Contraception

Question 1

T/F: Oral contraceptives either contain progestin or estrogen but never both.

Answer 1

False: Oral contraceptives either contain progestin alone or progestin plus estrogen

Question 2

Give the advantages and disadvantages of condoms as a contraceptive.

Answer 2

Advantages: protect against HIV and STI
Disadvantages: require motivation and consistency

Question 3

Give the advantages and disadvantages of diaphragm and cervical cap as a contraceptive.

Answer 3

Advantages: n/a
Disadvantages: not effective without spermicide

Question 4

Give the advantages and disadvantages of spermicide as a contraceptive.

Answer 4

Advantages: n/a
Disadvantages: must be used w/ barrier method and must be applied 1 hour pre-intercourse

Question 5

Give the advantages and disadvantages of contraceptive sponge as a contraceptive.

Answer 5

Advantages: n/a
Disadvantages: placement 1 hour before intercourse

Question 6

Give the advantages and disadvantages of oral contraceptives.

Answer 6

Advantages: highly effective and decreased risk of cancer
Disadvantages: adherence, various AEs –> significant AE with estrogen products

Question 7

Give the advantages and disadvantages of fertility awareness and withdrawal as a contraceptive.

Answer 7

Advantages:
Disadvantages: not effective

Question 8

Give the advantages and disadvantages of surgical sterilization as a contraceptive.

Answer 8

Advantages: generally 100% effective
Disadvantages: permanent and 3 months of alternate contraception required

Question 9

Give the advantages and disadvantages of transdermal patches as a contraceptive.

Answer 9

Advantages: need only be placed once every week
Disadvantages: adherence, less effective in overweight women, black box warning = increased estrogen s/p no first pass metabolism meaning increased risk of thrombosis

Question 10

Give the advantages and disadvantages of a vaginal ring as a contraceptive.

Answer 10

Advantages: generic, movement in vagina ok, can remove during sex
Disadvantages: irritation or wetness, discharge, foreign body sensation

Question 11

Give the advantages and disadvantages of injectable progestins as a contraceptive.

Answer 11

Advantages: q 3 months
Disadvantages: weight gain, decreased bone mineral density, delayed return of fertility

Question 12

Give the advantages and disadvantages of subdermal progestin implants as a contraceptive.

Answer 12

Advantages: can remain in place 3 - 5 years
Disadvantages: surgical procedure, takes about 30 days for return of fertility after removal

Question 13

Give the advantages and disadvantages of an IUD as a contraceptive.

Answer 13

Advantages: long term contraception, quick return of fertility, decreased risk of thrombosis
Disadvantages: surgical placement, inflammation, doesn’t protect against STI

Question 14

Give the advantages and disadvantages of a copper IUD as a contraceptive.

Answer 14

Advantages: can be used as emergency contraception, effective for 10 years
Disadvantages: contraindicated in patients with PMH of endocarditis, inflammation, increased cramping, increased volume of menstruation

Question 15

What is the number one AE associated with use of estrogen in an oral contraceptive?

Answer 15

Thrombosis –> DVT, PE, etc.

Question 16

What activity, when combined with the use of an estrogen containing contraceptive, greatly increases the risk of its main AE?

Answer 16

Smoking

Question 17

What are the three options for emergency contraception?

Answer 17

Plan B
Ella
Implanted copper IUD

Question 18

T/F: Plan B is a legend drug.

Answer 18

False: It is available OTC –> anyone can purchase it.

Question 19

Why is Ella not commonly used as an emergency contraceptive?

Answer 19

Because it requires a prescription

Question 20

What is the major problem with using Plan B as an emergency contraceptive?

Answer 20

The patient may experience nausea –> repeat the dose if vomiting occurs within 2 hours of ingestion

Question 21

What is a caution in prescribing an oral contraceptive that contains drospirenone?

Answer 21

Drospirenone is an analogue of spironolactone, a K sparing diuretic. Use caution in patients on an ACEi or ARB or any patient at risk for hyperK.

Question 22

What are the advantages and disadvantages of the progestin-only “mini pill”?

Answer 22

Advantages: lower risk of thromboembolism.
Disadvantages: adherence - must be taken within same 3-hour time window each day.

Question 23

What is the advantage of oral contraceptives that contain iron?

Answer 23

Some women become anemic from blood loss during menstruation. Iron containing pills help combat the anemia.