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GYN > contraception > Flashcards

contraception Flashcards

1
Q

Factors to Consider for contraception

A

Efficacy
Convenience
Duration of action
Reversibility and time to return of fertility
Effect on uterine bleeding
Frequency of side effects and adverse events
Affordability
Protection against sexually transmitted diseases

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2
Q

LARC

A

long acting reversible contraception

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3
Q

failure rate for NFP

A

20%

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4
Q

rate of pregnancy in people not planning for anything

A

25%

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5
Q

failure rate for withdrawl

A

18-20%

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6
Q

Lactation Amenorrhea Method

A

<6mo postpartum
exclusively breastfeeding
amenorrheic

can still get pregnant

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7
Q

Barrier methods

A

Male Condom-NOT WITH OIL BASED LUBE
Female Condom
effectiveness increased with spermicide

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8
Q

How do you use a diaphragm

A
  1. Pregnancy rate 16% with typical use
  2. Requires fitting by a clinician
  3. Not for preventing STD
  4. Leave in 6-8 hrs after intercourse then remove and wash
  5. May increase risk of UTI

can increase the risk of transmission of HIV positive

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9
Q

Cervical Cap can be left in

A

for up to 48 hrs

must be fitted like diaphragm

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10
Q

Monophasic pills

A

dose is the same throughout the pac

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11
Q

Triphasic

A

dose of progesterone is the same throughout but estrogen changes

when we talk about dosing it is always talking about estrogen dosing

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12
Q

implantable devices are what kind of hormone

A

progesterone only

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13
Q

benefits of taking BC pills

A

treats

endometrial cancer
acne
risk of ovarian cancer
dysmenorrhea

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14
Q

if you put someone on continuous extended cycle the need to be on this type of pill

A

monophasic

might do this with endometriosis

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15
Q

the weeks off

A

progesterone withdrawal to get withdrawal bleed

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16
Q

most current BC pills contain ____ estrogen

A

20-35 mcg

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17
Q

most SE with BC are due to

A

progesterone

PRO GESTASION

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18
Q

in women on a 20 mcg pill what would you do for breakthrough bleeding

A

after 3 months if their HPO axis is still not on track increase the dose

Very low dose (20 mcg) pills may cause more breakthrough bleeding than higher doses

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19
Q

when would you start people on 20mcg pill

A

teens and women who have not had bc beforev

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20
Q

has anti-mineralocorticoid and anti-androgen properties

A

Drospirenone

Marketed for pts with acne

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21
Q

this has a low androgen binding affinity it is indicated for pts with

A

Norgestimate

Indicated for pts with PCOS, acne

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22
Q

Synthetic progestins have this effect on pts

A

progestins bind to progesterone and androgen receptors

Androgen binding affinity can cause unwanted side effects (weight gain, acne)

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23
Q

what to do for ASE

A 
i.	Irregular menstrual bleeding – 32%
	Menses often get lighter and less painful with time
ii.	Nausea – 19%
        Usually resolves within 3 months
        Take W/ food
iii.	Weight gain – 14%
iv.	Mood swings – 14%
v.	Breast tenderness – 11%
vi.	Headache – 11%
vii.	CV or thromboembolic events
     higher rate for pts with hx of migraine of family hx
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24
Q

CI for combo pill

A

Previous thromboembolic event or stroke

Migraine esp w/ aura but menst migraine workds

History of an estrogen-dependent tumor

Liver disease

Pregnancy or breast feeding

Undiagnosed abnormal uterine bleeding- fibroids or endometrial cancer

Cerebral vascular or coronary artery disease (past or current history)

Complicated valvular heart disease

Women over age 35 years who smoke –> increases your risk for thromboembolic event or stroke

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25
Q

indications for progesterone only pill

meaning this person should NOT be on estrogen

A

pretty much the same as the CI of estrogen combo pill

Migraine headaches with aura but probably anyone now

Age over 35 years and smoker or obese

History of thromboembolic disease

Cardiac disease, especially coronary artery disease or congestive heart failure

Cerebrovascular disease

Early postpartum period

Hypertension with vascular disease or older than 35 years of age

Systemic lupus erythematosus with vascular disease, nephritis, or antiphospholipid antibodies

Hypertriglyceridemia

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26
Q

what are the risks of progesterone only pill

A

More breakthrough bleeding

Slightly higher failure rate

Must be taken at the same time (within 3 hours) every day; no placebo period

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27
Q

advantage of a Sunday start

A

never have period on a weekend

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28
Q

quick start method

A

neg UPT

back up method for 7 days

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29
Q

First day start

A

– start on 1st day of menses

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30
Q

Quick start method of BC what do you need

A

start on day Rx is given (neg UPT)

need to use back up for 7 days

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31
Q

Sunday start

A

start on 1st Sunday after menses

never have period on weekend!

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32
Q

Minipill, when do you have to use back up mehtod

A

when miss it more than 3 hours

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33
Q

Combined oral contraceptives- when do you have to use back up method

A

if >2 pills in a month are missed, use a back-up method for the rest of the pack

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34
Q

benefits of nuvaring

A

lower absorption of hormones
(no progesterone!)

Rapid return to ovulation after discontinuation

Lower doses of hormones so won’t get a lot of the PMS symptoms

Ease and convenience
Improved cycle control

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35
Q

CI to nuvaring

A

Same contraindications as estrogen pills

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36
Q

Transdermal estrogen patch risks

A

Similar side effect and efficacy data to NuvaRing and oral contraceptive pills

Same cardiovascular disease risk as birth control pills

probably need to rotate to avoid irritation

safer than the pill but you still get absorption of estrogen

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37
Q

why does birth control lower libido

A

estrogen binds to sex hormone binding globulin

lowering libido

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38
Q

name of Injectable contraceptives

A

Depot medroxyprogesterone acetate (DMPA)

39
Q

pro/con with Injectable progestin

A

99.7% effectiveness

Amenorrhea and weight gain may occur

Cannot use > 2 years due to risk of osteoporosis

Recommend giving first injection while the pt is on their period (know they are not pregnant) get a UPREG every time too

Document negative pregnancy test

40
Q

subdermal implants are what type of hormone?

A

progesterone only

41
Q

fertility return with implanon

A

Contraception is provided for three years

Fertility returns rapidly after removal of the rod

42
Q

primary reason for d/c the implanon

A

Irregular bleeding was the primary reason for discontinuation in premarketing studies

43
Q

ideal candidates for IUD

A
  1. Are at low risk of acquiring sexually transmitted infections
  2. Are not planning a pregnancy for at least one year
  3. Want to use a reversible contraceptive
  4. Want or need to avoid estrogen-based methods
44
Q

CI for IUD

A
  1. Severe uterine distortion
    a. Bicornuate uterus, cervical stenosis, or leiomyomata distorting the uterine cavity
  2. Active pelvic infection
  3. Known or suspected pregnancy
  4. Wilson’s disease or copper allergy (copper IUD)
  5. Unexplained abnormal uterine bleeding
  6. Current breast cancer (Mirena IUD)
45
Q

disadvantages of IUD

A 
	Changes in bleeding patterns
•	Amenorrhea
•	Unscheduled bleeding
	Breast tenderness
	Mood changes
	Acne
46
Q

advantages of iUD

A

 Reduction in menses & dysmenorrhea
 Treatment of endometrial hyperplasia
 Endometrial protection at perimenopause
 Treatment of endometriosis

47
Q

who should the insertion be scheduled

when f/u

A
  1. Cycle day 5-10 ideal
  2. Patient has been abstinent since LMP
  3. Documented negative pregnancy test
  4. Screening for STDs
  5. NSAIDs 30-60 minutes prior to procedure
  6. Insert IUD
  7. RTC in 4 weeks to check strings, side effects
48
Q

ASE for IUD

A
  1. Abnormal bleeding
    a. Intermenstrual bleeding or spotting
    b. Common in first 3 months
    c. Heavy bleeding (decreased with NSAIDs)
  2. Pregnancy complications / ectopic pregnancy
  3. Pain or partner feels strings
  4. Expulsion (more likely with Skyla)
    a. 3-10% copper; 6% Mirena
  5. Infection within first 20 days: 1/1,000
  6. Perforation: 1/1,000
    a. Risk with inexperience,
    immobile/retroverted uterus
49
Q

what can you do for pts with break through bleeding and IUD

A

put on a very small dose of estrogen

50
Q

risks of IUD

A
  1. Uterine perforation  due to inexperienced provider
  2. Syncope
  3. Diaphoresis
  4. Vomiting
  5. Unable to insert
  6. Cramping/bleeding
  7. Expulsion
  8. Embedment in myometrium
51
Q

permanent sterilization for women

A

BTL

52
Q

primary ocntraception methods for women in the US

A 
OCP
Female sterilization
condoms 
male sterilization
injectables 
other
53
Q

pregnancy rates with diaphragm and spermacide

A

Pregnancy rate 16% with typical use

Really only effective when you use spermacide

54
Q

how long can you leave a diaphragm in for

A

Leave in 6-8 hrs after

55
Q

who is the diaphragm not recommended for

A

Not recommended for HIV positive pts

56
Q

what are the pregnancy rates with a cervical cap and what affects this

A

Pregnancy rate 16%; 32% if previous births

57
Q

cervical cap come sin this many sizes and can be left in for how long

A

Leave in vagina 6-8 hrs (up to 48 hrs), then remove and wash

58
Q

sponge rates of pregnancy

A

same as the cervical caps

Pregnancy rate 16% for typical use; 32% if previous births

59
Q

what do you have to do before inserting a sponge

A

wet with water

60
Q

Nonoxynol-9 is

A

spermacide

61
Q

problems with spermacide

A

May cause local irritation, some increase in bacterial vaginosis infections, and may be messy

Effectiveness is reduced if the patient does not wait long enough for the spermicide to disperse before having intercourse, if intercourse is delayed for more than one hour after administration

62
Q

Estrogen/progestin-induced inhibition of the midcycle surge of

A

gonadotorpin

63
Q

gnrh

A

released in pulses from the hypothalamus
determines FSH and LH release (anterior pituitary)
and these control the maturation of the ovarian follicles

64
Q

Theca cells

A

has LFH receptors which sti,ulate a precursor to estrogen

granulosa cells have FSH receptors that also have a precursor needed to convert the theca cell precursor into estrogen

negative feedback signal to the pituitary

less FSH means only enough to stimulate one follicle

65
Q

lactation amenorrhea only works if

A
  1. The woman is less than six months postpartum
  2. She is breastfeeding exclusively (ie: not providing food or other liquid to the infant)
  3. She is amenorrheic
66
Q

can you leave a cervical cap, diaphragm, or a sponge in for longer

A

cervical cap 48 hours
sponger 30
diaphragm 8 hrs

67
Q

to avoid breakthrough bleeding

A

monophasic

68
Q

excess estrogen has this effect on the menstrual cycle

A

block gnRh and the development of the follicle

69
Q

rates of pregnancy with OTC

A

8% with regular use

1% with perfect use

70
Q

cyclic pills have this on and off

A

21 or 24 active followed by 7 or 4 inactive pills

71
Q

nausea weight gain moodiness

A

progesterone

72
Q

cardiac SE

A

estrogen

73
Q

drospirenone

A

progesterone with
anti-mineralcorticoid properties that lower testosterone

helps with bloating and acne
PMDD
PCOS

74
Q

Norgestimate

A

Ortho Tri-Cyclen and Previfem

these have low androgen binding affinity

75
Q

drospirenone

A

Yasmen and angeliq

these have mineralocorticoid

76
Q

weight gain is the result of

A

progesterone

77
Q

Migraine headaches with aura

CI for OCP

A

increased risk of stroke

NO ESTROGEN

78
Q

Undiagnosed abnormal uterine bleeding

why is this CI with OCP

A

Could be fibroids and don’t want to feed

79
Q

Liver disease

why no OCP

A

because liver needs to destroy hormones and excess estrogen can cause strain

80
Q

F/U for OCP

A 
in the months
sxs
SE
satisfaction
BP
HA assessment with chronic headaches

then can refill prescriptions annually

81
Q

emergency contraception

A 
copper paraguard  (within 5 days)
ella  and plan B  (ASAP)
82
Q

when can you take emergency contraception

how does it work

A

with 120 hours but most effective within 72

disrupts uterine lining
with whopping dose of progesterone

and then withdraw = bleeding

83
Q

hormones in plan be

A

Plan B contains two 0.75mg tabs levonorgestrel to be taken 12 hrs apart

Plan B One-Step contains one higher dose tab of levonorgestrel

Next Choice One-Step is another brand of levonorgestrel (one pill)

84
Q

10 year pregnancy rates with copper vs levo

A

levo 1.1

copper 2,.2

85
Q

copper IUD CI

A

Dysmenorrhea or menorrhagia

Wilson’s disease or copper allergy

86
Q

CI with morena

A

Hormonal sensitivities

Current breast cancer

87
Q

uterine distortion that would be CI with IUD

A

Bicornuate uterus,

cervical stenosis,

or leiomyomata distorting the uterine cavity

88
Q

Levonorgestrel IUD

A

200mcg progesterone released daily (Mirena)

Progestin effect is primarily local

Hormonal side effects, such as breast tenderness, mood changes, and acne may occur

Mirena, Skyla

89
Q

higher expulsion with copper or morena

A

morena

90
Q

Tubal ligation (BTL)

A

Mechanical blockade using clips, rings, coils, or plugs

Coagulation-induced blockage

91
Q

Coagulation-induced blockage works by

A

using electrical current or chemical agents

92
Q

Hysteroscopic Sterilization

A

Essure
2 part procedure
Fibrotic reaction causing stenosis of tubes
3 mo after fiber placed need to do HSG

93
Q

Only method of permanent sterilization that gives confirmation of sterilization

A

Hysteroscopic

GYN (13 decks)

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