Contraception and Sterilization Flashcards
Which general class of contraceptives provide the most effective reversible contraception?
Hormonal contraceptives
What is the implantable hormonal contraceptive called?
Etonogestrel rod implant (Nexplanon)
What hormones are contained in the combo oral contraceptives; describe how each hormone contributes to its function?
- Progesterone = major player –> suppresses LH and therefore ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium
- Estrogen: mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
How does the progestin-only oral contraceptive (mini-pill) work; chance of ovulation; and who is it mainly used in?
- MOA is primarily making cervical mucous thick and impermeable
- Ovulation continues in about 40% of users
- Mainly used in breastfeeding women and women who have contraindication to estrogen
When using a progestin-only OC (mini-pill) when must the patient take the pill and what if they mistime a dose?
- Because of low dose, they MUST be taken at same time everyday starting on first day of menses
- If pt is >3 hours late taking pill should use backup method for 48 hours
What are 4 benefits to using hormonal oral contraceptives?
- Menstrual cycle regularity
- Improve dysmenorrhea (painful periods)
- ↓ risk of iron deficiency anemia (shorter and less heavy cycles)
- Lower incidence of endometrial and ovarian cancer, benign breast and ovarian disease (cysts)
What are some of the side effects associated with oral contraceptives?
- Breakthrough bleding: 10-30% experience during first 3 months of use (make sure to counsel it will improve!)
- Amenorrhea
- Mild AE’s: bloating, weight gain (perceived), breast tenderness, nausea, fatigue, and HA
What is a contraindication for using hormonal oral contraceptives?
Migraine WITH aura
What are 5 serious AE’s associated with hormonal oral contraceptives?
- Venous thrombosis
- Pulmonary embolism
- Cholestasis and GB disease
- Stroke and MI
- Hepatic tumors
What is the name of the hormonal contraceptive transdermal patch; how often is it applied?
- OrthoEvra
- Apply one patch weekly for 3 weeks
Caution should be used when using the transdermal OC, orthoevra, in whom?
Women >198 lbs.
There is a greater risk of what AE associated with the transdermal patch, Orthoevra?
Greater risk of thrombosis
What are the benefits of the hormonal contraceptive ring, NuvaRing?
- Combo of progesterone and estrogen
- Associated w/ greater compliance due to once a month use
- Can be removed for up to 3 hours without affecting efficacy
- Better tolerated since not going thru GI tract and less breakthrough bleeding
Who can’t use combination contraceptives?
- Women over 35 who smoke cigs
- Women w/ personal hx of thromboembolic event
- Women w/ hx of CAD, cerebral vascular disease, CHF or migraine w/ aura, uncontrolled HTN
- Women w/ moderate to severe liver disease or liver tumors
Caution should be used in women with which underlying conditions when considering combination contraceptives?
- Diabetes
- Chronic HTN
- SLE
What is the name of the injectable hormonal contraceptive?
Depo medroxyprogesterone acetate (DepoProvera)
How long does injectable, DepoProvera, maintain contraceptive level of progestin; when is it preferred to be given?
- Maintains contraceptive level of progestin for about 14 weeks
- IM injection every 11-13 wks, preferred to be given within first 5 days of menses and if not, use a back up method for 2 weeks
What is the MOA of the injectable contraceptive, DepoProvera?
- Thickens cervical mucous
- Decidualization of the endometrium
- Blocks the LH surge and ovulation
What is the efficacy of the injectable contraceptive, DepoProvera?
Roughly equivalent to sterilization and is not altered by weight
Which AE associated with DepoProvera caused the FDA to issue a black box warning; what is this warning?
- Alterations of bone metabolism assoc. w/ ↓ estrogen levels
- Particular concern in adolescents
- Reversible after discontinuation
- BLACK BOX = if used for more than 2 years should consider alternative method
Side effects associated w/ injectable, DepoProvera?
- Alterationsinbone metabolism
- Irregular bleeding –> ↓ with use, but 25% will discontinue within one year
- Weight gain
- Exacerbation of depression
What is a strategy for improving the bleeding profile in someone suffering from irregular bleeding while on DepoProvera?
Short term use of estrogen add back (usually wait till after receiving 2nd dose)
What are some of the underlying conditions where the contraceptive DepoProvera can still be used?
- Women w/ seizure disorders
- Sickl cell anemia
- Anemia secondary to menorrhagia
- Endometriosis
- ↓ risk of endometrial hyperplasia
List 4 indications for choosing the contraceptive DepoProvera?
- Desire for effective contraception
- Need a method w/ better compliance
- Breastfeeding
- Can be used when estrogen is contraindicated
List 5 contraindications for the use of the contraceptive DepoProvera?
- Known or suspected pregnancy
- Unevaluated vaginal bleeding
- Known or suspected malignancy of the breast
- Active thrombophlebitis or current/past hx of thromboembolic events or cerebral vascular disease
- Liver dysfunction/disease
How long is the long acting reversible contraceptive (LARCS), Nexplanon good for?
Used for 3 years
What is the MOA of the long acting reversible contraceptive (LARCS), Nexplanon?
- Thickens cervical mucous
- Inhibits ovulation
List 6 side effects associated with the long acting reversible contraceptive (LARCS), Nexplanon?
- Irregularly irregular vaginal bleeding
- HA
- Vaginitis
- Weight increase (mild)
- Acne
- Breast pain
What are the contraindications for use of the long acting reversible contraceptive (LARCS), Nexplanon?
- Known or suspected pregnancy
- Current (yes) or past hx of thrombosis or thromboembolic disorders (consideration)
- Liver tumors or active liver disease (poorly metabolized)
- Undiagnosd abnormal uterine bleeding
- Known or suspected breast cancer (only absolute)
What are the names of the 5 hormone containing IUD’s?
- Copper T (Paragard)
- Levonorgestrel releasing = Mirena and Skyla + Liletta and Kyleena
What are some of the risks associated with IUDS?
- ↑ risk of infection within first 20 days post-insertion
- ↑ risk of ectopic pregnancy if pregnancy would occur
- Risk of uterine perforation at time of insertion requiring laparoscopy for removal
- Risk of malposition and necessitating hysterscopy for removal
List 6 contraindications to using IUDS; which are specific to levonorgestrel containing and which to Copper T?
- Breast cancer - levonorgestrel containing only
- Recent puerperal sepsis
- Recent septic abortion
- Active cervical infection
- Wilson disease - Copper T only
- Uterine malformations (uterine septums/fibroids/enlarged >10cm)
Which IUDS are used for 5 years and which are used for 3 years?
- Mirena/Kyleena are used for 5 years
- Liletta/Skyla used for 3 years
List 4 benefits to using the levonorgestrel containing IUDS.
- ↓ in menstrual blood loss (up to 50%)
- Less dysmenorrhea (painful periods)
- Protection of endometrial lining from unopposed estrogen
- Convenient and long term
How long is the Copper T IUD, Paragard, used for and what is it’s MOA?
- Used for 10 years
- Copper interferes w/ sperm transport or fertilization and prevention of implantation
Women who use diaphragms as a method of contraception are more likely to get what?
UTI’s
What are the contraindications to using emergency contraception?
NO medical contraindication to use
Which hormone is found in Plan B and how quickly must use take it?
- Progestin only (levonorgestrel) 2 pills taken 12 hrs apart
- Must be used within 120 hrs after unprotected intercourse
How long after unprotected sex can you take the emergency contraceptive, Ella; what is it’s MOA?
- Indicated for up to 5 days after unprotected sex
- Postpones follicular rupture / inhibit or delay ovulation
How long after vasectomy does it take for complete azoospermia?
Takes about 10 weeks
What are the benefits and risks to using electrocautery for female sterilization?
- Fast!
- ↑ risk of thermal injury to surrounding tissue
- Poor reversibility
- Greater risk of ectopic pregnancy
What are the differences between hulka anf filshie clips used for female sterilization?
- Hulka = MOST reversible method, but greatest failure rate >1%
- Filshie = lower rate of failure because of larger diameter
Female sterilization is done using which methods?
- Laparoscopy
- Mini-laparotomy
- Hysteroscopy
- At time of C-section
Why is the use of salpingectomy as a means of female sterilizaton increasing in use?
Due to recent literature regarding decrease in ovarian cancer risk
What is the most common method of female sterilization throughout the world and how is it done?
- Mini-laparotomy
- Use small infra-umbilical incisions in postpartum period or suprapubic incisions as an interval procedure
