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Women's Health Exam 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

Age to discuss reproductive health

A

15-55 YO;

“what are your plans for pregnancy in the next year?”

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2
Q

Emergency Contraceptives (EC)

A

2 doses of contraceptive pills w/i 72 hours of unprotected sex

  • Yuzpe “old school” - estrogen 200 mg
  • Plan B or Preven - no estrogen

IUD insert w/i 5 days
- Paraguard (copper IUD)

Ulipristal Acetate (Ella)- SPRM effective up to 120 hrs (5 days); hormonal up to 72 hours (3 days)

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3
Q

Short acting BC

A

oral contraceptive pills
nuva ring
orthoEvra Patch
Depo Provera

*efficacy irreversibly proportionate to frequency

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4
Q

Best candidate for short acting BC

A
  • women who have short interval prior to wanting pregnancy (excludes depo provera)
  • not looking for long term prevention
  • using for non-contraceptive benefits
  • financial concerns/uninsured
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5
Q

OCP MOA

A

suppress ovulation, thicken cervical mucous, thinning of endometrial lining

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6
Q

Progestin only pill (POP) or “mini pill”

A

contain only progestin
less likely to consistently suppress ovulation (focus on thickening mucous and thinning lining)
usually used when estrogen contraindicated

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7
Q

Combination oral contraceptives (COCs)

A

estrogen + progestin
progestin type differs – important for SE profile
Estrogen helps w/ cycle regulation

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8
Q

major progestin only SE

A

irregular, unpredictable bleeding

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9
Q

Types of combo pills

A

monophasic
triphasic
continuous pills

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10
Q

Monophasic pills

A

single dose of estrogen + prosterone for 21-24 days; + placebo pills for 4-7

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11
Q

Triphasic pills

A

not really used anymore

differing dose of estrogen/progesterone throughout course of pack; 7 placebos; lower total dose of estrogen

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12
Q

Continuous pills

A

ex. Seasonique
Monophasic; 84 active, 7 placebo

withdrawal bleeding every 3 months

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13
Q

Continuous pills good for

A

dysmenorrhea

anemia

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14
Q

Caution to COCs

A

well controlled DM, HTN
smoking <35 YO
common migraine h/a
liver disease

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15
Q

Contra to COCs

A 
uncontrolled HTN
CAD
uncontrolled DM
complex migraine h/a (auras)
hx of thromboembolism
hormone sensitive cancers
smoking >35 YO
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16
Q

Eligibility criteria for BC

A

1- no restriction w/ a condition
2- advantages > risks
3- risk > advantages; only used when other methods aren’t available/acceptable
4- unacceptable health risk

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17
Q

POP

A

mini pill
breastfeeding, post-partum moms
estrogen contra
more likely to fail if not taken properly (inadequate ovulation suppression due to non-therapeutic levels)

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18
Q

SE of POP

A

break through bleeding (lack of estrogen)

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19
Q

Progestin-only option

A

Minipill
Depo Provera Shot
Nexplanon implant
Progestin IUD (mirena, skyla, liletta, kyleena)

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20
Q

Pros/cons of minipill

A

pro: pregnant right after stoping
con: spotting; depression, hair/skin changes, change in sex drive

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21
Q

Pros/cons of shot

A

pro: works for 12 mo; decreases periods, no daly pill
cons: spotting, no period, weight gain, depression, hair/skin changes, change in sex drive; delay in getting pregnant after you stop; SE last up to 6 mo after stopping

22
Q

Pro/cons of implant

A

pro: long lasting (up to 4 years); no daily pill; pregnant after removed
cons: irregular bleeding; no period at all after 1 year

23
Q

Progestin only IUD pro/con

A

Pro: works 3-7 years; no daily pill; improve cramps/bleeding; prego after removed

Cons: lighter periods, spotting or no period at all

24
Q

Contra to estrogen

A 
immediate postpartum (increased risk of VTE)
early lactation can be suppressed
hx of thrombophelias
hx of CVD
smokers >35
classic migraines
liver dysfunction
25
Q

Non-contraceptive benefits of OCPs

A

cycle regulation
tx of heavy menses (progesterone thins lining)
tx of acne (suppresses ovarian production of testosterone) - SE vaginal dryness and dysmenorrhea
tx of dysmenorrhea (no prostaglandins)
prevent functional ovarian cysts
prevent ovarian, colon and endometrial CA

26
Q

CA prevention of BC

A

endometrial > ovarian > colon

27
Q

Excluding pregnancy when starting a new method

A
  1. no intercourse since last menstrual
  2. consistent/correctly on reliable method of contraception
  3. w/i first 7 days after normal menses
  4. she is w/i 4 weeks postpartum (non nonlactating)
  5. 1st 7 days postabortion or miscarriage
  6. fully/nearly fully breastfeeding, amenorrhoeic, and less than 6 mo postpartum
28
Q

back up/additional contraception not needed

A

copper-containing IUD

29
Q

> 7 days after menses, use back up BC for 7 days

A

Progesterone-IUD

injectable

30
Q

> 5 days after start of menses, use back up BC for 7 days

A

Implant

COCs

31
Q

> 5 days after menses started, back up for 2 days

A

POP

32
Q

bimanual exam and cervical inspection needed before BC

A

copper IUD

progesterone IUD

33
Q

BP needed before BC

A

COCs

34
Q

No exam needed BC

A

implant
shot
POP

35
Q

Depo Provera

A 
medroxyprogesterone acetate (progesterone only)
Failure: low
Contra: none -- caution with DM, HTN, CVD

SE: irregular cycle, amenorrhea, bone mineral density loss (reversible) – don’t use for more than 2 years due to bone loss

back up if >7 days after menses, use for 7 days

36
Q

Transdermal options

A

nuva ring
ortho Evra Patch

failure: low

Estrogen + progesterone

Contra: same as COCs

37
Q

Barrier methods

A

block fertilization
condom, diaphragm, cervical cap/sponge
failure: high
contra: sensitivity to material

non-contraceptive benefit: lower risk of STD

38
Q

LARCs types

A

implants

intrauterine devices

39
Q

sub-dermal implant

A

hormonal suppression of ovulation

Types: implanon/nexplanon, both contain progestin only

Failure: very low
Contra: allergy to material

40
Q

IU devices

A

MOA: unknown
formulation: progestin containing vs. copper (worse dysmenorrhea)

Failure: very low
Contra: active infection, sensitivity to copper, uterine anomaly, untreated cervical disease

41
Q

SE of IUD

A

follicular cytsts more common

dysmenorrhea w/ copper

42
Q

Types of progestin IUD

A

mirena (FDA approve for menorrhagia)
skyla
liletta

43
Q

Non-progestin IUD

A

Paraguard (copper)

44
Q

Non-contraceptive benefits of IUDs

A

treat menorrhagia (Mirena)

reduce average menstrual blood flow (not FDA approved)

45
Q

LARC benefits

A 
eliminate user input
hormone levels consistent further decreasing ovulation
eliminate frequent doc visit
one less thing for mom to remember
plan pregnancies better
46
Q

Most common sterilization

A

laparscopic

47
Q

types of sterilization

A

laparoscopic
postpartum via mini-laparotomy
transcervical (essue) - removed from market

48
Q

Contraindications to sterilization

A

surgical restrictions

incomplete childbearing

49
Q

Non contraceptive benefit of sterilization

A

Ovarian CA?

50
Q

Laparoscopic sterilization aka

A

“interval” sterilization

51
Q

Laparoscopic procedure

A

requires ventilation and therefore done under general anesthesia
requires hospital/surgery center
outpatient surgery
effective IMMEDIATELY

Women's Health Exam 1 (5 decks)

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