Contraception

Question 1

Contraceptive RX list

Answer 1

• ESTROGENS: estradiol, Ethinyl estradiol
• PROGESTINS: Progesterone, norethindrone, (levo)norgestrel
• PROGESTERONE RECEPTOR MOD: ulipristal, mifepristone

Question 2

Contraception types (7)

Answer 2

• surgical sterilization
• IUD
• Estr/Progest
• Progestin
• Barrier
• Natural Family planning
• ER contraception

Question 3

Before sex =Permanent

Answer 3

• trans-cerv sterilization
• tubal ligation
• vasectomy

Question 4

After sex

Answer 4

• copper IUD
• Ulipirstal
• Plan B
• Combo pill

Question 5

Before w/ sex = REVERSIBLE= Long-acting

Answer 5

• HORMONAL= Progest IUD, Implant

* NON-HORMONE= Copper IUD

Question 6

BEFORE SEX = REVERSIBLE = SHORT-ACTING

Answer 6

*HORMONAL = E/P COMBO = Nuvaring, Pill, Nuvaring, PROG ONLY= Pro-pill, Depot

*NON-HORMONAL= Condom, Diaphragm, Sponge, Natural family Planning, cervical cap
BARRIER = 10-20% failure

Question 7

Window after stopping pill to avoid pregnancy?

Answer 7

NO

Question 8

Failure rate

Answer 8

Hormonal = 10%

IUD = <1%

Question 9

Depot side effects

Answer 9

• weight = 10-15lb per year

* Transient bone density decrease

Question 10

Progesterone effects

Estrogen effects

Answer 10

PROG: *LH suppression (ovulation)

• Cervical mucus plug
• Atrophic endometrium

ESTR: *FSH suppression (no follicle stim)

• Altered tubular transport
• moderates side effects of progest(acne, bleeding)

REMOVAL: withdrawal bleed (progesterone)

Question 11

E/P contraindications

Answer 11

*Chronic liver dz
*HTN
*Migrain w/ aura
*Personal Hx of breastcancer (not FH), NOT breast cancer BRCA risk
*Nephropathy
*Ischemic Cardio
*DVT
*
Estrogen = endometrial (only auterine women can take straight estrogen)

Question 12

E/P toxicities

Answer 12

• N/V
• HA
• Breast large/tender
• Alterations in libido
• Breakthrough bleeding
• Acne, oily skin, hirsuitism (progestin)
• Hair loss

Question 13

Copper IUD side effects

Answer 13

*copper IUD

• WILL NOT GIVE PID W/ INFXN
• CAN HAVE IF NULLIPAROUS
• 70’s DELCON SHIELD = braided cotton string, ascending infxn

Question 14

E/P benefits

Answer 14

• PMS tx
• Heavy periods
• Menstrual cycle control
• Treating acne
• Preventing STIs
• DOWN ovarian/endo/colon cancer
• Dysmenorrhea/endometriosis TX

Question 15

IUDs

Answer 15

• COPPER: stop sperm+ implantation, 10yrs
• LNG-IUD= stop ovulation, stop cerv mucus, stop sperm
• CONTRA: Bact STI= Tx b/f insertion (HPV OK), unexplained uterine bleed, large fibroids, Wilson’s dz/copper allergy, OK:young, nulliparous, many partners, STI past Hx
• S.E.: uterine perf, expulsion, cramp, PID (1st 30days), Copper: heavy menses, LNG (w/ prog): spotting, less period

Question 16

Depot Medroxyprogestrone

Answer 16

• can take 6 months to reverse

* Diapgragm

Question 17

Natural planning

Answer 17

Cervical mucus monitoring (ovulation= thin, stringy, stretchy, don’t have sex for 7days after) > calendar/bracelet (abst= 9-20d)

Ovulation thermometer= rises at ovulation (rises in 0.something) = don’t do when sick

Ovulation stick= 2 lines - ovulate in 24 hrs (sperm lives 2-3 days), line shows up and you had sex yesterday= NOT CONTRACEPTION

Question 18

ER contraception

Answer 18

*High dose levonorgestrone pill (Plan B) = w/in 72 hrs, less effective if obese
*combo e/p = several pills (not good, estrogen makes you pills)
*Ulipristal= may early abortion
*Copper IUD = turns into Birth control (10 yrs), all weights
W/IN 120 hours (5d)
DELAY OVULATION = NOT WORK IF IMPLANTED
S.E: bleed (take preg test if missed), N/V, Headache, ab pain (ulipristal)

Question 19

Mifepristone

Answer 19

• anti-prog
• UP to 9weeks, then mech abortion
• shed lining
• Follow-plan = image to confirm