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OB/GYN > Contraception > Flashcards

Contraception Flashcards

1
Q

Why use contraception?

A

Prevent unwanted pregnancies
Space pregnancies
Prevent pregnancy when it’s dangerous or life-threatening to mother

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2
Q

Other Names for Emergency Contraception

A

Postcoital contraception

“Morning after pill”

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3
Q

Examples of Emergency Contraception

A

Plan B: levonorgestrel
Plan B One Step: levonorgestrel
Ella: ulipristal
Copper IUD

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4
Q

Oral Hormonal Emergency Contraception (Levonorgestrel)

A

No pregnancy test or exam
No medical contraindication
OTC
Effective up to 120 after event

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5
Q

SE of Levonorgestrel

A 
N/V
Irregular bleeding the month after treatment
Dizziness
Fatigue
HA
Breast tenderness
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6
Q

Emergency Contraception that Requires Precautions or Some Contraindications

A

Ulipristal

IUD insertion

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7
Q

Levonorgestrel MOA

A

Inhibiting or delaying ovulation

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8
Q

Copper IUD MOA

A

Interfering with fertilization or tubal transport

Prevent implantation by altering endometrial receptivity

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9
Q

Counseling for Emergency Contraception

A

Obtain pregnancy test if no menses 3-4 weeks after EC
Discuss risk of pregnancy & STIs with unprotected sex
Encourage patient to start a regular contraception method OR review correct use of current one
EC is back up, not a primary contraceptive method

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10
Q

Considerations for Choosing a Contraceptive Method

A 
Efficacy (failure rate)
Safety
SE
Convenience
Cost
Personal lifestyle & pattern of sexual activity
Reversibility
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11
Q

Goals for Educating Patients

A

Dispel misconceptions
Review SE & risks
Compare options to maximize choice appropriate to lifestyle & ability to use correctly
Educate proper use
Distinguish between contraception & protection for STIs
Encourage patients to talke about birth control issues with partner
Patient’s personal needs change over time
Discuss EC with all patients

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12
Q

Categories of Contraception

A

Hormonal
IUD (IUC)
Barrier
Permanent

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13
Q

Options for Contraception Failure

A

Inappropriate use
Failure to use
Failure of method

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14
Q

Hormonal Methods of Contraception

A 
Oral pills
Transdermal patch
Injections
Intrauterine devices
Subdermal implants
Intravaginal
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15
Q

MOA of OCP

A

Suppression of GnRH
Stabilizes endometrium to minimize breakthrough bleeding
Influence of progestin

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16
Q

Types of Suppression of GnRH

A

Inhibits the LH surge
Prevents ovulation
Suppresses FSH secretion
Prevents ovarian folliculogenesis

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17
Q

The Influence of Progestin in OCPs

A

Suppress LH secretion
Suppress ovulation
Thickens cervical mucus
Creates atrophic endometrium unfavorable to implantation
Impairs normal tubal motility/peristalsis

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18
Q

Advantages of Newer Progestins

A

Less effect on carb & lipid metabolism
More effective at reducing acne & hirsutism
Higher HDL/lower LDL
Higher sex hormone binding globulin (SHBG)
Greater affinity to progesterone binding sites
Reduced amenorrhea

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19
Q

Other Uses for OCP

A

Endometriosis: reduce pain
Treatment for acne or hirsutism
Treatment for heavy, painful or irregular menstrual periods
Reduce occurrence of recurrent ovarian cysts
PCOS
PMS/PMDD
Decreased risk of ovarian CA & colon CA
Decrease menstrual migraine

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20
Q

Reasons for High Dose Estrogen

A

Spotting or absence of withdrawal bleeding that can’t be managed at lower doses
Dysfunctional uterine bleeding
Reduce recurrent ovarian cysts

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21
Q

OCP Preparation Types

A

Mono phasic
Multiphasic (biphasic or triphasic)
Extended cycle (withdrawal flow every 12 weeks)
Progestin-only pill

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22
Q

Choosing a Pill Formulation

A

Start with monophasic
Perimenopausal women: lower estradiol pill
Consider androgenic influence of progestin
Breastfeeding women: progesterone only pill

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23
Q

Education for Patients on OCP

A

When to start pill
Take at same time everyday
Miss 1 pill: take ASAP
Miss 2 pills: double up for 2 days
High risk if next cycle not started on time
Nausea in first days
Notify office if: severe/frequent HA, SOB, chest pain, or edema
Menses shorter, lighter, with less cramping

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24
Q

Contraceptive Patch

A

Change every 7 days for 3 weeks; then 1 week off

Delivers constant medication

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25
Q

Vaginal Ring

A

Delivers medication for 3 weeks intravaginally
Remove 1 week, then insert new one
Falls out: rinse with water & reinsert

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26
Q

Absolute Contraindications for Estrogen Contraception

A 
Hx of thromboembolic event, stroke, or known thrombogenic mutation
Known CVD, cardiomyopathy, BP 160/100 or greater, complicated valvular HD
SLE with positive antibodies
Women 35+ who smoke
Migraines with aura
Women 35+ with migraines
Hx of cholestatic jaundice
Hepatic CA or benign adenoma
Active liver disease or severe cirrhosis
Breast CA
First 21 days postpartum
Undiagnosed abnormal uterine bleeding
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27
Q

Careful Consideration prior to Estrogen Contraception

A 
HTN
Anticonvulsant therapy
Migraines without aura
DM
Hx of bariatric surgery with malabsorptive procedure
Psychotic depression
Ulcerative colitis
Obese
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28
Q

Hormone Contraceptive SE

A 
Nausea/bloating
Breast tenderness
Spotting/break through bleeding
Amenorrhea
Fatigue
Headache
Depression/moodiness
Decreased libido
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29
Q

Early SE of Hormone Contraceptives

A

Bloating
Nausea
Breast tenderness
Mood changes

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30
Q

Most Common SE of Hormone Contraception

A

Breakthrough bleeding

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31
Q

When should you try a preparation with more estrogen?

A

Instances of amenorrhea

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32
Q

SE of Excess Estrogen

A 
H/V
Bloating/edema
Hypertension
Migraine headache
Breast tenderness
Decreased libido
Weight gain
Heavy menstrual flow
Leukorrhea
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33
Q

SE of Estrogen Deficiency

A

Early cycle spotting
Breakthrough bleeding
Amenorrhea
Vaginal dryness

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34
Q

SE of Excess Progestin

A 
Acne
Increased appetite/weight gain
Fatigue
HTN
Depression
Hirsutism
Vaginal yeast infections
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35
Q

SE of Deficient Progestin

A

Late breakthrough bleeding
Amenorrhea
Heavy menstrual flow

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36
Q

Risks with Estrogen-Progestin Contraception

A 
CVD
HTN: mild elevation
Stroke: ischemic (low risk)
Carb & Lipid Metabolism
Venous Thromboembolic disease
Increased incidence of cholilithiasis
Breast CA
Cervical CA
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37
Q

Risk of Ischemic Stroke with Estrogen-Progestin Contraception

A

Extremely low risk
Estrogen dose dependent
Other factors: smoking, older age, HTN, migraine with aura, obesity, prothrombotic mutations

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38
Q

Carbohydrate & Lipid Metabolism

A

Mild insulin resistance
Estrogen: serum triglycerides & HDL increase, LDL decrease
Progestin: decrease HDL, increase LDL

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39
Q

Venous Thromboembolic Disease & Estrogen-Progestin Contraception

A

Dose dependent
Risk varies with type of progestin
Older & obese women at greater risk

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40
Q

Hormonal Contraceptive Drug Interactions that may Decrease OCP Efficacy

A 
Phenobarbitol
Phenytoin
Cabamazepine
Barbituates
Griesofulvin
Primidone
Topiramate
Oxcarbazepine
St. John's Wart
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41
Q

Hormonal Contraceptive Drug Interactions that don’t have an Effect on Metabolism

A

Gabapentin
Lamotrigine
Levitiracetam
Tiagabine

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42
Q

What antimicrobial decreases the effectiveness of OCPs?

A

Rifampicin

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43
Q

Progestin Only Mehtods

A

Depo medroxyprogesteron acetate (DMPA or DepoProvera)
Progestin implant
Progestin IUD (Mirena, Skyla)

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44
Q

MOA of Progestin Only Methods

A 
Inhibition of gonadotropin secretion
Inhibition of follicular maturation & ovulation
Thickens cervical mucus
Creates thin, atrophic endometrium
Ovum transport slowed
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45
Q

Individuals with Progestin Only or Not Hormonal Contraception

A 
Breast feeding
Hepatic disease: acute viral hepatitis, hepatocellular adenoma, liver CA, severe cirrhosis, symptomatic, gallbladder disease, cholestasis
Post-partum: first  weeks
Age 35+ & smoker or HTN
Hx of DVT/PE/retinal artery occlusion
Anticipated major surgery
Migraines with aura: any age
Migraines without aura: 35+ or
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46
Q

Advantages to Progestin Only Methods

A

Fewer contraindications
Fewer drug interactions
Long acting
Non-contraceptive benefits

47
Q

Types of Non-Contraceptive Benefits with Progestin Only

A 
Scanty/no menses
Decreased menstrual cramps
Decreased risk of endometrial CA, PID
Decrease endometriosis pain
Low risk of ectopic
48
Q

Disadvantages to Progestin Only Methods

A 
Menstrual cycle disturbances
Possible weight gain
Possible moodiness/aggravation of depression
Decrease in bone density
Increased risk of T2DM
49
Q

Depot Medroxyprogesterone Acetate (CMPA or DepoProvera)

A

Administer every 3 months
Safe post delivery
Return to fertility may take 18+ months after last injection

50
Q

SE of DMPA

A 
Weight gain
Dizziness
Headache
Nervousness
Libido decreased
Menstrual irregularities
51
Q

Clinical Advantages of DMPA

A

Sickle cell anemia: decrease in crises

Intrinsic anticonvulsant effect

52
Q

Implanon/Nexplanon (Progesterone Implant)

A

Single rod: etonogestrel
Lasts for 3 years
Upper arm sub-dermally

53
Q

Jadelle (Progesterone Implant)

A

2 rods: levonorgestrel

Lasts for 5 years

54
Q

SE of Progestin IUD/IUC

A

Irregular bleeding
Breast tenderness
Mood changes
Acne

55
Q

Non-hormonal IUC

A

Copper IUD

56
Q

MOA of Copper IUD

A

Interfere with sperm transport

Prevents fertilization of ova

57
Q

SE of Copper IUD

A

Heavy menses

Dysmenorrhea

58
Q

Ideal Candidates for IUC

A

Not planning pregnancy for 1 year
Want reversible form of contraception
Want/need to avoid estrogen
Want “minimal user effort”

59
Q

IUC Complications

A

Uterine perforation, embedding, cervical perforation

60
Q

IUCs Disadvantages & Cautions

A

PID
Menstrual problems
Expulsion
Pregnancy complication if conception occurs

61
Q

Risk Factors of Expulsion of IUD

A

Nulliparity
Heavy menses
Severe dysmenorrhea

62
Q

Counseling for Expulsion of IUD

A

Check for string after each menses

63
Q

Clues of Possible Expulsion of IUC/IUD

A 
Unusual vaginal discharge
Cramping or pain
Intermenstrual or post-coital spotting
Dyspareunia
Absence or lengthening of IUD string
Presence of IUD at cervical os or in vagina
64
Q

IUCs & PID

A

Serious complication
Most commonly in first few weeks after insertion
Aggressive treatment needed
Do not reinsert IUD in patient with hx of PID

65
Q

IUC Contraindications

A 
Severe uterine distortion
Acute pelvic infection
Known or suspected pregnancy
Wilson's disease or copper allergy
Unexplained abnormal uterine bleeding
Current breast CA
66
Q

Barrier Advantages & Indications

A

Intermittent contraception
STI protection
Decreased cervical neoplasia risk

67
Q

Barrier Disadvantages & Cautions

A 
Allergic to spermicide, rubber, latex, or polyurethane
Abnormalities in vaginal anatomy
Inability to learn correct technique
Hx of TSS
Repeated UTIs
68
Q

Characteristics Associated with Higher Risk of Failure of Barriers

A

Frequent intercourse

69
Q

Failure of Barrier Methods

A

Lack of trained personnel to fit device
Lack of clinical time to provide instruction in use
Full-term delivery within past 6 weeks
Recent spontaneous abortion or vaginal bleeding of any cause

70
Q

Diaphragm

A

Female contraceptive device
Dome-shaped cup
Partially filled with spermicidal cream/jelly
Inserted deep into vagina to cover cervix
Left in vagina 6-8 hours after intercourse

71
Q

Women not Good Candidates for Diaphragm

A 
Allergic to latex/silicone or spermicides
Significant organ prolapse
Frequent UTIs
HIV infection or high risk
Difficulty with insertion
Adolescents
72
Q

Contraindications of a Diaphragm

A

Hx of TSS

73
Q

Advantages of a Diaphragm

A 
Safe/reusable
Inexpensive
Offer some protection against gonorrhea & chlamydia
Immediately effective & reversible
No hormonal SE
Can be used during breastfeeding
74
Q

Disadvantages of a Diaphragm

A 
Willing to insert before each sexual experience & left in place for 6 hours post sexual experience
Requires skill to insert
Must be within reach prior to coitus
May increase frequency of UTIs
Refitting after childbirth
Not available everywhere
75
Q

Failure Rate of Correct Diaphragm Use

A

6%

76
Q

Failure Rate of Typical Diaphragm Use

A

12%

77
Q

Cervical Cap

A

Reusable, deep rubber cup that fits over cervix

Used with spermicide & remain in for 6-8 hours

78
Q

Efficacy of Cervical Cap

A

Nulliparous: 86%

Paroud women: 71%

79
Q

SE of Cervical Cap

A

UTIs
Vaginal infections
TSS

80
Q

Contraceptive Sponge

A

Disk with nontoxynol-9
Moisten with tap water prior to insertion
One size fits all
Benefit for 24 hours
Left in place for 6 hours after intercourse
Increased risk of TSS

81
Q

Define Female Condom

A

Lines vagina & shields introits providing physical barrier during intercourse

82
Q

Problems with Female Condom

A

Breakage
Slippage
Incorrect penetration

83
Q

Failure Rate of Correct Female Condom Use

A

5%

84
Q

Failure Rate of Typical Female Condom Use

A

21%

85
Q

Male Condom Advantages

A 
Accessible & portable
Inexpensive
Male participation
Erection enhancement
Hygienic
Prevention of sperm allergy
Proof of protection
Decreased risk of STIs
86
Q

Male Condom Disadvantages

A 
Reduced sensitivity
Interference with erection
Interruption of coitus
Latex allergy
Embarressment
Breakage/slippage
87
Q

Failure Rate of Typical Male Condom Use

A

18%

88
Q

Failure Rate of Correct Male Condom Use

A

2%

89
Q

Advantages & Indications of Spermicides

A 
Purchased OTC
Used without partner involvement
Immediate protection
Back-up option
Mid-cycle use to augment other methods
Emergency measure if condom breaks
Provides lubrication
90
Q

Disadvantages & Cautions of Spermicides

A

Irritation
Vaginitis
Irritate vaginal lining & enhance spread of viruses

91
Q

Failure Rate of Typical Spermicide Use

A

28%

92
Q

Failure Rate of Correct Spermicide Use

A

18%

93
Q

Withdrawal Method of Contraception

A

Coitus interrupted
Require men to withdraw before ejaculation
Failure occurs if not timed correctly or pre-ejaculatory fluid contains sperm

94
Q

Failure Rate of Correct Use of Withdrawal

A

4%

95
Q

Failure Rate of Typical Use of Withdrawal

A

22%

96
Q

Lactation as a Method of Contraception

A

Breastfeeding delays ovulation

Subfertility

97
Q

Lactation can only be relied upon to prevent pregnancy when:

A

Woman is

98
Q

Factors Contributing to Low Utilization of Fertility Awareness-Based Methods

A

Information limited
Provider bias against or lack of education about methods
Complicated
High failure rate

99
Q

Fertility Awareness Not Recommended when:

A

Recent menarche
Recent childbirth
Approaching menopause
Recent discontinuation of hormonal contraceptives
Currently breastfeeding
Cycles 32 days
Unable to interpret fertility signs correctly
Persistent vaginal infections that affect signs of fertility

100
Q

Fertility Awareness Methods

A

Ovulation method
Symptothermal
Cervical mucus
BBT alone

101
Q

Ovulation Method of Fertility Awareness

A

Predict fertile time based on recent cycle history

102
Q

Symptothermal Method of Fertility Awareness

A

BBT & cervical mucus

Other symptoms of ovulation

103
Q

Cervical Mucus Method of Fertility Awareness

A

Increase in amount

Thin & slippery

104
Q

BBT Alone Method of Fertility Awareness

A

BBT increases 0.5-1 degree at ovulation

105
Q

Failure Rate of Correct Use of Fertility Awareness Methods

A
106
Q

Failure Rate of Typical use of Fertility Awareness Methods

A

24%

107
Q

Failure Rate of Typical Use of Sterilization

A
108
Q

Failure Rate of Correct Use of Sterilization

A
109
Q

Timing of Surgical Sterilization of Women

A

C-section
Early postpartum
Interval: laparoscopic or hysteroscopic as office procedure

110
Q

Types of Laparoscopic Sterilization in Women

A

Bipolar electrocautery
Mechanical devices: clips/bands
Tubal excision

111
Q

Tubal Ligation

A

No contraindications
Decreases risk of ovarian CA
Failure may lead to ectopic pregnancies

112
Q

Factors Associated with Regret of Female Sterilization

A

Young age:

113
Q

Male Sterilization

A

Safer
Less expensive
Lower failure rate
No increased risk of: impotence, testicular or prostate CA, atherosclerotic disease, immunologic disease

OB/GYN (12 decks)

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