Contraception and sterilization (Wootton)

Question 1

What provide the most effective reversible contraception?

Answer 1

Hormonal contraceptives

Question 2

Majority of oral contraceptives are a combination of ____ and ____.

Answer 2

Estrogen and progesterone

Question 3

Oral contraceptives cause suppression of what hormones?

Answer 3

1) Hypothalamic GnRH

2) Pituitary LH and FSH

Question 4

The __1__component of the oral contraceptive is the major player by suppressing LH and therefore ovulation as well as thickening cervical mucus, inhibiting sperm migration and creating an unfavorable atrophic endometrium for implantation.

The __2__ component mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding.

Answer 4

1) Progesterone

2) Estrogen

Question 5

The progestin-only oral contraceptives have a MOA of?

Answer 5

Making cervical mucus thick and impermeable

Question 6

The progestin-only oral contraceptives is mainly used in __1__ women and women who have a contraindication to __2__.

Answer 6

1) Breastfeeding

2) Estrogen

Question 7

Some benefits of oral contraceptives include a __1__ menstrual cycle.

They can improve __2__ which is a common side effect of menstruation.

They decrease the risk of __3__ due to shorter and less heavy cycles.

They can lower incidence of __4__ and __4__ cancers.

Answer 7

1) Regular
2) Dysmenorrhea
3) Iron deficiency anemia
4) Endometrial and ovarian

Question 8

What are side effects seen with oral contraceptives either in the first three months or in the first year?

Answer 8

1) Breakthrough bleeding

2) Amenorrhea

Question 9

Some serious side effects of oral contraceptives include?

Answer 9

1) Venous thrombosis
2) PE
3) MI
4) Hepatic tumors

Question 10

The transdermal patch contraceptive has what hormones in it?

There is caution with use in women greater than how many pounds?

Side effects and precautions same as oral contraceptives except for greater risk of?

Answer 10

1) Estrogen and progesterone
2) 198 pounds
3) Thrombosis

Question 11

The vaginal ring contraceptive has what hormones in it?

Why is it associated with greater compliance?

Answer 11

1) Estrogen and progesterone

2) Because of its once a month use

Question 12

What is the prescription for the newer vaginal ring, the annovera vaginal ring?

Answer 12

Prescription for 13 months in one reusable ring

Question 13

For the annovera vaginal ring you place in vagina for __1__ days and remove for __2__ days and then reuse.

Answer 13

1) 21 days

2) 7 days

Question 14

What populations can not use oral contraceptives?

Answer 14

1) Over 35 and smoke
2) History of thromboembolic event
3) Moderate to severe liver disease

Question 15

Depot medroxyprogesterone acetate (Depo provera) is given by __1__ every 11-13 weeks.

It maintains contraceptive level of __2__ for about 14 weeks.

Preferred to be given within first 5 days of __3__ and if not use a backup method for 2 weeks.

Answer 15

1) Intramuscular injection
2) Progestin
3) Menses

Question 16

The MOA of Depot medroxyprogesterone acetate is a thickening of __1__.

Decidualization of the __2__.

It blocks the __3__ and ovulation.

Answer 16

1) Cervical mucus
2) Endometrium
3) LH surge

Question 17

With Depo-Provera, alterations of ____ metabolism is associated with decreased estrogen levels.

Answer 17

Bone

Question 18

What side effects are associated with Depo-Provera?

Answer 18

1) Irregular bleeding
2) Weight gain
3) Exacerbation of depression

Question 19

What implantable hormonal contraceptive is a single, radiopaque, rod-shaped implant containing 68 mg etonogestrel, 4cm long and 2mm in diameter?

It can be used for how many years?

Answer 19

1) Nexplanon (Etonogestrel implant)

2) Three years

Question 20

What is the MOA of Nexplanon?

Answer 20

1) Thickens cervical mucus

2) Inhibits ovulation

Question 21

What are side effects of implants?

Answer 21

1) Headache
2) Weight increase
3) Breast pain

Question 22

What are contraindication of implant?

Answer 22

1) Known or suspected pregnancy
2) Liver tumors or active liver disease
3) Known or suspected breast cancer

Question 23

What are some complication of implant insertion?

Answer 23

1) Infection
2) Deep insertion
3) Persistent pain or paraesthesia at site

Question 24

The copper T (Paragard), Mirena/Liletta and Skyla/Kyleena are all what type of contraception?

Answer 24

Intrauterine devices

Question 25

Intrauterine devices have an increased risk of ____ if pregnancy would occur.

Answer 25

Ectopic pregnancy

Question 26

The levonorgestrel containing IUDs such as Mirena/Liletta and Skyla/Kyleena are contraindicated with?

Copper T is contraindicated with?

Answer 26

1) Breast cancer

2) Wilson’s disease

Question 27

A benefit of IUDs is protection of the ___ from unopposed estrogen.

Answer 27

Endometrial lining

Question 28

What is the MOA of Copper T (Paragard)?

Answer 28

Copper interferes with sperm transport

Question 29

Diaphragms are small latex covered, dome shaped devices that must be used with a ____.

Answer 29

Spermicide

Question 30

Diaphragms may be instered up to 6 hours before intercoure and must be left for how many hours after?

Answer 30

6 to 8 hours

Question 31

Women who use diaphragms are more likely to get?

Answer 31

Urinary tract infections

Question 32

A cervical cap (FemCap) is a smaller version of diaphragm that is applied to the cervix itself. It has a high risk of displacement and?

Answer 32

Toxic shock syndrome

Question 33

A cervical cap (FemCap) similar to a diaphragm must be used with a?

Answer 33

Spermicide

Question 34

What form of barrier contraceptive is small, pillow shaped and contains spermicide?

Answer 34

Sponge

Question 35

A sponge is more effective in ____ women.

Answer 35

Nulliparous

Question 36

Basal body temperature method is done by checking temperature daily before getting out of bed and noting a .5 to 1 degree change at time of ovulation and avoid sex for ___ days after.

Answer 36

3 days

Question 37

Cervical mucus method is done by the woman assessing her cervical mucus and notes changes around ovulation (spinnbarkeit) and avoid sex for ___ days after peak.

Answer 37

4 days

Question 38

How is the Symptothermal method done?

Answer 38

Combine cervical mucus and basal body temperature methods

Question 39

What emergency contraception method uses a regimen of tablets within 72 hours of unprotected sex?

Answer 39

Combined oral contraceptive method

Question 40

Plan B is __1__ only 2 pills taken twelve hours apart and is over the counter for women older than 17.

It must be used within __2__ after unprotected intercourse.

Answer 40

1) Progestin (levonorgestrel)

2) 120 hours

Question 41

Ella is __1__ which postpones follicular rupture/inhibit or delay ovulation.

It is indicated for up to __2__ days after unprotected intercourse.

Answer 41

1) Ulipristal acetate

2) 5 days

Question 42

What is the most frequently used method of contraception in the U.S?

Answer 42

Sterilization

Question 43

A vasectomy is performed by occlusion of the ____.

Answer 43

Vas deferens

Question 44

Laparoscopy is performed by occlusion of the ____.

Answer 44

Fallopian tubes

Question 45

With laparoscopy, electrocautery can increase risk of thermal injury to surrounding tissues, poor reversibility, and has a greater risk of ____ if failures occur.

Answer 45

Ectopic pregnancy

Question 46

With laparoscopy, what is the most reversible method but greatest failure rate?

What has the highest incidence of postoperative pain?

Answer 46

1) Hulka

2) Bands (falope rings)

Question 47

What sterilization technique is increasing in use due to recent literature regarding decrease in ovarian cancer risk?

Answer 47

Salpingectomy

Question 48

Which sterilization technique uses small infra-umbilical incision in postpartum period or suprapubic incision as an interval procedure?

Answer 48

Mini-laparotomy

Question 49

A trancervicial approach to tubal ligation uses stainless steel inner coil and a nickel titanium outer coil placed into the fallopian tube with aide of ____.

Answer 49

Hysteroscope