Contraception Flashcards
(132 cards)
1
Q
What happens in the follicular stage?
A
FSH stimulates several follicles to develop. The dominant follicle synthesizes enough estradiol to create negative feedback and decrease FSH levels
2
Q
What happens in the ovulatory phase?
A
Estradiol levels peak and exert positive feedback to induce an LH surge, which facilitates the release of the mature ovum. Estrogen promotes proliferation of the endometrium and development of progesterone receptors in the endometrium.
3
Q
What happens in the luteal phase?
A
Progesterone prevents new follicle development as well as differentiation of the endometrium. If no pregnancy occurs, the corpus luteum degenerates, leading to menstrual bleeding.
4
Q
What hormone makes people feel better during menstruation?
A
estrogen- increases energy and feel good feeling
5
Q
What hormone makes people feel bloated, low, and slow?
A
Progesterone
6
Q
What percentage of pregnancies are unintended in the United States?
A
nearly half (45%)
7
Q
What percentage of unintended pregnancies were paid for my medicaid?
A
2/3
8
Q
What are the challenges for family planning?
A
few easy effective methods, low patient compliance and lack of knowledge, societal conflict about FP, clinical challenge, little time, tight budgets, risk taking behaviors
9
Q
What do you need before prescribing contraception?
A
Medical history and blood pressure
10
Q
What is not required prior to prescribing contraception?
A
pap smear, pelvic/breast exam, STI testing, hgb
11
Q
Estrogen has positive effects on ?
A
bone mass, increases serum triglycerides, and improves HDL and LDL ratios
12
Q
Estrogen stimulates which pathways
A
coagulation and fibrinolytic pathways
13
Q
Progesterone increases ___ ____ and _____ ____
A
body temperature and insulin levels
14
Q
Progesterone may depress the ?
A
Central nervous system
15
Q
Estrogen is contraindicated with which types of migraines
A
migraines with aura
16
Q
Progestins are primarily responsible for?
A
contraceptive effect
17
Q
Progestins exhibit a ______ effect in the ______ _____ ____ axis
A
negative
hypothalamic-pituitary-ovarian axis
18
Q
Progestins cause ____ of the endometrium, which ?
A
atrophy
prevents implantation
19
Q
The ____ component improves efficacy by ______ ____ release
A
estrogen
suppressing FSH
20
Q
Estrogen provides _____ ____
A
cycle control
21
Q
What are the three goals of contraceptive treatment?
A
safety, tolerance, effectiveness
22
Q
If a patient has a history of ____, do not use estrogen
A
clotting
23
Q
Progesterone decreases the ____ _____ and may take a ____ to come back
A
endometrial lining; a year
24
Q
Non-contraceptive benefits of OC
A
decreased dysmenorrhea, irregularities, and blood loss
fewer ovarian cysts
lower incidence of benign breast conditions
reduced hospitalizations for gonorrheal PID
endometriosis suppression
25
Contraception significantly reduces the chance of what cancer?
endometrial and ovarian
26
What is contraindicated in a family history of breast cancer?
estrogen
27
venous thrombo-embolism risk increases how much with OC use?
3-5 times
28
Adverse drug reactions with OC
cholestatic jaundice, benign hepatic neoplasms, myocardial infarction, stroke, neurological migraines
29
Estrogen contraindications
migraine with aura, uncontrolled hypertension, postpartum <3 weeks, history of DVT, SMOKING (over 35 and smoking >15 cigarettes/day)
30
Traditional dosing of OC
21 days active drug + 7 days inactive drug
31
Extended cycle dosing for OC
84 days of active drug then 7 days off
32
Withdrawal bleed
Once every 3 months
33
monophasic dosing
same dose of estrogen and progestin for full cycle
34
biphasic dosing
vary the dose of progestin, with an increase in the amount of progestin in the latter half of the active pills (these are rarely used today)
35
triphasic dosing
vary the dose of estrogen, progestin, or both (more popular today)
36
Is there a benefit to doing triphasic dosing? Why?
no benefit to triphasic dosing and you cannot do continuous dosing with this dosing as you are more likely to have break through bleeding
37
If a patient comes to the office for OC and has a negative hcg, when can they start the pill?
same day-but use a backup method for 2 weeks
38
If you are on OCP, can you still have withdrawal bleeding?
yes-at the end of the pack as there are still hormone adjustments
39
OC cycle is better controlled with which dosing?
30-35EE rather than 20mcg
40
Extended cycle dosing decreases what?
the days of bloating and menstrual cramping
41
Which OC would you choose for acne control?
Yazmin
42
If a patient suffers from depression or mood swings around the menstrual cycle, avoid what?
progesterone
43
According to a new study, women have a ___ ____ in pregnancy if on abx.
7 fold increase
44
Emergency contraception dosing
Progestin Only 0.75mg (plan B): must be taken within 72 hours of unprotected sex. pills stat of 1 pill 12 hours apart
45
If taken appropriately, how effective is plan B?
95% within 24 hours, 89% within 72 hours
46
What age do you have to be to buy OTC plan B?
over age 17
47
Plan B is less effective if BMI is >?
26 (165 lbs)- due to lower serum levels; patient may need to double the dose: also offer IUC and oral ulipristal
48
Does plan B disrupt or harm an implanted pregnancy?
No
49
Plan B MOA
inhibits ovulation, thickens cervical mucus, inhibits tubal transport of egg or sperm, may interfere with fertilization or early cell division
50
Ulipristal acetate (ELLA) is what kind of contraception
emergency contraception-decreases risk of unintended pregnancy by 90%
51
ulipristal acetate is effective for how many days after unprotected intercourse?
5 days
52
Ulipristal acetate loses efficacy at what BMI?
35
53
what is ulipristal?
mixed progestin agonist/antagonist
54
Is ulipristal acetate OTC?
No-prescription only; cost is 40-68$
55
side effect of ulipristal acetate?
dizziness, typically resolves in 1 day; also headache, nausea, tiredness, cramping, and abdominal pain
56
dose of ulipristal?
30mg orally in 1 dose
57
MOA of ulipristal?
delays ovulation. not an abortifacient; also has a direct effect on inhibiting follicular rupture making it more effective closer to obulation
58
when is ulipristal preferred?
for overweight and/or obese patients
59
What is the first line contraceptive in teens?
IUD
60
Can IUD's be used as emergency contraception?
Yes-for up to 7 days after unprotected intercourse
61
Is an IUD an abortifacient?
no-it is not disrupting an already established pregnancy
62
Nuvaring contains what ingredients?
progesterone, etonogestrel, and estrogen ethinylestradiol
63
how long can each ring be used for?
one cycle, which consists of a 3 week period of continuous ring use followed by a ring free period of one week
64
how much hormone does each ring release
15 ug of ethinyl estradiol and 120 ug etonogestrel per day over the 3 week periods
65
What is annovera
combo estrogen progesterone ring that can be used for one year, taken out, and washed every cycle
66
patch is the highest dose of ?
estrogen/progesterone
67
what group of people does the patch not work well in?
obese patients as it is absorbed differently in adipose tissue
68
Does the ring/patch or pill have better adherance?
Theoretically the ring/patch as it is not daily
69
how often does the patch need to be changed?
every 9 days
70
progesterone only medications have been thought to affect ____ _____
bone density; but patient regain this when they go off of their medication, bone loss is not permanent;
71
While on progesterone only medications, encourage what supplements?
vitamin D (800 u) and calcium (1200mg)
72
which contraceptive methods are considered highly effective?
male and female sterilization, implants, hormone shot, intrauterine devices: they are not user dependent
73
IUD's release how much levonorgestrel?
between 14 and 20mcg daily
74
how long can an IUD be left in place?
3-5 years
75
what is the benefit of an IUD systemically?
the small level of circulating hormone has low risk of systemic side effects
76
What does the IUD do?
thickening of cervical mucus, endometrial atrophy, and inhibits sperm motility and function
77
IUD has minimal effect on?
ovulation suppression
78
how long does it take for normal endometrium function to return after discontinuation of IUD
1-3 months
79
What IUD's are the smallest?
Skyla and Kyleena, smaller in length and width compared to Mirena and Liletta. They have a smaller diameter insertion tube and Skyla has a silver ring at the top for visualization on ultrasound. The smaller size may make it easier to insert in nulliparous women
80
How long does implanon provide protection?
3 years
81
What is implanon made of?
one rod that contains 68mg of etonogestrel, an active metabolite of desogestrel.
82
Who can insert implanon?
Trained providers, it is easier now because it is only one rod to insert rather than several
83
What is depo-provera?
a long acting injectable, progestin only contraception.
84
How many miligrams in each injection and how long does it last for?
150mg IM for 12-13 weeks
85
how does depo provera work?
thickens cervical mucus and atrophies the endometrium.
86
Are their other injections rather than IM?
yes, subcutaneous 104mg injection offers a lower overall hormone dose with no change in efficacy, even in patients with a higher BMI
87
How early or late can they get their injection?
They should get it every 12 weeks, although a week early or late is acceptable
88
Will DMPA change a women's bleeding pattern?
yes-causing an increased number of days of spotting or amenorrhea
89
what is the primary reason women d/c DMPA?
increased spotting or amenorrhea
90
What is another negative side effect of DMPA?
weight gain
91
How long does it take to restore normal fertility cycles after DMPA?
9-10 months
92
What should you counsel patients on before prescribing depo provera
to increase dietary calcium intake and weight bearing exercise along with smoking cessation to mitigate BMD changes
93
Two brand names of POPs (progestin only pills)
micronor and no-QD
94
What is special about POPs?
They contain no estrogen
95
What populations are contraindicated for receiving estrogen?
migraine with aura, uncontrolled hypertension, postpartum <3 weeks, history of DVT, SMOKING (over 35 and smoking >15 cigarettes/day) and breastfeeding
96
Dosing specifications for POPs?
must take the dose at the exact same time every day as the medication takes 2-4 hours to work and only last for 22 hours
97
what is the primary contraceptive method of POPs?
thickening of the cervical mucosa and prevention of sperm penetration
98
Even if the POP is taken a few hours late, you must use _____ _____ for ___ ____
backup contraception: 48 hours
99
traditional COC dosing
21 days active pill, 7 days inactive pills
100
extended menstrual cycling
84 days of active pill and 7 days off; produces withdrawal bleeding every 3 months
101
What is different about seasonique?
considered monophasic but contain 10mcg of EE in the last week of one cycle of dosing
102
Lybrel dosing
continuous cycle without any hormone free weeks for 1 years.
103
Can other monophasic COC's be dosed continuously?
yes-just take the active pill continuously without the inactive pill
104
What is the newest dosing regimen for monophasic COC's?
24 active and 4 inactive pills per cycle
105
First day start
the first pill is taken on the first day of the menstrual cycle. No backup method is needed when using this initiation method because ovulation will be suppressed with the first cycle
106
Sunday start
the first pill is taken on the Sunday following the start of menses; a backup method is recommended for the first 7 days
107
Quick start
The first pill is taken on the day of the office visit; a backup method is recommended for the first 7 days. This method can be used if the clinician is reasonably sure that the patient is not pregnant
108
3 most common reasons for missed pills
being away from home, forgetting, or not having the pill available
109
If you miss one active pill
take pill as soon as you remember, taking two pills in 1 day if missed pill was the day prior (use backup contraceptive for 7 days)
110
missed two to four active pills
take two pills for 2-3 days (use back up contraception for 7 days)
111
Missed 5 or more active pills
start a new pack on the next start day (ex.Sunday for sunday starters) Use backup contraception until 7 days of active pills are taken
112
How much hormone does the ring release?
15 mcg of EE and 120mcg of etonogestrel daily
113
Dosing for vaginal ring
ring is placed in the vagina for 3 weeks and then removed for 1 week.
114
what is the benefit of the ring
does not need to be placed by a provider, releases a steady, low dose of hormone which offers better cycle control in the form of decreased breakthrough bleeding when compared to COCs, and offers convenient once-monthly self-administration
115
how much hormone is released by the ring
approximately 50% compared to COC and 30% of levels used with the patch
116
Extended cycling with the ring caused what?
increased serum triglycerides and HDL levels
117
research is being done on what types of rings?
dual purpose of contraception and protection from STI's
118
dosing or ortho evra topical patch?
20mcg of EE and 150mg of norelgestromin, which is the primary active metabolite or norgestimate
119
does norelgestromin undergo liver metabolism?
yes, however, it results in the metabolite levonorgestrel which is highly bound to sex hormone binding globulin, limiting it biological impact
120
How often is the patch applied
once a week for 3 weeks and then 1 week off
121
when should the first patch be applied
on the first day of menses; if it is started on any other day, a backup method should be used for 7 days
122
where should the patch be applied
abdomen, upper torso, outer arm, or buttocks and rotated with each patch change. It should be placed on skin that is clean and dry
123
Side effects of patch
similar to those of COC, and skin irritation
124
Decreased patch efficacy in patients with?
increased BMI
125
bleeding is a common side effect of POP and COC, does it usually resolve?
yes, within the first 3-6 months
126
why do some women experience break through bleeding after extended use?
decidualization and fragility of the endometrium, which is a progestational effect-stopping the dosing regimen is unnecessary
127
how can you improve bleeding?
determine when the bleeding is occurring during the cycle and change pill formation
128
side effects from systemic absorption of levonorgestrel
breast tenderness, mood changes, and acne
129
commin side effects of COC, the ring, and patches
nausea, weight gain, mood swings, breast tenderness, and headaches
130
if patient are experiencing a lot of side effects, the provider should encourage?
the patient to try a different pill formulation to manage side effects rather than discontinuing the method altogether
131
what typically resolves the side effects
continued use of the same method
132
what are the three major influences on the continuation of contraception
the number and severity of side effects, concerns over medical risks (cancer, blood clots), and nonmedical factors such as not understanding directions and complicated packaging
