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Endo/Repro > Contraception and Sterilization > Flashcards

Contraception and Sterilization Flashcards

1
Q

What are the two general contraceptive mechanisms?

A
  • Inhibit the formation and release of the egg

- Imposing a mechanical, chemical, or temporal barrier between the sperm and the egg

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2
Q

What is looked at when comparing the different methods?

A
  • Method failure rate or the rate inherent in method if used correctly
  • Typical failure rate or the rate when the method is actually used by the patient
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3
Q

What are the five basic things you have to think about when choosing a birth control?

A
  • Efficacy
  • Safety
  • Availability
  • Cost
  • Acceptability
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4
Q

What are the most effective reversible contraception?

A
  • Hormonal contraceptives
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5
Q

What are the different types of hormonal contracetpives?

A
  • Oral contraceptive pills
  • Injectable: Depo medroxyprogesterone acetate
  • Implantable: etonogestrel rod implant
  • Hormone containing IUD: levonorgestrel
  • Contraceptive patches
  • Contraceptive rings
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6
Q

How do oral contraceptive pills work?

A
  • Suppress the hypothalamic gonadotropin releasing factors with subsequent suppression of pituitary production of FSH and LH
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7
Q

What does progesterone do in OCP?

A
  • Major player
  • Suppresses LH and therefore ovulation as well as thickens the mucosa, inhibiting sperm migration and creating unfavorable atrophic endometrium for implantation
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8
Q

What does estrogen do in OCP?

A
  • Improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
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9
Q

What are the different ways OCPs are packaged?

A
  • Phasic formations: monophasic and triphasic
  • Classic packaging is 21 days of hormones with 7 days of placebo; now could see 24 days of hormones and 4 days of placebo
  • Also have continuous regimens versus every 3 month cycling
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10
Q

What is the use of progestin only OCPs?

A
  • Primarily used for making cervical mucous thick and impermeable
  • Ovulation continues in 40%
  • Mainly used in breastfeeding women and women who have a contraindication to estrogen
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11
Q

What must be done in progestin only OCPs due to the low dose?

A
  • Taken at the same time every day starting on the first day of menses (if late for more than 3 hours, then should use backup method for 48 hours)
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12
Q

What are the benefits of OCPs?

A
  • Menstrual cycle regularity
  • Improve dysmenorrhea
  • Decrease risk of iron deficiency anemia
  • Lower incidence of endometrial and ovarian cancers, benign breast and ovarian disease
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13
Q

What are some mild/moderate side effects of OCPs?

A
  • Breakthrough bleeding
  • Amenorrhea
  • Bloating
  • Weight gain
  • Breast tenderness
  • Nausea
  • Fatigue
  • Headache
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14
Q

What severe side effects of OCPs?

A
  • Venous thrombosis
  • PE
  • Cholestasis and gallbladder disease
  • Stroke and MI
  • Hepatic tumors
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15
Q

What are some details about the patch?

A
  • Apply one patch weekly for 3 weeks
  • Can apply anywhere but breasts
  • Caution in use in women over 198 lbs
  • Side effects are similar to OCPs but greater risk to thrombosis
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16
Q

What is the ring associated with?

A
  • Greater compliance due to once a month use

- Better tolerance since not going through GI tract and less breakthrough bleeding

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17
Q

Who can’t use hormonal contraceptives?

A
  • Women who smoke and are over 35
  • Women with personal history of DVT/PE
  • Women with history of CAD, cerebral vascular disease, CHF, or migraine with aura, uncontrolled HTN
  • Diabetes, chronic HTN, lupus get individualized prescribing
  • Women with moderate to severe liver disease or tumors
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18
Q

How often is depo provera injected?

A
  • Every 11-13 weeks
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19
Q

How long are the levels of progestin maintained after a depo provera injection?

A
  • About 14 weeks
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20
Q

When is the depo provera injected?

A
  • Within first 5 days of menses and if not, use a back up method for 2 weeks
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21
Q

What is the MOA for depo provera injection?

A
  • Thickening of cervical mucosa
  • Decidualization of the endometrium
  • Blocks LH surge and ovulation
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22
Q

What is the efficacy of depo provera?

A
  • Equivalent to sterilization and not altered by weight
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23
Q

What is the relationship between depo provera and bone density?

A
  • Alterations of bone metabolism associated with decreased estrogen levels
  • Particular concern in adolescents
  • Reversible after discontinuation
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24
Q

What are some side effects with depo provera?

A
  • Irregular bleeding
  • Weight gain
  • Exacerbation of depression
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25
Q

How does depo provera affect bleeding?

A
  • Decreases bleeding with use and 80% are amenorrheic after 5 years
  • Can improve bleeding profile with short term use of estrogen
  • Menses can take up to a year to regulate
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26
Q

What are some indications for depo provera?

A
  • Desire for effective contraception
  • Need a method with better compliance
  • Breastfeeding
  • Can use when estrogen is contraindicated
  • Women with seizure disorders
  • Sickle cell anemia
  • Anemia secondary to menorrhagia
  • Endometriosis
  • Decrease risk of endometrial hyperplasia
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27
Q

What are some contraindications to depo provera?

A
  • Known or suspected pregnancy
  • Unevaluated vaginal bleeding
  • Know or suspected malignancy of breast
  • Active thrombophlebitis, or current/past history of thromboembolic events or cerebral vascular disease
  • Liver dysfunction/disease
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28
Q

What is nexplanon?

A
  • Single, radiopaque, rod-shaped implant containing 68 mg etonogestrel, 4 cm long and 2mm in diameter
29
Q

How long is nexplanon used?

A
  • For 3 years

- Preferred to be inserted in first 5 days of menses and if not then use backup for 7 days after insertion

30
Q

What is the MOA of nexplanon?

A
  • Thickens cervical mucous

- Inhibits ovulation

31
Q

What are some side effects of nexplanon?

A
  • Irregularly irregular vaginal bleeding
  • Headache
  • Vaginitis
  • Weight increase
  • Acne
  • Breast pain
32
Q

What are the indications of nexplanon?

A
  • Desires a convenient effective method of contraception

- May be used in breastfeeding patients

33
Q

What are some contraindications of nexplanon?

A
  • Known or suspected pregnancy
  • Current or past history of thrombosis or thromboembolic disorders
  • Liver tumors or active liver disease
  • Undiagnosed abnormal uterine bleeding
  • Known or suspected breast cancer
34
Q

What are some complications with insertion?

A
  • Infection
  • Bruising
  • Deep insertion
  • Migration
  • Persistent pain or paraesthesia at insertion site
35
Q

What are the different types of IUDs?

A
  • Copper T (paragard)

- Levonorgestrel releasing (Mirena/Liletta, Skyla/Kyleena)

36
Q

What are some risks of an IUD?

A
  • Increased risk of infection within first 20 days post-insertion
  • Increased risk of ectopic pregnancy if pregnancy would occur
  • If becomes pregnant, should be offered removal if the strings are visible
  • Risk of uterine perforation at time of insertion requiring laparoscopy for removal
  • Risk of malposition and necessitating hysteroscopy for removal
37
Q

What are some contraindications of IUDs?

A
  • Breast cancer (levonorgestrel containing only)
  • Recent puerperal sepsis or chorioamnionitis
  • Recent septic abortion
  • Acute cervical infection
  • Wilsons disease (Copper T only)
  • Uterine malformations
38
Q

How long is mirena/kyleena used?

A
  • 5 years
39
Q

How long is liletta used?

A
  • 3 years
40
Q

What is skyla used for?

A
  • Used for 3 years

- Originally used for nulliparous women

41
Q

What are the benefits of hormonal IUDs?

A
  • Decrease in menstrual blood loss
  • Less dysmenorrhea
  • Protection of the endometrial lining from unopposed estrogen
  • Convenient and long term
42
Q

How long can the copper IUD be used?

A
  • 10 years
43
Q

What is the MOA for the copper IUD?

A
  • Copper interferes with sperm transport or fertilization and prevention of implantation
44
Q

What are some details about barrier methods?

A
  • Depend on the proper use before, or at the time of intercourse
  • Higher failure rate
  • Inexpensive
  • Require little to no medical consultation
45
Q

What is special about condoms when compared to all barrier methods?

A
  • Only method with protection against STI
46
Q

What are condoms made out of?

A
  • Latex
  • Non-latex
  • Animal membrane
47
Q

What may decrease risk of condom breakage?

A
  • Reservoir tip
48
Q

What is a female condom?

A
  • Vaginal liner
  • Slippage and breakage rate of 3%
  • Recommended to be left in for 6-8 hours after intercourse
49
Q

What is a diaphragm?

A
  • Small latex covered dome shaped device
  • Must be used with a spermicide
  • May be inserted up to 6 hours before intercourse and must be left in for 6 to 8 hours after
  • Several sizes and must be fitted to the individual by a healthcare professional
50
Q

What are women more at risk for when they use diaphragms?

A
  • UTI
51
Q

What is a cervical cap?

A
  • Smaller version of a diaphragm
  • Applied to the cervix itself
  • High risk of displacement and toxic shock syndrome
  • Used with a spermicide
  • Left in place for 6 hours after intercourse
52
Q

What is a sponge?

A
  • Small, pillow shaped sponge containing spermicide
  • Dimple in sponge fits over the cervix/opposite side has a loop for removal
  • Only one size
  • More effective in nulliparous women
  • Left in place for 6 hours after
53
Q

What is the calendar method?

A
  • Calculation of fertile period and avoid sex during that time
  • Cycle beads
54
Q

What is the basal body temperature method?

A
  • Check temperature daily before getting out of bed and will not a 1/2 or 1 degree change at time of ovulation and avoid sex 3 days after
55
Q

What is the cervical mucus method?

A
  • Women assesses her cervical mucus and notes changes around ovulation and avoid sex for 4 days after peak
  • Stretchier it is, the closer to ovulation
56
Q

What is the symptothermal method?

A
  • Combines cervical mucus and basal body temperature

- Awareness of other signs of ovulation –> cramping, breast tenderness, changes in position or firmness of cervix

57
Q

What is the use of emergency contraception?

A
  • Woman who have unprotected sex
58
Q

What are the two types of emergency contraception?

A
  • Plan B

- Ella

59
Q

What is plan B?

A
  • Progestin only –> 2 pills taken 12 hours apart
  • Over the counter for women older than 17
  • Must be used within 120 hours after unprotected intercourse
  • Failure rate 1.1%
60
Q

What is ella?

A
  • Ulipristal acetate 30mg
  • Indicated for up to 5 days after unprotected intercourse
  • Postpones follicular rupture/inhibits or delays ovulation
61
Q

What is sterilization?

A
  • Highly effective birth control without ongoing expense
  • Most frequently used method in US
  • All methods prevent sperm from meeting egg
  • Should be considered permanent
62
Q

What do you talk about when counseling patients?

A
  • Permanent
  • Address all other options
  • Reasons for choosing sterilization
  • Discuss procedure
  • Screen for indicator of regret
  • Possibility of failure and increase risk of ectopic pregnancy
  • Need to use condoms for STI protection
63
Q

What is a vasectomy?

A
  • Occlusion of the vas deferens
  • Safer
  • Not immediately effective –> complete azoospermia complete within 10 weeks
64
Q

What are some post operative complications of a vasectomy?

A
  • Bleeding
  • Hematomas
  • Acute/chronic pain
  • Local skin infections
65
Q

How can a female be sterilized?

A
  • Done by laparoscopy, mini-laparotomy and at time of C section
66
Q

How is a laparoscopy sterilization done?>

A
  • Small incisions, low rate of complications

- Occlude the fallopian tubes with electrocautery, clips,, bands, or a salpingectomy

67
Q

What sterilization method has the highest fail rate but the best chance for reversibility?

A
  • Hulka clips
68
Q

What is a mini-laparotomy?

A
  • Most common approach in the world

- Use small infraumbilical incision in postpartum period or suprapubic incision as an interval procedure

Endo/Repro (31 decks)

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