Contraception 2 Flashcards
What exam should be performed prior to IUD insertion?
Pelvic exam: bimanual and speculum/cervical inspection
What are 2 contraindications to an IUD?
- Uterine anomaly
- PID/current infection
When can IUDs be inserted?
Any time as long as reasonably certain not pregnant
When is back up NOT needed after insertion of a Cu-IUD vs LNG-IUD?
- Copper- no back up needed
- LNG- no back up if inserted w/in 1st 7d of menses
Which type of contraception is recommended for adolescents
Long acting reversible contraception (IUDs preferred)
What 3 conditions is an IUD not recommended?
- Cervical cancer
- Purulent cervicitis
- Current Chlamydia/gonorrhea or high likelihood of STI exposure
If a patient becomes pregnant with an IUD- what are they at increased risk of? (3)
- Ectopic pregnancy
- spontaneous abortion
- preterm delivery
What is the MOA of the Levonorgestrel IUD?
- Thickens cervical mucus
- Alters endometrium to prevent implantation of fertilized ovum
What is the MOA of the copper IUD?
- Inhibits sperm motility
- Inflammatory rxn of the endometrium phagocytizes the sperm
How long can the LNG-IUD be used for? The copper IUD?
LNG- 3-5 years
Copper- 10 years
The copper IUD may cause what 2 things
May increase menstrual blood loss and dysmenorrhea
What is the MOA of the Etonogestrel implant (3)
- thickened cervical mucus
- inhibit tubal motility
- inhibit follicular maturation and ovulation
What is a side effect of the etonogestrel implant
unpredictable, irregular menstrual bleeding
You wouldn’t prescribe the Etonogestral implant if the patient has history of what 2 medical conditions?
- breast cancer
- Liver diseases
What is the MOA of emergency contraception
disrupts normal follical development and maturation
(blocks LH surge and inhibits ovulation)
What is the effect of emergency contraception on an implanted pregnancy
does NOT disturb
(not an abortifacient)
How long after sexual intercourse are emergency contraceptives effective
up to 72 hrs
Within what time frame can a copper IUD be inserted as a form of emergency contraception?
Within 5 days or beyond 5 days if it is not > 5 days after ovulation
What are the 3 emergency contraceptiv pill options
- Ulipristal acetate (UPA), 30 mg single dose (Ella)
- Levonorgestrel (Plan B)- single dose or split dose
- Combined estrogen and progestin in 2 doses (less effective and more SEs)
What are side effects of emergency contraception
Nausea and vomiting
(if V w/in 3 hrs of taking EC, take another dose)
When can contraceptives be started after taking UPA, LNG and combined estrogen/progestin (emergency contraceptive pills)
Immediately
When should a preg test be perfromed after taking UPA, LNG and combined estrogen/progestin (emergency contraceptive pills)
if no withdrawal bleed w/in 3 weeks
Emergency contraceptives:
How long should back-up be used after taking UPA, LNG and combined estrogen/progestin?
post UPA: Back up x14 days or until next menses
Post LNG and combined estrogen/progestin: Back up x7days
POPCORN
A patient has an increased risk of regret after steriliazation if they meet what 8 criteria?
- < 30y/o
- Low parity
- Sterilization at time of C-section
- Change in marital status
- Poverty
- Minority status
- Misinformation about permanence or risks
- Hurried decision
Vasectomy: Alternative contraception is needed until when
Until 2 consecutive sperm samples show no motile sperm
What 4 forms of contraception are recommended for women >45y/o?
Progestin only or non-hormonal options:
- Progestin only pills
- implants
- LNG-IUD
- Cu-IUD
What is the best contraceptive method for preventing unintended, rapid repeat pregnancy and abortion in young women?
LARC
You should take caution with which 2 contraception methods in obese patients?
- Ortho Evra Patch
- Depot Provera medroxyprogesterone (causes weight gain)
Obesity and Contraception:
- Hormonal contraception decreases risk of what 2 conditions
endometrial hyperplasia and cancer
ACOG and North American Menopause society recommend continued contraceptive use until when?
menopause or age 50-55
When should you follow up with a patient after prescribing contraceptives?
- Any time for side effects
- If want to change methods
If you have an obese patient with h/o PCOS that frequently travels, what contraceptive should you recommend
Copper IUD
(Can’t do anything with estrogen b/c of hypercoag state, no Depo b/c of obesity)
