta, Mirena, or Kyleena (hormonal IUDs) are malpositioned are they still effective? what about the copper IUD?
if the hormonal IUDs are malpositioned they are STILL effective
BUT copper IUD isn't effective if malpositioned
138
disadvantage of Skyla, Liletta, Mirena, Kyleena (hormonal IUDs)?
irregular spotting
139
what is the name of the copper IUD?
paragard
140
what is the MOA of paragard?
prevents implantation by enhancing cytotoxic inflammatory response w/in endometrium
141
what can paragard also be used as that the hormonal IUDs can't be?
emergency contraception
142
disadvantages of paragard?
heavy period, dysmenorrhea
143
what are options for emergency contraception?
Coper IUD (Paragard) - MOST EFFECTIVE
Pills (Progestin only M/C, but can take combo pills too)
Ulipristal selective progesterone receptor modulator pill
144
emergency contraception is offered to any women up to how many days after unprotected sex?
5 days
145
what is the MOST EFFECTIVE form of emergency contraception?
Paragard (copper IUD)
146
what is Plan B?
levonorgestrel (1 pill)
147
what is Ulipristal selective progesterone receptor modular?
type of emergency contraception that you need rx for
changes the way progesterone works, so don't use another form of hormonal contraception b/c it will make it less effective
NEED TO WAIT 7 DAYS BEFORE RESTARTING HORMONAL CONTRACEPTION AND WILL NEED NON-HORMONAL BACK-UP IN THE MEANTIME
148
when is it ok for postpartum women to have sex again?
6 weeks postpartum
149
what are the progesterone only methods of contraception? when can you use these postpartum?
progestin only pills, Depo, Nexplanon, hormonal IUDs
can use these if breastfeeding
150
when is a postpartum woman at increased clot risk if begin taking combo OCPs?
5/6 weeks postpartum -> avoid estrogen
151
when can a postpartum woman begin taking combo OCPs again?
>5/6 weeks postpartum if NOT breastfeeding
