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Women's Health > Contraception and Sterilization - Exam 2 > Flashcards

Contraception and Sterilization - Exam 2 Flashcards

1
Q

What are some alternative reasons a pt might choose to use contraception other than trying NOT to get pregnant?

A

Endometriosis
Polycystic Ovarian Syndrome (PCOS)
Premenstrual Dysphoric Disorder (PMDD)

Acne

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2
Q

What 4 factors make it LESS likely that a women would NOT being using contraception?

A

Lower income

Uninsured

Never married

Zero or one parity

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3
Q

Do patients have to have a pelvic exam before being prescribed contraception?

A

NO! pelvic exam is NOT required

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4
Q

Sperm have been found in cervical mucus _____ sec after ejaculation

A

< 90 seconds

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5
Q

What is the underlying cause of why breastfeeding a newborn is a form of birth control?

A

Suckling → reduced GnRH, LH and FSH

If breastfeeding is exclusive - menses for first 6 months after birth are usually anovulatory

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6
Q

When is it recommended to start using a reliable contraception method after delivery? How effective is Lactational Amenorrhea as a form of contraception?

A

starting 3 mo after delivery

0.9-1.2% pregnancy rate in first 6 months
After 12 months - 7.4% pregnancy rate

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7
Q

When is considered a woman’s fertile period? How effective is periodic abstinence?

A

2-3 days before ovulation to 2-3 days thereafter

10-25 pregnancies per 100 woman-years

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8
Q

What are the 5 different types of periodic abstinence?

A

Calendar Method

Temperature Method

Combined Temperature/Calendar Method

Cervical Mucus (Billings) Method

Symptothermal Method

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9
Q

_____ is the most effective determinant of periodic abstinence. When using the calendar method, Ovulation normally ____ before 1st day of next menstrual period

A

serum LH peak

14 days

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10
Q

_____ is the MC method of periodic abstinence and requires _____. How effective is it?

A

calendar method

regular menstrual cycles

Least reliable method!! - 35% failure rate in 1 yr!!

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11
Q

_____ is more efficacious than calendar method. What is the procedure? What signals the end of the fertile period?

A

temperature method

  1. Taken in AM, before any physical activity
  2. Slight drop in temperature 24-36 hrs after ovulation
  3. Temperature then rises 0.3-0.4 C (0.5-0.7 F) and stays there for the rest of the cycle

Third day after onset of elevated temperature - end of fertile period

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12
Q

What is one drawback of the temperature method?

A

Timing of ovulation for any given cycle is retrospective

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13
Q

What is the effectiveness of the combined temp/calendar method and cervical mucus method?

A

Among well-motivated and compliant couples - failure rates of only 5 pregnancies per 100 couples per year

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14
Q

What is the “Billings Method” of contraception?

A

Cervical Mucus Method

Predicts ovulation by observing changes in cervical mucus

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15
Q

How does your cervical mucous change around ovulation? What is it the rest of the menstrual cycle?

A

cervical mucus becomes thin and watery

Rest of menstrual cycle - thick and opaque

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16
Q

What is the symptothermal method of contraception?

A

Combines cervical mucus and temperature methods and hormonal symptoms that occur right before ovulation

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17
Q

**Which method if the most effective of all the periodic abstinence methods?

A

symptothermal method

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18
Q

What is the difference between COCs and POPs? How effective is it? What does it depend on?

A

COCs - Combination Oral Contraceptives of estrogen and progestin

POPs: progestin-only pills

3-9 per 100 pts

efficacy is user dependent

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19
Q

What is the MC form of estrogen only birth control?

A

ethanyl estradiol (MC)

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20
Q

ethanyl estradiol (MC), mestranol, 17β-estradiol, or estradiol valerate

A

all forms of estrogen only BC

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21
Q

norethindrone, levonorgestrel, desogestrel, norgestimate, drosperinone

Which ones are preferred for less SE but carry a higher risk of _____

A

all forms of progestin only birth control

desogestrel, norgestimate) and 4th gen (drospirenone) progestins have less SE but carry higher VTE risk

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22
Q

_______ is also a spironolactone analogue

A

drospirenone

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23
Q

What is the difference between monophasic and multiphasic BC? What is the standard dosing?

A

Monophasic - same dose of hormones daily

Multiphasic - different doses of hormones during cycle

21 days of active hormone followed by 7 days of placebo

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24
Q

When should you expect withdrawal bleeding after stopping active pills? What is the normal day amount for new prep birth control?

A

Expect withdrawal bleed 2-5 days after stopping active pills

Newer preparations - 24 active pills, 4 inert pills

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25
What is the idea administration of starting oral BC? traditional? quickstart?
Ideal - begin COC the first day of a menstrual cycle traditional: begin the Sunday following the onset of menses quickstart: begin any day of the cycle (commonly the day prescribed)
26
When should you take oral BC?
Strongly encourage regular routine of taking pills same time daily
27
What is the recommendation if you missed a high dose monophasic single dose of oral BC?
Single-missed dose, high-dose monophasic - conception is unlikely Make up pill next day will minimize breakthrough bleed
28
What is the recommendation if you missed several doses or 1 missed dose of lower dose pills?
Double next dose, add barrier contraceptive technique for next 7 days
29
What is the recommendation if you missed ANY BC pills and had unprotected sex in the past 5 days?
consider emergency contraception
30
What is the MOA for COC?
supresses FSH and LH so there is no follicular development Alter consistency of cervical mucus Make endometrium less receptive to implantation
31
______ is the class of medication that has the most overall interactions with COC
Anticonvulsants
32
What are the benefits of COC?
reduced risk of ovarian and endometrial cancers improved bone mass decreased progression of RA improves acne lower risk of ectopic preg and PID decrease in benign fibrocystic breast disease Improvement in dysmenorrhea and premenstrual s/s
33
Why do you think we see the reduction in ovarian cancer and endometrial cancer with COC use?
less LH and FSH which decrease cell turnover in the ovary leading to less risk of cancer
34
_____ is the biggest/ most concerning side effect of COC
VTE especially in the presence of recent leg trauma, pelvic surgery, factor V Leiden, venous stasis
35
What are the other 4 major side effects of COC?
Myocardial Infarction - only in presence of risk factors Stroke - hemorrhagic or ischemic - especially if smoking, increased age, migraines or HTN Liver Disease Cervical Dysplasia/Cancer - increased risk
36
**COC may cause or worsen _______ and should NOT use in women with a hx of _______
HTN or HA migraines with aura
37
**If the pt is breastfeeding and taking oral BC, which type is preferred?
breastfeeding pts should use progesterone only birth control
38
What are the CI to COC?
39
What is the major difference between progestin only and combo OCP? How effective is progestin only?
progestin only birth control does NOT suppress ovulation 2-7 pregnancies per 100 woman/year
40
What is the MOA of progestin only OCP?
Unknown Theorized - cervical mucus becomes less permeable Endometrial activity may go out of phase
41
What is the disadvantage of progestin only contraceptives?
Must take at same time each day - even 2-3 hr delay diminishes efficacy for ~48 hrs Higher rates of irregular bleeding Higher overall pregnancy rate
42
What pt populations ARE ideal candidates for POPs?
older women who smoke sickle cell anemia migraines HTN lupus breastfeeding
43
What are the CI to POPs?
Unexplained uterine bleeding Breast cancer Hepatic neoplasms Pregnancy Active severe liver disease
44
What are the top 4 emergency oral contraceptive methods?
Yuzpe Levonorgestrel Ulipristal IUD insertion
45
What is the Yuzpe method of emergency contraception? What are the pt education points? What are the SEs?
100 μg ethinyl estradiol and 500–600 μg levonorgestrel 2 doses, 12 hours apart 1st dose - within 72 hrs of intercourse, the sooner it is taken the better nausea and vomiting
46
What is the Levonorgestrel emergency contraception?
Single dose of Levonorgestrel 1500 μg (more common) or two 750 μg doses taken 12 hrs apart still needs to be taken within 72 hours of intercourse, may be effective up to 5 days after intercourse
47
What is the MOA of Levonorgestrel?
Prevents LH surge but does NOT stop fertilization or implantation
48
What is the Ulipristal emergency contraceptive method? What is the MOA?
Single dose of 30 mg within 72 hours but may be effective up to 5 days after intercourse Prevents LH surge; may also help delay ovulation after LH surge Does not stop fertilization or implantation
49
_____ can be used for emergency contraception that are not oral forms. What is the associated timing?
IUD Insert up to 5-7 days from time of intercourse for copper and 5 days for levonorgestrel IUD
50
Why are IUDs preferred for emergency contraception?
Better efficacy rates for pregnancy prevention No drop in efficacy with increased BMI Can be left in place to prevent future pregnancies
51
What hormones are in the vaginal ring? What is the pt education?
ethinyl estradiol and etonogestrel or segesterone 3 weeks per month all the time, no need to remove for sex
52
What is the effectiveness for vaginal rings?
0.65 per 100 woman-yrs
53
What hormones are in the transdermal patch? What is the pt education?
ethinyl estradiol and either norelgestromin or levonorgestrel daily 7 days New patch Q wk x 3 wks, followed by patch-free wk apply to the buttocks, lower abdomen, upper outer arm, upper torso (except breast)
54
What is the effectiveness for transdermal patch? What pt population is this option NOT good for?
0.7 per 100 woman-yrs perfect use not good for obese women
55
Which transdermal patch is CI for use in women with a BMI above 30?
Twirla
56
What should you do if the transdermal patch comes off for less than 24 hours? more than 24 hours?
Detached < 24 hrs - cycle continues as usual Detached > 24 hrs - new patch, backup contraception for 1 week
57
How often do pts need to get the depo shot? What is in it?
every 3 months 17-acetoxy-6-methyl progesterone
58
What effect does depo have on the body?
suppressed FSH/LH, thickening cervical mucus and thinning of endometrium
59
How effective is it the depo shot?
Perfect use - 0.3 pregnancies per 100 woman-yrs Typical use - 3 pregnancies per 100 woman-yrs
60
what are the benefits of the depo shot?
Lower risk of ectopic pregnancy Lower risk of endometrial cancer (up to 80%) Lower risk of sickle cell crises May improve endometriosis Does not increase risk of vascular disease
61
**What is the major side effect of the depo shot? Why?
decreased bone density due to the higher levels of progesterone can also cause irregular menses
62
**What are 2 important points regarding the pt education of the depo shot?
Can also cause irregular menses Prolonged menstrual flow and spotting for first 6 months but often become amenorrheic later in the course of therapy Up to 10 months to return to baseline fertility
63
Which BC has no strong association with weight gain, mood changes, or hair loss?
depo shot
64
What type of BC are the arm implants? How long are they approved for?
etonogestrel, a progesterone Approved for up to 3 years
65
What is the MOA of an implanted BC? How effective is it?
changes cervical mucus and tubal motility, can interfere with gonadotropin release, alters endometrium Very high efficacy: No reported pregnancies
66
What are the SE of implanted arm BC? Does it impact bone density?
- irregular menses, weight gain, headache NO impact on bone density
67
How long is the copper IUD good for? What is the MOA?
-approved for 10 years (may be good for longer) thought to be spermicidal, interfere with with ovum development or fertilization, and cause inflammation of endometrium
68
How effective is the copper IUD?
0.6 per 100 woman-years with perfect use, 0.8 per 100 woman-years typical
69
What are the risks/SE of all IUDs in general?
ectopic pregnancy, spontaneous abortion, uterine perforation, expulsion
70
Does the copper IUD have a lower or higher risk of repro cancers?
Associated with lower risk of cervical, endometrial, and ovarian cancer
71
What are the CI to copper IUD?
Intrauterine Contents Infections Uterine or cervical cancer wilson's dz
72
What is the hormone dose with Mirena and Liletta? How long is it good for?
52 mg dose 8 years
73
What is the MOA for Mirena/Liletta?
Thins endometrium, thickens cervical mucus, decreased tubal motility Anovulation in 10-15% of cycles
74
How effective is Mirena/Liletta?
0.1 per 100 woman-yrs (1 yr); 0.7 per 100 woman-yrs after 5 years
75
What is the important pt education for IUDs?
Irregular menses 1st 3-4 months of use but then bleeding tends to decrease significantly
76
What does does Kyleena have? How long is it approved for?
19.5 mg of levonorgestrel 5 years
77
What is an advantage/disadvantage of Kyleena/Skyla when compared to Mirena/Liletta?
Kyleena/Skyla are smaller and may be better for women with a smaller uterus but NOT approved to treat heavy menses like Mirena/Liletta are
78
_____ is the lowest dose of levorngestrel IUD. What dose? How long is it good for?
Skyla 13.5mg 3 years
79
What are the CI for progesterone IUDs? **What are the 2 highlighted ones?
Intrauterine Contents Infections Cancer: uterine or cervical cancer **suspected or known breast cancer **acute liver dz or liver tumor prior ectopic pregnancy
80
How common is IUD expulsion?
5% of women expel IUD within the first year
81
What is the active ingredient for most spermicides? What is the concerned the more "natural" one?
Nonoxynol-9 Phexxi
82
How does Phexxi work? what are the 3 ingredients?
Lowers vaginal pH, causing sperm to become immobile lactic acid, citric acid, potassium bitartrate
83
What is the pt education for spermicides? How long do they last?
Must be placed high in vagina, in contact with cervix, shortly before intercourse around 1 hour
84
_____ is the biggest SE of spermicides?
local inflammation
85
What is the active ingredient in a contraceptive sponge? When can you insert it? How long does it have to stay in place after coitus?
Nonoxynol-9-impregnated polyurethane disc Inserted up to 24 hrs prior to intercourse Must remain in place for 6 hrs after coitus
86
Is a contraceptive sponge more or less effective than a diaphragm or condom?
More convenient but less effective than diaphragm or condom
87
_____ is the MC used mechanical contraceptive in the world. What kind does NOT protect against STIs?
male condom Lamb’s cecum condom is not impermeable to most organisms
88
How do you properly use a diaphragm and spermicide combo? What side do you place the spermicide?
Mechanical barrier between vagina and cervix that is a circular rubber dome supported by a metal spring Spermicide applied on CERVICAL side Device is ineffective without spermicide
89
What is the timing for diaphragm and spermicide? Are these universally sized?
Place up to 6 hours before intercourse Leave in place 6-24 hours after NO!! need to get one fitted and need to refit if the pt gain/loses weight
90
How effective are Diaphragm + Spermicide?
Failure 6 per 100 woman-yr with perfect use 15-20 per 100 woman-yr with typical use
91
What is a cervical cap? How long does it need to stay in place?
Small, cuplike diaphragm placed over cervix that is held in place by suction Leave in place for 8-48 hrs after intercourse
92
What are the disadvantages of a cervical cap?
Difficult to fit cap properly Many women unable to feel their own cervix May use for 1-2 days, but foul discharge usually develops after 1 day
93
What are the requirements in order to be surgically sterilized in the US?
most states have to be over 21 have to be mentally competent state funded insurance: waiting period of 30-180 days
94
What are the options for female tubal sterilization?
Electrocoagulation Mechanical tubal occlusion Ligation of tube with suture material Salpingectomy
95
Which female tubal sterilization method has low long-term failure rate, but highest serious complication rate? Also has a relatively high incidence of ______
Electrocoagulation ectopic pregnancy
96
What are reasons for failure for a female tubal sterilization?
surgical error tubal fistula reanastomosis equipment failure luteal pregnancy
97
______ Female Tubal Sterilization technique showed the greatest decreased risk of ovarian cancer
salpingectomy
98
What does Female Tubal Sterilization due to menstration? functional ovarian cysts?
can be irregular Less duration, less volume of flow, less dysmenorrhea 2x increase in functional ovarian cysts
99
_____ was the stainless steel coil surrounded by polyester fibers and nickel/titanium alloy outer coil that is no longer sold in the US
Essure Permanent Birth Control
100
______ 60-second radiofrequency thermal injury to proximal fallopian tube that is no longer sold in the US as of 2012
Adiana Permanent Contraception
101
**male sterilization has ____ less failure and ____ less postop complication rates vs female sterilization
30x less failure and 20x less postop complication rates vs female sterilization
102
What is the important pt education with regards to male sterlization?
Sterility is not immediate Need 1-2 consecutive sperm counts of zero
103
______ is the safest and most effective method for pregnancies termination. When is it performed? ____ of abortions in the US
Suction curettage Primarily performed at 12 weeks or less gestation >90%
104
What are the advantages of suction curettage?
rapid, minimal blood loss, low risk of perforation very low failure rates and very low mortality rates
105
________ use instruments to scrape inside of uterine cavity but has a _____ for uterine injury than suction.
Surgical Curettage Higher risk not commonly used when compared to suction curettage
106
________ and _____ is the MC and highly effect method of medical abortion. When is it used?
mifepristone (Mifeprex) + misoprostol (Cytotec) 1st-trimester, <49 days from FDLMP
107
What are the benefits of using a pharm abortion?
cheaper, less invasive, and less scarring risk; no need for anesthesia
108
What are the CI to pharm abortion?
active liver or renal disease severe anemia acute IBD bleeding risk (coagulopathy, anticoagulant therapy)
109
What is a sample regimen for a medical abortion?
110
What are some higher risks and NOT commonly used methods for abortions?
Intra-Amniotic Instillation: aspirate all of the amniotic fluid and reinject hypertonic NaCl solution and the fetus will pass within 48 hours vaginal prostaglandins to trigger preterm labor and delivery misoprostol to cause uterine contractions and cervical ripening
111
Which abortion method has the highest rate of complications?
Intra-Amniotic Instillation up to 20%
112
______ is the MC abortion technique in the 2nd trimester. How does it work?
Dilation and Evacuation Modification of suction curettage. Cervical ripening agents are used and large suction cannulas and specially designed forceps to break up and remove fetal tissue from the uterus
113
What are the post-abortion follow up instructions?
114
What are the long term abortion sequelae from having 1 abortion? 2+ abortions?
1 procedure - essentially unchanged risk vs. pts with one normal pregnancy 2+ procedures - possible increased risk for mid-trimester pregnancy loss No correlation with ectopic pregnancy risk for having an abortion
115

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