Contraception

Question 1

What are the goals of healthy people 2020 in regards to contraception?

Answer 1

Improving unplanned pregnancy planning, spacing, and preventing unintended pregnancy

Question 2

What is the MOST effective means of contraception?

Answer 2

LARC - Long acting reversible contraception

Has pregnancy rate of less than 1% (most effective)

Question 3

What are some examples of LARCs?

Answer 3

Arm implant - Nexplanon

IUDs

Question 4

Which type of IUD does not use hormones?

Answer 4

Copper IUD

Question 5

How long does the copper IUD last? Name 2 benefits and 2 down-sides

Answer 5

10 years

Benefit: Highly effective, long lasting, non-hormonal
Down-side: Can make menses heavier with unscheduled bleeding :(

Question 6

When would you NOT want to prescribe a copper IUD?

Answer 6

Heavy or painful menses
Iron deficiency anemia
Wilson disease
Copper allergy (obv)

Question 7

How long do levonorgestrel-releasing IUDs last?

Answer 7

3-5 years

Question 8

What are the risks of all IUDs?

Answer 8

Uterine perforation, expulsion, infection

Question 9

How long does the nexplanon arm implant last? What type of implant is it?

Answer 9

Etonogestrel implant that lasts 3 years

Question 10

What type of hormone does the depo shot use?

Answer 10

Progestin

Question 11

How often is an injection of depo given?

Answer 11

Every 12 weeks

Question 12

What are two majors risks of depo?

Answer 12

Weight gain! Very common

Mood changes

Question 13

When would you not want to use the depo shot?

Answer 13

If a patient has a desire to return to fertility quickly upon discontinuation - according to prof. white it could take 12-18 months (at the longest) when coming off of progestin only BC

Question 14

What are the 3 types of combination hormonal contraceptives?

Answer 14

Pill, patch, ring

Question 15

Contraindications of pill/patch/ring (I am not going to include them all, there is a ton)

Answer 15

Breast cancer (current or history of)
Diabetes with vascular dz
DVT or PE (current or history of)
Migraines with auras or migraines over 35
Uncontrolled HTN
Women over 35 who smoke

Question 16

What is the least effective contraception methods (if used alone)?

Answer 16

Barrier methods (Pregnancy rate during 1st year = 18%)

Question 17

What is the only type of contraception that protects against STIs?

Answer 17

Barrier methods!

Question 18

What is the mechanism of action of the copper IUD?

Answer 18

Foreign body reaction and chemical changes that may be toxic to sperm and ova

Question 19

What ist he MOA of hormonal contraception?

Answer 19

Thickens cervical mucus
Alters endometrium to affect implantation
Inhibits secretion of gonadotropin to prevent follicular maturation and ovulation

Question 20

What are the two most effective emergency contraception methods?

Answer 20

Copper IUD

Ulipristal (Ella) - requires prescription

Question 21

What is the least effective method of emergency contraception?

Answer 21

Estrogen-progestin regimen (i.e. birth control pill)

Question 22

If you have a minor who comes into the office requesting birth control, but their parent says no, who do you listen to?

Answer 22

The minor

“All minors may give consent to certain sensitive types of treatment where an obligation of parental consent may be an obstacle to treatment”

Question 23

What should you always remember to educate your patients on when starting them on contraceptives?

Answer 23

Contraception does not protect against STI’s! and no method is 100% effective (besides abstinence)