contraception Flashcards
what is mechanism of copper IUD vs LNG IUD?
- copper IUD: acts as pre and post fertilization; inhibition of sperm, altered tubal motility, destruction of ovum
- LNG IUD: same as copper IUD + endometrial thinning/altered cervical mucus
what are the different types of LNG IUD– what are differences, how long do they last?
52 mg of LNG
- Mirena: LNG-20, delivers 20 mcg daily; 5 years
- Liletta: LNG-18, delivers 18.6 mcg daily; 4 years
- 5 mg LNG
- Kyleena: LNG 19.5, delivers 17.5 mcg dialy (5 years) - 5 mg LNG
- Skyla- LNG-13.5, delivers 14 mcg daily, 3 years. smaller T frame
back-up needed with LARCs?
- no backup contraception needed for copper IUD
- for LNG IUD, need 7 days of backup contraception unless:
a) immediately s/p surgical AB
b) within 21 days of childbirth
c) transition from other reliable method
d) within 7 days of menses - for implant - all the above except within 5 days of menses for (d)
risk of migration of implant?
- up to 40%
- best way to localize with newer generation is xray
- older version, high frequency US (52 hz and higher)
contraindication to IUD
- active pelvic infection/STDs
- pregnancy
- malignancy
- undiagnosed vaginal bleeding
- uterine anomalies
- PID, PP endometritis, septic AB within the past 3 months
what is definition of postpartum IUD inseriton?
- up to 10 minutes after delivery
- increased risk of expulsion (10-27%) vs interval or psot-AB
- contraindicated in pts with IAI/endometritis, PPH, sepsis
actinomyces comes back on pap, with IUD in place. what do you do?
- do not need treatment if asymptomatic.
when are the highest PID rates after IUD?
- first 3 weeks
what are benefits of OCPs other than contraception?
- regular menses
- decreased dysmenorrhea
- RR endometrial ca/ovarian ca
- decreased fxnl ovarian cysts and benign disease
- treatment of endometriosis
criteria for being reasonably certain someone is not pregnant
- menses in last 7 days
- no intercourse since last menses
- breast feeding (85%+ feeds), amenorrhoeic, < 6 mos of delivery
- within 4 weeks postpartum
- using contraception reliably
starting OCPs- when do you need backup?
- no backup contraception needed if menses 5 or fewer days ago
- if more than 5 days, the abstinence until next cycle or backup contraception x 7 days
when can you start OCPs postparutm?
- not within the first 21 days, risk of VTE too high
- between 21-30 days, risk of VTE goes down. but intereference with breast feeding occurs up to 30 days. so if breast feeding, can initiate OCPs at 30 days on. if not can initiate at 21 days
- any risk factor for VTE, should way 4-6 weeks after delivery to start OCPs. VTE risk does not return to baseline until 12 weeks PP
contra-indications to OCPs
- breast cancer
- any estrogen sesnitie tumor
- thrombophilia
- smoke over 35 years
- CHD/CVA
- migraine with aura
- superficial DVT
DM and OCPs?
- okay to use, would use alternative if 20+ years or microvascular
specific meds that mess with metabolism?
- liver enzyme inducers:
- carbamazepine (tegretol), felbamate, phenobarbital, phenytoin, primidone.
- OCPs reduce lamotrigene (lamictal)
- st johns wart: hepatic enzyme inducer increases E&P metabolism
what antibiotic reduces estrogen levels?
rifampin
what antiretroviral reduces estrogen levels?
fosamprenavir
essure/tubal occlusion follow-up?
- 3 months HSG, if tube(s) patent repeat in 3 months
- if still patent in 6 months, then consider procedure failure
- have to be on contraception during confirmation period
obesity and ocps?
- increased risk of vte and failure
- however benefits outweigh risk, and vte risk in pregnancy is higher
- if hx of roux en y can decrease absoprtion
SLE and OCPs?
if no evidence of vasculitis, nephritis, APAS, then okay!
