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UMN OBGYN Residency > Contraception > Flashcards

Contraception Flashcards

1
Q

Describe the mechanism of combined oral contraceptives

A

Estrogen > Suppress FSH > No folliculogenesis > prevents ovulation

Progesterone > Thickens cervical mucus, impairs tubal motility + peristalsis, endometrial decidualization and eventual atrophy

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2
Q

List common contraindications for COCs

A
  • Age 35 + Tobacco Use
  • Risk factors for CAD
  • HTN
  • Hx VTE, Stroke, Thrombogenic mutations
  • Valvular heart disease
  • Breast Cancer
  • Liver disease
  • Migraine w/ Aura
  • Roux-en-Y (no PO contraception due to impaired absorption)
  • Pt using meds that induce hepatic enzymes (OCPs not as effective due to increased metabolism)
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3
Q

Which progesterones are considered to have low androgenicity? medium androgenicity? high androgenicity?

A

Low: Norgestimate, dropirenone, desogestrel

Medium: Norethindrone

High: Norgestrel, Levonorgestrel

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4
Q

What is the failure rate for OCPs with “typical use”?

A

7-10%

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5
Q

What is the failure rate for POPs with “typical use”?

A

9%

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6
Q

What is the failure rate for DMPA with “typical use”

A

6%

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7
Q

What is the mechanism for DMPA?

A

Suppresses gonadotropins, thickens cervical mucus, decreases tubal motility

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8
Q

What is the BLACK BOX warning for DMPA?

A

Loss of 5% of bone mineral density with 5 years of use, completely reversible after5 years if used < 2 years

*Conflicting data on fracture risk

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9
Q

What is the failure rate for LARCs?

A

All methods effective with failure rate <1%

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10
Q

What is the failure rate for Nexplanon?

A

0.05%

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11
Q

Describe key points when counseling patients about Nexplanon/”The implant”

A
  • 68 mg Etonogestrel*
  • Effective for 3 years
  • Failure rate 0.05%
  • 1-2% risk of insertion/removal complications
  • 10% discontinue for AUB
  • Typically 10 days of spotting for every 90 days

**Contraindication: Current breast cancer

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12
Q

What is the mechanism of action of Nexplanon?

A

Suppresses ovulation, thickens cervical mucus, decreased tubal motility

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13
Q

What is the mechanism for LNG-IUD?

A

Decreased sperm migration due to thickened cervical mucus viscosity

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14
Q

Describe key points when counseling patients about LNG-IUD

A
  • Effective 3-5 years pending type
  • Failure rate 0.2% in first year
  • Risk of expulsion 2-10% in first year
  • Risk of perforation = 1.4 per 1,000 insertions
  • Side effects = AUB, pain, N/V, HA, mood changes, ovarian cyst formation
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15
Q

What is the mechanism of Cu-IUD?

A

Inflammatory! Decreased sperm migration, ovum transport, ovum destruction

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16
Q

Describe key points when counseling patients about Cu-IUD

A
  • Effective 10 years
  • Failure rate 0.8% in first year
  • Risk of expulsion 2-10% in first year
  • Risk of perforation = 1.1 per 1,000 insertions

**Contraindications = Wilson’s disease

UMN OBGYN Residency (23 decks)

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