Contraception Flashcards
what contraceptives protect against endometrial cancer?
CHC, depot, non medicated IUCs
what contraceptives protect against ovarian cancer?
CHC
how soon after a hysteroscopic tubal sterilization or vasectomy do you need to check for completion?
3 mo
what are the potential side effects of a diaphragm?
UTIs, vaginal irritation, recurrent yeast infections
when should you not prescribe COCs in women >35?
if they smoke
this increases their risk for cardiovascular risk
what tests do you need before prescribing COCs?
blood pressure
pregnancy
what test do you need before prescribing a diaphragm or cervical cap?
bimanual exam
when should you not prescribe COCs to a woman > 35?
if they smoke,
will increase cardiovascular risk
if they have a migraine w/ aura
will inc. risk of stroke
what is the main mechanism of COCs?
inhibit ovulation
what does the estrogen component of a COC do?
suppresses FSH release, stabilizes endometrium
what does the progesterone component of a COC do?
increases mucus thickness and keeps implantation from happening
is levonorgestrel prescribed for emergency contraception
yes
what is the initial recommended estrogen treatment?
low dose,
what can higher doses of estrogen cause?
inc. risk of DVT/PE and stroke
what can a lower dose estrogen cause?
spotting or breakthrough bleeding
which generation of progesterone has a higher rate of DVT? what is the name?
3rd gen
Norgestimate
what are extended cycle COCs good for? what commonly happens with them
endometriosis, PMDD, lifestyle reasons
breakthrough bleeding
side effects of COCs
breakthrough bleeding, N, wt gain, mood swings, breast tenderness, headaches, acne, facial hair growth
what COC health risks are increased with smoking?
VTE, stroke, MI
what are the health risks with COCs?
VTE, stroke, MI, inc. triglycerides, cervical neoplasias
what doubles the risk of cervical neoplasia?
> 5 years on COCs
who is at increased risk of stroke on COCs?
women with migraines + aura
what should obese women be prescribed?
progestin only, IUDs, barriers, sterilization
what class of drugs can lower the contraceptive blood levels if taken at the same time?
antiepileptics
use DMPA or IUD
what antibiotic causes dec. COC hormone levels?
rifampin
what can you safely prescribe for systemic lupus erythematous patients?
progestin only options
especially if they have vascular/renal dz, anitphospholipid ABs
what is the MOA of progestin only contraceptives?
suppress ovulation
thicken cervical mucus
alter tubal motility
altering endometrium
what contraception can breast feeding mother use?
progestin only or IUDs
contraindications for progesterone only?
pregnancy, carcinoma of the breast/genitals, undiagnosed vaginal bleeding
sever hepatic dysfunction
when should you use progesterone only
migraines, >35 w/ smoking and obesity, hx of DVT, cardiac dz, cerebrovascular dz, HTN, systemic lupus, hypertriglyceridemia
why must you adhere to the strict criteria of progesterone only?
does not effectively suppress ovulation, so if not adhered to properly can dec the efficacy
what are the side effects of progesterone only
spotting, ovarian cysts, breast tenderness, irregular bleeding
what are the side effects of depo?
menometrorrhagia, wt gain, bone loss
what does the black box warning for depo say?
inc. risk of bone loss
do not use depo for more than 2 years
what are the side effects of the ring?
vaginitis, leukorrhea, spotting, HA, nausea
when is the patch less effective?
in obese women
what is the biggest risk with the patch?
2 fold inc. in DVTs
what are the 4 options for emergency contraception?
progestin only (plan B)
ulipristal
copper IUD
estrogen and progestin (higher doses)
what is the moa of ulipristal? and who is it good for?
bind to progesterone receptors so inhibits ovulation and alters endometrium
good for obese patients
what are the adverse effects of IUDs
perforation, expulsion, infections
what is the contraindication of a copper IUC?
wilsons dz, copper allergy
what do you have an inc. risk of with IUDs?
ectopic pregnancy
