Contraception

Question 1

Distorted uterine cavity

Answer 1

no IUD

Question 2

Breast Cancer

Answer 2

Can use Copper IUD

Question 3

Cirrhosis

Answer 3

mild -any

severe - Copper IUD

Question 4

DVT

Answer 4

Anything but combined methods

Question 5

DM

Answer 5

Nephropathy/Retinopathy/neuropathy- no OCP’s or Injection
Diabetes with vascular disease- no combined or injections
Diabetes >20 years- no combined or injections

Question 6

Endometrial or GTN

Answer 6

Think before using IUD

Question 7

Headaches

Answer 7

consider non-combined method

Question 8

Malabsorptive bariatric procedures

Answer 8

no pills in general

Question 9

AIDS

Answer 9

Don’t place a IUD

Question 10

Hypertension

Answer 10

Consider non-estrogen containing. If uncontrolled or vascular disease no injection/no estrogen

Question 11

H/O MI

Answer 11

Copper IUD is preferred

Question 12

Liver tumors

Answer 12

focal nodualar hyperplasia- any method

Adenoma or malignancy- copper IUD

Question 13

Multiple risk factors for arterial cardiovascular disease

Answer 13

no estrogen or injection

Question 14

Peripartum Cardiomyopathy

Answer 14

No estrogen

Question 15

Infected uterus or cervix

Answer 15

No IUD

Question 16

Smoking

Answer 16

less than 35 estrogen is ok

Question 17

Stroke

Answer 17

IUD

Question 18

APLS

Answer 18

IUD

Question 19

HIV with Ritonavir booster protease inhibitor

Answer 19

No Pills

Question 20

Anticonvulsants

Answer 20

No pills

Question 21

Rifampicin

Answer 21

no pills

Question 22

Benefits of OCP’s

Answer 22

bone density, endometriosis, benign breast disease, ovarian cysts, acne, hirsutism

Question 23

Quick Start

Answer 23

backup contraception for 1 week

Question 24

How does progesterone work

Answer 24

thickens cervical mucus, thins the lining and slows tubal motility

Question 25

missing a pill

Answer 25

if missing 2 pills in the 3rd week or 3 in any other week start a new pack and use back-up

Question 26

Emergency options

Answer 26

Plan B- levonorgesterol .75 q 12
Plan B one step - 1.5 mg
Ella (Ulipristal) 30 mg x1
Yuzpe Regimen

Question 27

Patch

Answer 27

change weekly
150 ug norelgestromin and 20 ug EE
increased risk for VTE

Question 28

Nuvaring

Answer 28

wear for 3 weeks
15 ug EE and 120 ug etonorgesterol
lowest estrogen

Question 29

Medroxyprogestrone acetate

Answer 29

relative contra: cerebro or cardiac vascular disease, SBP>160, DBP >90, Liver tumors, diabetic vascular diease, SLE with APLS

70% irregular bleeding in the 1st year
80% amenorrhea after 5 years

Question 30

Implanon

Answer 30

30-50 mcg of etonogesterel

Question 31

Levonorgesterol IUD

Answer 31

30-50% amenorrhea
vasovagal response with insertion - atropine
IUD expulsion in 3-10%
unable to see string- endocervical brush

Question 32

Contraindication to copper IUD

Answer 32

infection, irregular cavity and wilson’s diease

Question 33

STD screening and IUD placement

Answer 33

Not necessary in low risk and can be done at the same time as placement in high risk
must have negative pregnancy test

Question 34

Pregnancy with IUD in place

Answer 34

If pregnancy continued, increased risks of
spontaneous abortion, infection, and preterm
delivery; removal of IUD reduces but does not
eliminate these risks

Question 35

What is the most effective emergency contraception?

Answer 35

Copper IUD

Question 36

HIV on HAART

Answer 36

Efavirenz, protease interact with hormonal contraception making both less effective. Consider Mirena IUD

Question 37

Seizures

Answer 37

phenytoin, carbamazepine, and phenobarbital decrease effectiveness of birth control
- IUD or Depo

Question 38

On antibiotic that decreases OCP effectiveness?

Answer 38

rifampin