Contraception and sterilization (Wootton) Flashcards
What provide the most effective reversible contraception?
Hormonal contraceptives
Majority of oral contraceptives are a combination of ____ and ____.
Estrogen and progesterone
Oral contraceptives cause suppression of what hormones?
1) GnRH
2) LH and FSH
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.
1) Progesterone
2) Estrogen
1) The progestin-only oral contraceptives have a MOA of?
2) Who is it mainly used in?
1) Making cervical mucus thick and impermeable
2) Breastfeeding and anyone with contraindication to estrogen
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.
1) Regular
2) Dysmenorrhea
3) Iron deficiency anemia
4) Endometrial and ovarian
What are side effects seen with oral contraceptives either in the first three months or in the first year?
1) Breakthrough bleeding
2) Amenorrhea
Some serious side effects of oral contraceptives include?
1) Venous thrombosis
2) PE
3) MI
4) Hepatic tumors
VMPH (VaMPHire)
1) The transdermal patch contraceptive has what hormones in it?
2) There is caution with use in women greater than how many pounds?
3) Side effects and precautions same as oral contraceptives except for greater risk of?
1) Estrogen and progesterone
2) 198 pounds
3) Thrombosis
The vaginal ring contraceptive has what hormones in it?
Why is it associated with greater compliance?
1) Estrogen and progesterone
2) Because of its once a month use
What is the prescription for the newer vaginal ring, the annovera vaginal ring?
How long do you place the annovera vaginal ring in then remove?
Prescription for 13 months in one reusable ring
2) Keep in for 21 days
Remove for 7 days
a
Null
What populations can not use oral contraceptives?
1) Over 35 and smoke
2) History of thromboembolic event
3) Liver disease
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.
1) Intramuscular injection
2) Progestin
3) Menses
The MOA of Depot medroxyprogesterone acetate is a thickening of __1__.
__2__ of the Endometrium.
It blocks the __3__ and ovulation.
1) Cervical mucus
2) Decidualization
3) LH surge
With Depo-Provera, alterations of ____ is associated with decreased estrogen levels.
Bone metabolism
What side effects are associated with Depo-Provera?
1) Weight Gain
2) Irregular bleeding
3) Exacerbation of depression
WIE
What are the types of LARCS
Long acting reversible contraceptives)
Implant and IUD
1) What implantable hormonal contraceptive is a single, radiopaque, rod-shaped implant containing 68mg ETONOGESTREL, 4cm long and 2mm in diameter?
2) It can be used for how many years?
3) MOA?
**LARCA
1) Nexplanon (Etonogestrel implant)
2) Three years
3) Thickens cervical mucus and Inhibits ovulation
What are side effects of implants?
Irregularly irregular vaginal bleeding!!
Headache
Weight gain
What are contraindication of implant?
1) Known or suspected pregnancy
2) Liver tumors or active liver disease
3) Known or suspected breast cancer
What are some complication of implant insertion?
1) Deep insertion
2) Infection
3) Persistent pain or paraesthesia at site
DIP
What are the types of IUD (Intrauterine Devices)
Copper T (paragard)
Mirena/Liletta
Skyla/Kyleena
Intrauterine devices have an increased risk of ____ if pregnancy would occur.
Ectopic pregnancy
1) The levonorgestrel containing IUDs such as Mirena/Liletta and Skyla/Kyleena are contraindicated with?
2) Copper T is contraindicated with?
1) Breast cancer
2) Wilson’s disease
A benefit of IUDs is protection of the ___ from unopposed estrogen.
Endometrial lining
What is the MOA of Copper T (Paragard)?
Copper interferes with sperm transport
Diaphragms are small latex covered, dome shaped devices that must be used with a ____.
Spermicide
Women who use diaphragms are more likely to get?
Urinary tract infections
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?
What must it be used with?
1) Toxic shock syndrome
2) Spermicide
What form of barrier contraceptive is small, pillow shaped and contains spermicide?
Who is it more effective in?
1) Sponge
2) Nulliparous
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.
3 days
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.
4 days
How is the Symptothermal method done?
Combine cervical mucus and basal body temperature methods
What emergency contraception method uses a regimen of tablets within 72 hours of unprotected sex?
Combined oral contraceptive method
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.
1) Progestin (levonorgestrel)
2) 120 hours
Ella is __1__ postpones follicular rupture/inhibit or delay ovulation.
It is indicated for up to __2__ days after unprotected intercourse.
1) Ulipristal acetate
2) 5 days
What is the most frequently used method of contraception in the U.S?
Sterilization
1) A vasectomy is performed by occlusion of the ____.
2) Laparoscopy is performed by occlusion of the ____.
1) Vas deferens
2) Fallopian tubes
With laparoscopy, electrocautery can increase risk of
- Thermal injury to surrounding tissues
- Poor reversibility
- Greater risk of ____ if failures occur.
Ectopic pregnancy
With laparoscopy, what is the most reversible method but greatest failure rate?
What has the highest incidence of postoperative pain?
1) Hulka/Filshie
2) Bands (falope rings)
What sterilization technique is increasing in use due to recent literature regarding decrease in ovarian cancer risk?
Salpingectomy
Which sterilization technique uses small infra-umbilical incision in postpartum period or suprapubic incision as an interval procedure?
Mini-laparotomy
