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a_GYNGU > Contraception > Flashcards

Contraception Flashcards

1
Q

Case 1)

  • Olivia, a 16 year old healthy female presents to the gynecology clinic with her mother for a well woman exam. Her mother would like to have a “check-up”.
  • Olivia reports her menarche was at age 11. Her cycles are regular, occurring every 33 days. The cycles last 10 days, and she uses 5 pads per day. She has a lot of menstrual cramps which sometimes makes her miss school. QUESTIONS
  • Are Olivia’s menstrual cycles normal?
  • What advice can you give Olivia concerning what constitute normal menstrual cycles?
  • In private, Olivia discloses to you that she is currently sexually active with her boyfriend. They do not use contraception. She DOES NOT want you to tell her mom, but would like to be prescribed some type of birth control. What counseling would you give Olivia? What type of birth control would you recommend to Olivia.
A

Are Olivia’s menstrual cycles normal?

  • Long (menorrhagia)
  • Heavy
  • Or “Abnormal uterine bleeding with heavy bleeding”

What counseling would you give Olivia? What type of birth control would you recommend to Olivia.

  • In Texas, you cannot give birth control without parental consent until the kid is 18; she can, however, bet tested for STDs without telling mom
  • LARPs
  • Nexplanon
  • IUD
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2
Q

Which is the best contraceptive option for Olivia?

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

A

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device- this is the best because it will address the contraceptive issues and her heavy periods

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3
Q

Case 2)

  • Susan is a 50 year old healthy female who smokes presents to your gynecology clinic.
  • She reports that she used oral contraceptive pills when she was younger.
  • In the last year, her menstrual cycle has become very irregular. Her cycles are occurring every 1-2 months but are heavier than normal.
  • She is beginning to experience hot flushes. She would like to re-start her OCPs to regulate her menstrual cycles and to stop her hot flushes.

What advice would you give her concerning oral contraceptives in the perimenopause period?

Which is the best contraceptive option for Susan?​

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

A
  • CANNOT give her combined OCPs
  • She smokes and is > 35 yo
  • Could give her low dose HRT, but that has some cancer risks (much lower dose so lower CV risks, but maybe try something else first)

—A. Combined oral contraceptive pills- DON’T GIVE; smoker and CV risk

—B. Contraceptive patch- estrogen containing; don’t give (CV risk)

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

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4
Q

Case 3)

  • Veronica is a 22 year old healthy female who has 5 children. She has been married to her high school sweetheart since she turned 18.
  • She comes to your pre-operative clinic requesting to have her tubes tied (i.e. tubal ligation).

Is Veronica a good candidate for having a tubal ligation?

Which is the best contraceptive option for Veronica?—

A. Post partum tubal ligation

—B. Interval tubal ligation

—C. Combined oral contraceptive pills

—D. Contraceptive implant

—E. Intrauterine device

A
  • It is considered unethical to sterilize someone < 30 yo without some big extenuating circumstance (e.g. terminal disease)
  • There are LARPs that are just as effective (or more!) than tying your tubes

A. Post partum tubal ligation- NO

—B. Interval tubal ligation- NO

—C. Combined oral contraceptive pills

—D. Contraceptive implant

—E. Intrauterine device- can be really long lasting (10 yrs); could have 1 and then get her tubes tied later

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5
Q

—Case 3 cont’d)

  • Veronica’s older sister, Valerie, is 30 years old.
  • She presents to your obstetrical clinic at 8 months pregnant. She is pregnant with her 5th child.
  • This child has been diagnosed with Tetralogy of Fallot. The pediatric cardiac surgeons plan to repair the child’s heart soon after birth.
  • Valerie would like to have a post-partum tubal ligation.

What counseling would you give Valerie regarding a post-partum tubal ligation?

A
  • Don’t typically like to tie someone’s tubes when they’re deciding from a place of stress
  • Give her birth control, let the baby be born, and let her deal with that; then readdress the issue
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6
Q

—Case 4:

  • Mary is a 31 year old healthy female who presents for her well woman exam. She was recently married, but does not want to have a child for at least a year.
  • In passing, she reports that she was diagnosed with a deep vein thrombosis when she was a teenager after she broke her leg in a car accident. She is no longer taking blood thinners.

What type of birth control would be best for Mary?

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

A

Not A or B because of the estrogen (CV factors)

  • In addition to a history of clots, a personal Hx of a migraine with aura is also a direct C/I to estrogen birth control (it’s a risk for stroke!)

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive; reversible, 12 wks

—D. Contraceptive implant

—E. Intrauterine device

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7
Q

Case 5)

  • Abigail is a 23 year healthy female who started oral contraceptive pills 3 months ago.
  • Overall, she really likes that her acne has improved with the birth control pills and that her cycles are regular in timing.
  • However, she reports that she has a hard time remembering to take the pills at times. What other birth control options should she consider that will give her regular cycles and improve her acne?

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

A

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

Since she likes the anti-androgen effects of the pill, the progesterone-only methods are out

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8
Q

What is the overview of birth control methods (broadly, 2 categories)?

A

1. Estrogen + progesterone

Regulate cycles: shorter, lighter, more regular

Require more participation

2. Progesterone

Make periods lighter but not necessarily more regular

Longer term

Require lest effort

12 wks shot

Implant,

IUD

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9
Q

—Case 6)

  • Christiana is a 19 year old female who has been homeless for the last year.
  • She admits to IV drug use and prostitution.
  • She has recently been through rehab and is committed to getting off drugs.
  • She has not been screened for sexually transmitted infections (STIs).

Until she is screened for STIs, which type of birth control should be avoided?

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device

A

—A. Combined oral contraceptive pills

—B. Contraceptive patch

—C. Injectable contraceptive

—D. Contraceptive implant

—E. Intrauterine device- increased risk of PID with current STD infection

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10
Q

Case 7)

  • Jessica is a 22 year old female who recently enrolled in the Army.
  • She has sickle cell disease which results in a pain crisis about once a year.
  • She has been on Depo Provera for the last 2 years.

Which of the following is a side effect of Depo Provera (injectable contraceptive)?

—A. Weight loss

—B. Headaches

—C. Heavier menstrual cycles

—D. Decreased bone density

—E. Vaginal discharge

A
  • She’s young, so Depo is great, but there’s a question of decreasing bone density; need to be counseled about BMD
  • When you stop Depo, BMD goes back up
  • Women in the army on Depo may have increased risk of fracture
  • —Sickle cell pts have fewer pain crises with Depo; good option for them
  • Depo is the only form of birth control that shows weight gain

A. Weight loss

—B. Headaches

—C. Heavier menstrual cycles

—D. Decreased bone density

—E. Vaginal discharge

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11
Q

Case 8)

  • Heather is a 18 year old healthy female who is going away to college this fall. Her girlfriends have told her about Nexplanon.

How would you counsel her concerning Nexplanon? What is the most common reason Nexplanon is removed?

—Which of the following is the most common side effect of Nexplanon (implantable contraceptive)?

A. —Weight gain

—B. Headaches

—C. Irregular menstrual cycles

—D. Decreased bone density

—E. Vaginal discharge

A

A. —Weight gain

—B. Headaches

—C. Irregular menstrual cycles- typically light, irregular bleeding (spotting 2-3 wks at a time)

—D. Decreased bone density

—E. Vaginal discharge

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12
Q

Case 9)

  • Alexis is a 19 year old healthy female who had unprotected sex last night.
  • She calls your office to discuss her options for emergency contraception.

What advice do you give her?

Which of the following is not a form of emergency contraception?

—A. High doses of oral contraceptive pills

—B. Plan B

—C. Paragard

A

—A. High doses of oral contraceptive pills

—B. Plan B

—C. Paragard

D. All of the above

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13
Q

Describe the classes of OCPs

A
  • In most OCPs, the estrogen is the same (levels can change), it’s just the progesterone types and levels that change
  • Monophasics delivery the same progesterone thorughout the month
  • Triphasics change the progesterone dose each week (trying to give you less overall)
    • Irregular bleeding higher on triphasics
  • The ? dose of estrogen means lighter, but more irregular periods
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14
Q

What are Tier 1 contraceptive methods?

A
  • Intrauterine devices (IUDs)
  • Progestin implants

These provide the highest level of pregnancy protection, with 1st year failure rates in typical use of < 1%

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15
Q

What are Tier 2 contraceptive methods?

A

Other hormonal methods: 1. combined hormonal products and 2. progestin-only injections and pills

  • Injection (q 3 mo)
  • Monthly vaginal rings
  • Weekly patches
  • Daily pills
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16
Q

What are Tier 3 contraceptive methods?

A
  • Barrier methods
  • Male condoms
  • Dipahgrams, cervical caps, shields, and female condoms
  • Behavioral methods
  • Coitus interruptus
  • Fertility awareness methods
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17
Q

What are the different contraceptive implants?

A

Implanon- single rod system

  • Progestin (etonogestrel) mixed into matrix of plastic rod
  • Placed into inner nondominant arm
  • Indicated for up to 3 yrs of use
  • 1st yr failure of only 0.38%
  • C/Is:
  • Breast cancer in the past 5 yrs
  • Anticonvulsants may cause higher failure rates (Phenobarbital, Dilantin; increase P450 activity)
18
Q

What are the different intrauterine contraceptives? Describe

  • C/Is
A

4 now (this paper only lists 2)

  • Copper T380A
  • Approved for 10 yrs (effective for 20)
  • Excellent pregnancy protection and rapidly reversible
  • Mechanism: immobilizes and kills sperm
  • Menses may be heavier and longer
  • Mirena (levonorgestrel-releasing)
  • Better IUD choice for heavy or painful menses
  • Effective 5+ yrs
  • Thickens cervical mucus to prevent sperm entry into upper genital tract
  • High doses of progestin change endometrium
    • Early months: frequent unscheduled bleeding and spotting
    • Bleeding becomes rare in later mo; by 12 mo, 20% of no bleeding/spotting (most often, people see spotting 1-3 days/mo)

Only absolute C/Is to immediate IUD placement are active infection or cancer in the cervix/uterus (or distortion of uterine cavity or incorrect size)

19
Q

How do tier 2 contraceptives work?

A

Thickening cervical mucus and blocking LH surge to prevent ovulation

  • Must remove barriers to successful use to achieve optimal success; quick-start protocols
  • Can be started any day of a woman’s cycle (as long as not pregnant/has had unprotected sex in past 5 days or uses emergency contraception)
20
Q

In what forms are combined hormonal contraceptives (synthetic estrogens and progestin) available?

A
  • Pills (once daily)
  • Transdermal patches (once/week)
  • Vaginal rings (once/month)
21
Q

What are some other health benefits with combined hormonal contraceptives?

A
  • Treatment of acne
  • Premenstrual dysphoric disorder
  • Lighter, shorter, less painful, and more regular menses
  • Also decreased risk for ovarian and endometrial cancer
22
Q

What are risks of combined hormonal contraceptives?

A
  • Venous thromboembolism (VTE)
  • Deep vein thrombosis
  • Pulmonary embolism

(Still, greater VTE risk in pregnancy)

  • Benign hepatic tumors (rare)
  • Cholelithiasis
  • Mild HTN

Don’t give if older and smoke

Absolute C/Is:

  • Heart attack Hx
  • Stroke
  • Breast cancer
  • Labile HTN
  • Advanced diabetes
  • Migraine with aura
  • Hepatic failure
23
Q

What women cannot use progestin-only methods of contraception?

A
  • Breast cancer in the past 5 yrs
  • Drugs that increased cytochrome P450 (can have depot DMPA injections)
24
Q

What is the mechanism for Progestin-only methods?

  • Reversability?
A

Thicken cervical mucus

  • DMPA also suppressed gonadotropins to inhibit ovulation

POPs are immediately reversible while DMPA takes about 10 mo to return to ovluation

25
Q

What are menses like on progestin-only pills and injections?

A
  • POPs: own cycles but with less blood loss
  • DMPA: Initially unschduled bleeding, but most achieve amenorrhea
26
Q

What is the only contraceptive that causes weight gain? What are the offsetting benefits?

A

DMPA (depot injections)

  • Reduced acute sickle cell crisis
  • Reduced pain from endometriosis and reduced endometrial cancer
  • Reduced menorrhagia and dysmenorrhea
27
Q

What is the advantage of Tier 3 contraceptives (barrier and behavioral)?

A
  • Need to be use donly at time of intercourse
  • However, this decreases their use and increases their failure rates
28
Q

What is the failure rate of male condoms when used correctly? In typical use? Compare this to withdrawal

A
  • Correct male condom use: failure rate = 2%
  • Typical male condom use: 17.4%
  • Similar to withdrawal
29
Q

When would polyurethane condoms be used?

A
  • Couples with latex allergies
  • Women using petroleum-based vaginal products
30
Q

T/F: with condoms, spermicide lubricated latex condoms offer more protection against STIs and pregnancy

A

False

31
Q

Each of the female barriers works best with what?

A

Spermicidal gel

32
Q

Male latex condoms can be combined with all female barrier methods except for what?

A

The female condom

33
Q

Multiple use/applications of spermicide may increase what?

A

Transmission of HIV

34
Q

What is the most effective behavioral contraceptive method?

A

Coitus interruptus/withdrawal

  • For recently breastfeeding women, lactational amenorrhea is very effective
  • 2% failure rate if women exclusively breastfeed on demand and have no menses for first 6 mo postpartum
35
Q

What is contained in emergency contraception pills?

  • What ages can buy these
A
  • Levonorgestrel, “Plan B”
  • Use within 72 hrs of exposure (provide at risk women with prescription in advance)
  • NOT an abortifacient; no teratogenic effect if inadvertently administered during pregnancy. Works only by suprressing ovulation
  • Norgestrel

Only available to 18+ yo in the US

36
Q

What is the most common method of birth control used by women > 30 yo? Methods?

A

Permanent sterilization

  • Fallopian tube sterilization (ligatoin, clip, ring,plug…)
  • Vasectomy (takes 6-10 ejacualtions to achieve azoospermia)
37
Q

T/F: There are no long-term hormonal, metabolic, or autoimmune effects associated with vasectomy

A

True

38
Q

Are sterilization methods less effective in younger or older women?

A

Less effective in younger women

  • Optimize rates if done postpartum
  • Long term complications are low, but at least 6-10% of women consdier reversal, and many more express regret
39
Q

What did Roe v. Wade establish as acceptable regarding the age of a fetus and allowing abortion?

A

Induced abortion is a legal procedure until fetal “viability” is achieved, usually describe as 24 weeks of gestational age (unless anomaly)

40
Q

Early in the pregnancy (< 49 days) what can be offered in terms of abortion?

A

Both medical and surgical procedures

Medical:

  • Mifepristone (anti-progestin) followed by misoprostol (a prostaglandin) to induce uterine contractoins and expel (96%)
  • Methotrexate to induce abortion (less effective, slower)

Surgical:

  • Aspiration with a manual vacuum/suction curettage (>99% effective) in early pregnancy after cervical dilation achieved with Misoprostol or Laminaria
41
Q

When are 2nd TM abortions generally performed?

A

Prenatal diagnosis has revealed a serious genetic abnormality or because of an intrauterine fetal demise

  • PG or Misoporstol intravaginal suppositories are used to induce contractions and the fetus is delivered vaginally

a_GYNGU (17 decks)

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