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Contraception > Contraception > Flashcards

Contraception Flashcards

1
Q

Combination pills

A

Alter the dosage of estrogen and progestin throughout the cycle
Ethinyl estradiol + norgestimate (oath-cyclen, Ortho Tri-cyclen, Ortho Tri-cyclen Lo
Ethanol estradiol or menstranol, synthetic estrogens
Norethindrone

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2
Q

Progestin-Only

A

Mini-pills
Not as effective
MOA affects the cervical mucus and the endometrium
Most likely changes tubal transport of ocyte and sperms

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3
Q

Estrogenic effects of OCP’s

A
  • Ovulation inhibited by suppression of FSH/LH
  • Implantation inhibited by alteration of the endometrium
  • Ovum transport is accelerated
  • Luteolysis may occur as estrogen causes progesterone levels to fall
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4
Q

Progestational effects

A
  • Thick cervical mucus interferes with sperm transport
  • Capacitation may be inhibited
  • Ovum transport is accelerated
  • Implantation is hampered by suppression of endometrium
  • Ovulation inhibited by hypo-thalamic-pituitary-ovarian disturbance
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5
Q

Advantages of OCP’s

A
  • Excellent protection against unwanted pregnancy
  • Safe for most women
  • Decreased menstrual cramps and pain
  • Less menstrual blood flow
  • Improvement to facial acne
  • Women control own fertility
  • Excellent reversibility and easy to use
  • May provide protection against ovarian and endometrial cancer, ectopic pregnancy, PID, functional ovarian cysts, endometriosis, uterine fibroids
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6
Q

Disadvantages of OCP’s

A
  • May lead to mood changes
  • No protection against STD’s, HIV
  • Expensive for some women
  • Rare circulatory complications which may be dangerous
  • increased risk of rare liver tumors
  • pills must be taken every day
  • possible SE of Nausea, HA’s, breakthrough bleeding
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7
Q

Excessive estrogenic effects

A
  • Dysmenorrhea
  • Nausea
  • Chloasma
  • CVA
  • DVT
  • Thromboembolic disease
  • PE
  • Telangiectasis
  • Hepatic adenoma/adenocarcinoma
  • Cervical changes
  • Breast tenderness
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8
Q

Deficiencies in estrogen

A
  • No withdrawal bleeding
  • Decreased duration in menstrual bleeding
  • Continuous spotting/bleeding
  • Breakthrough bleeding on day of cycle 1-9
  • Atrophic vaginitis
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9
Q

Excessive progestational effects

A
  • Breast tenderness
  • Transient hypertension
  • Depression
  • Fatigue
  • Decreased libido
  • Decreased duration of menstrual bleeding
  • Increased appetite
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10
Q

Deficiencies in progesterone

A
  • Breakthrough bleeding DOC 10-21

- delayed menses

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11
Q

Excessive androgenic effects

A
  • Hirtuism
  • Acne
  • Oily skin
  • Edema
  • Increased libido
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12
Q

Excess estrogen/deficient progesterone combo effects

A
  • Dysmennorrhea
  • Menorrhagia (excessing bleeding during menses)
  • n/v
  • HA
  • Irritability
  • bloating/edema
  • syncope
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13
Q

Absolute contraindications of OCP’s

A
  • H/o thromboembolic disorders
  • H/o CVA
  • CAD
  • Known breast carcinoma
  • Pregnancy
  • Benign or malignant liver tumor, impaired liver function
  • Previous cholelithiasis during pregnancy
  • Undiagnosed, AUB
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14
Q

General consideration of OCP’s

A

Being with low-dose combined or multiphasic pill (35mcg or less)
Progestin only pills may be used for women w/ hx of migraine HA’s, who are breast feeding or who have contraindications to combo pills

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15
Q

Adverse effects of OCP’s

A
  • AUB (may need higher dose)
  • Amenorrhea or hypermennorrhea (may need progestin increased)
  • Birth defects (estrogen is preg category X)
  • Cancer (pts w/ + family hx of breast ca should not use)
  • Hypertension
  • Weight gain, increased appetite, fatigue, depression, acne, hirtuism (may need to decrease progestin)
  • Nausea, edema, breast tenderness (may need to lower estrogen)
  • Thromboembolic disorders
  • Abx and anticonvulsants can decrease effectiveness of OCP’s
  • OCP’s can decrease effectiveness of warfarin, insulin and some hypoglycemics
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16
Q

Nuva RIng

A

Flexible, prescriptive contraceptive ring

Typical failure rate is <1-2%

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17
Q

MOA of Nuva RIng

A

Releases synthetic estrogen and progestin for 1 month
Release of hormone through vaginal contact
Prevents ovulation

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18
Q

Advantages of Nuvaring

A 
Convenient, once per month insertion
Easily reversible
Fewer mood swings 
Discreet
May lead to shorter, lighter and more regular menstrual periods
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19
Q

Disadvantages of Nuvaring

A

Similar to OCP’s
Diaphragm’s, cervical caps, or shields cannot be used as back up
May worsen depression

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20
Q

Contraindications of Nuvaring

A

Age >35 yo
Smoking
Uncontrolled hypertension
Hx of any cardioembolic disorder

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21
Q

Management of Nuvaring

A

Inserted 1x per month for 21 days (not more not less)
Must be inserted on the same day of the week as it was inserted last cycle or pregnancy may occur
If ring slides out–MUST be inserted within 3 hours
Unopened packages must be proceed from sunlight or high temps

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22
Q

The Patch- Ortho Evra

A

Transdermal contraceptive patch that releases synthetic estrogen and progestin
Failure rate <1-2%

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23
Q

Advantages of the patch

A

Once per week administration
can be worn for 3 weeks
easily reversible

24
Q

Disadvantages of the patch

A

Site reactions
Same as OCP’s
Reduced effectiveness in women >90kg
More estrogen released than OCP’s–increased risk for cardioembolic effects

25
Q

Contraindications of the patch

A

Age >35
Smoking
Hypertension
Hx of cardioembolic disorders

26
Q

Management of the patch

A

Apply to arm, buttocks, torso, abdomen (NEVER breast) on either the 1st day of her menstrual cycle or the first sunday following that day
Patch is removed after 7 days, then reapplied
If the patch is off for >24 hours, restarting a new 4 week cycle is necessary

27
Q

Depo-provera

A

Long-acting progestin administered IM

Typical first year failure rate <1%

28
Q

MOA of depo

A

Suppresses FSH and LH, blocking the LH surge, inhibiting ovulation
thickens cervical mucus interferes with sperm transport and penetration
alters endometrium

29
Q

Advantages of Depo

A

Highly effect, long-acting, convenient
Prolonged amenorrhea possible
Useful in reducing pain associated with endometriosis
No-estrogen related side effects
Possible reduction in risk of PID and endometrial and ovarian cancers

30
Q

Disadvantages of Depo

A 
Menstrual irregularities (usually amenorrhea)
Delayed return of fertility (usually 1 year)
Injection q3months
Can cause lipid changes (decreased HDL)
Possible reduction in bone density with long-term use
31
Q

Contraindications of Depo

A

Allergy
Unexplained uterine bleeding
Pregnancy

32
Q

Management of Depo

A

Must have pregnancy test if >2weeks since 3month period
Two week grace period for injection
DO NOT massage injection site
Back up method should be used during first 2 weeks after injection , unless administered by DOC 5

33
Q

Nexplanon

A

Single, thin flexible rod which contains etonogestrel
Failure rate 0.01%
MOA: same as other progestins, Long-acting reversible contraceptive (LARC)

34
Q

Advantages of nexplanon

A 
Continous protection for 3 years
no estrogen related s/e
few serious system complications 
Scanty or absent menses/decreased anemia
decreased menstrual cramps
may decrease risk of endometrial cancer
35
Q

Management of nexplanon

A

Requires informed consent
Irregular menstrual periods, including menses, spotting and absent periods
initial expenses are higher

36
Q

IUD

A

Artificial device with either metal wrapping or chemically impregnanted surface
Failure rate 1-3%

37
Q

Types of IUD’s

A 
Copper-releasing (Paragard)-10 years
Progestin releasing (Mirena)- 5 years
38
Q

Advantages of IUD’s

A

Progestin-releasing may decrease menstrual loss and dysmenorrhea

39
Q

Disadvantages of IUD’s

A

Pain and cramping many accompany used
Increased menstrual bleeding
Pregnancy- SA in up to 50% of cases if IUD left in uterus
Ectopic pregnancy occurs in 5%

40
Q

Undesirable effects of IUD’s

A 
Spotting, bleeding, hemorrhage, anemia
Cramping and pain
Expulsion of IUD
Loss of IUD string
Pregnancy 
PID--rate is higher in the first 6 weeks of insertion
41
Q

Contraindications of IUD’s

A

Active, recent or recurrent pelvic infections including GC and Chlamydia
pregnancy
Risk for PID
Undiagnosed, irregular or abnormal uterine bleeding

42
Q

Management of IUD’s

A

May be inserted anytime during the cycle

May insert 4-8 weeks postpartum

43
Q

Diaphragm/Cervical cap

A

Flexible, dome shaped cup constructed of latex, rubber
blocks sperm from cervical Os
First year failure rate 18%
May provide some protection against STD’s when used with spermicidal gel
Inserted before sexual activity

44
Q

Management of diaphragm

A

Should have refitted if weight gain exceeds 20 lbs
Avoid oil based lubricants
Must be left in vagina for 6 hour post intercourse

45
Q

Disposable BC

A

Spermicides & condoms

46
Q

Spermicides

A

nonoxynol-9 or octoxynol
21% first year failure rate
OTC
Enhances effects of barrier methods

47
Q

Condoms

A

Sheath-like covering usually made of latex
Typical first year failure rate Male 12% female 21%
OTC, safe, protection against STDs

48
Q

Management of Condoms

A

Avoid use of oil-based lubricants

Leave 1/2 inch of empty space at end of condom

49
Q

Emergency Contraception

A

Mechanisms used to either prevent fertilization or the implantation of a fertilized egg in the uterus

50
Q

Oral emergency contraception

A

Levonorgestrel (plan B)
OTC, w/o prescription for women 17 yo, need prescription for <17
Taken within 72 hours of unprotected sex
NOT the “abortion pill”
85% effective
SE: N/V, fatigue, HA, dizziness, diarrhea, breast tenderness

51
Q

IUD emergency contraception

A

An alternative form of emergency contraception
Must be inserted within 5 days of intercourse
99% effective

52
Q

Sterilization

A

Failure rate: Female 1:400, male 1:600
Female tubal ligation, male vasectomy
Permanent form of contraception for both

53
Q

Calendar method

A

Record serial cycles, identifying longest and shortest cycles
Determine fertile phase by subtracting 18 days from the shortest cycle and 11 days from the longest cycle
Abstain during this time

54
Q

Basal Body Temp graph

A

Record daily BBT prior to rising in AM over a 3-4 month period
Temp drops 12-24 hours prior to ovulation and rises following ovulation
Avoid intercourse from 2-3 days prior to expected drop and approx 3 days following the rise

55
Q

Cervical mucus test (billings test)

A

Record changes in cervical mucus (Spinnbarkeit) over 3-4 month period
Not when mucus changes from scant and thick amount to thin with increased spinnbarkeit
Abstain from time of mucus change until approx 4 days after change

56
Q

Symptothermal method

A

Uses both BBT and cervical mucus changes

57
Q

Lactational Amenorrhea

A

Patient relies on breastfeeding for natural family planning, as breastfeeding often delays onset of ovulation and menstruation for approx 6 months

Contraception (1 decks)

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