Contraception Flashcards
Effects of this component of OCPs includes: inhibition of the midcycle surge/ovulation. Usual dose is 30-35mcg
ethinyl estradiol
Can treat other problems including acnes, dysfunctional uterine bleeding, ovarian cysts, endometriosis
high dose estrogen pills
Name the older, more androgenic progesterones that lower HDL. Dose is 0.15-1.0mg
Norethindrone, norethindrone acetate, levonorgestrel
Name the newer, less androgenic progesterones. Have less effect on carbs/lipid metabolism, more effective at reducing hirsutism.
Norgestimate & desogestrel
What is there an increased risk of with newer progestins?
thromboembolism
Makes endometrium less suitable for implantation. Alters cervical mucus making it less permeable to penetration of sperm. Impairs normal tubal motility and peristalsis
progestins
What forms of OCP have a cycle that is 24 days on, 4 days off?
drospirenone containing forms
What is the timeframe for the extended cycle OCPs?
84 days on, 7 days off
What pill formulation are lactating women usually given?
mini-pill
How long must a patient continue a backup method until pill has taken effect?
7-14 days
What is the Sunday start method?
start 1st Sunday after period
What does education for 1-2 missed pills include?
If miss 1 pill still covered for birth control. If miss 2 pills in a row must use back up method for the rest of that cycle
How does OCP therapy affect dysmenorrhea, Fe deficiency anemia, ectopic pregnancy, ovarian cancer, benign breast dz, endometriosis?
lowers the risk of developing these conditions
Most common side effect of OCP that is independent of progestin
breakthrough bleeding
What can you do to address breakthrough bleeding as a side effect?
add extra estrogen or switch to more estrogenic progestin
Why is the risk of cervical cancer increased with OCP?
In HPV positive OCP users a metabolite of estradiol can act as a cofactor w/ oncogenic HPV
What are women who get frequent migraines at risk of with concurrent OCP use?
cerebral thromboembolis
What is the effect of drugs that increase liver microsomal enzyme activity on OCPs? Examples include Phenobarbitol, phenytoin, carbamazepine, barbituates, griesofulvin. st. john’s wort
accelerates OCP metabolism
What effect do antibiotics such as rifampin, tetracycline, PCNs, cephalosporins have on OCP?
decrease OCP efficacy.
Delivers 20 mcg estradiol and 150 mcg of norelgestromin daily. Delivers constant level of hormone. Ortho-Evra worn for 3 wks, 1 wk off for menses.
contraceptive patch
Delivers 15 mcg estradiol and 120 mcg estonogestrel daily for 3 weeks intravaginally. Removed for 1 week then a new one is inserted
vaginal ring
Inhibition of ovulation by inhibiting gonadotropin secretion. Inhibits follicular maturation. Thickens and decreases amount of cervical mucus. Creates thin, atrophic endometrium. Ovum transport may be slowed
Progestin only mechanism of action
Indications for progestin only methods
htn, age >35 and smoker or obese, migraines, SLE
Black box warning for Depo-provera
bone density decrease
How long might fertility be delayed after stopping DMPA?
18 months after last injection
Single rod with slow release of 68mg etonogestrel. Lasts for 3 years. Inserted in the upper arm subdermally in the office. Irregular bleeding was the primary reason of discontinuation
Implanon/Nexplanon
How long is Mirena and Styla approved for?
Mirena 5 yrs and Styla 3 yrs
Local progestin effect where endometrial concentration of levonorgestrel are 1000 x higher then seen w/ implant and blood levels are very low.
Intrauterine Contraception (IUC)- Mirena and Styla
releases copper continuously into the uterine cavity; this interferes with sperm transport and prevents fertilization of ova
Paragard
How long can Paragard remain in place?
10 yrs
Type of birth control that the following patients are ideal candidates for: low risk of STIs, not planning pregnancy for 1 yr, want a reversible form of contraception and need to avoid estrogen
IUC
A dome-shaped cup made of latex or silicone. Partially filled w/ spermicidal cream/jelly and then inserted into the vagina over the cervix
must be left in the vagina for 6 to 8 hrs after intercourse, then needs to be removed
diaphragm
CI for diaphragm
toxic shock syndrome
Reusable, deep rubber cup that fits over the cervix, must be used with a spermicide has to remain in for 6-8 hrs can be left in place for up to 48 hours
cervical cap (FemCap)
circular disk that contains 1000 mg of nonoxynol-9 and has attached loop for removal. moistened w/ tap water before insertion
“one size” fits all; does not require a prescription, or fitting
sponge
Lines the vagina and shields introitus providing physical barrier during intercourse. More problems with breakage, slippage and incorrect penetration
female condom
Disadvantages include: irritation, yeast vaginitis, enhanced spread of HIV
spermacides
Associated w/ subfertility, but can only be relied upon to prevent pregnancy when: The woman is < 6 months postpartum. She is breastfeeding exclusively. She is amenorrheic
lactation
What dose of emergency contraceptive is available OTC without age restrictions?
The single 1.5 mg dose regimen
Inhibiting or delaying ovulation. Interfering w/ fertilization or tubal transport. Preventing implantation by altering endometrial receptivity. Causing regression of the corpus luteum
emergency contraceptive
How long are emergency conraceptives effective for?
up to 120hrs after the event
Recommended for couples who desire permanent contraception or sterilization
vasectomy
comparable to sterilization in terms of efficacy, but are non-surgical and reversible for women who request sterilization
LARC methods
