Contraception/Infertility Flashcards
menses occurs during which phase
follicular
at the start of menses, estrogen is (low/high) and progesterone is (low/high)
low, low
prenancy tests test for
hCG
women planning to conceive should take which supplement
folate (B9)
which contraceptive may cause delay in the return to fertility
medroxyprogesterone
T/F: female internal condoms provide more protection than male external condoms
T
Caya
diaphragm
what type of lubricant should be used with condoms
water or silicone-based
phexxi
Rx, vaginal gel that maintains acidic pH, do not use if vaginal ring or history of UTI
hormonal contraceptives work by inhibiting
production of FSH, LH
common estrogen in oral contraceptive
ethinyl estradiol
common progestins in oral contraceptive
norethindrone, levonorgesterol, drospirenone
monophasic
same dose estrogen and progestin throughout
multi-phasic
mimic estrogen and progestin levels in menstrual cycle
drospirenone is unique in that it…
is a mild potassium-sparing diuretic which dec bloating/weight gain
which drug is used for moderate to severe pain associated with endometriosis
Orlissa (Elagolix)
Which hormonal drugs are indicated for heavy menstrual bleeding (menorrhagia)
Natazia, Mirena (IUD)
which drug is indicated for heavy bleeding associated with fibroids
Oriahnn
what non-hormonal drug is available for menorrhagia
Lysteda
which hormonal drug may be used for migraine prophylaxis and is safe in migraines with aura
mini-pill (progestin-only)
why can’t estrogen be used in migraines with aura
risk of stroke
what’s an important counseling point for mini pills
must take pill within 3 hours of scheduled time
“Lo” indicates
= 35 mcg estrogen (i.e. less SE)
“Fe” indicates
iron supplement is included
“24” indicates
shorter placebo time
Monophasic formulations
Junel, Microgestin, Sprintec, Loestrin, Yasmin
Triphasic formulation
Tri-sprintec
extended cycle formulation
Seasonique
Xulane
transdermal patch
Nuvaring
vaginal ring
brand names of mini pills
Errin, Camila, Nora-BE
Injected contraception containing only progestin
depot-provera
depo provera is injected how often
every 3 months
which patient can receive Xulane? a) 35 yo F, plays golf professionally, smoker b) 30 yo F, uncontrolled HTN, does not drink alcohol c) 26 yo F BMI is 29, DM II d)24 yo F who recently gave birth two weeks ago
c; patches have higher estrogen exposure so do not use in pts with high clotting risk
which patients are considered high clotting risk
> 35 and smokes, CVD/ blood clots, postpartum, BMI>/=30
Depot provera generic
DMPA (medroxyprogesterone acetate)
DMPA is injected how
IM or SC
T/F: all IUDs are hormone free
F; some can contain levonorgestrel
after 1 year, DMPA users may become
amenorrheic
which contraceptive is approved with no placebo pills and allows you to skip menses
amethyst
spotting usually resolves in
3-6 months
drospirenone is contraindicated in
renal or liver disease
nuva ring can be reused for how long
1 year
major side effects of estrogen
nausea, breast tenderness, melasma, bloating
what are symptoms you should watch out for that indicate clotting
ACHES (abdominal pain, chest pain, H/A, eye problems, swelling or sudden leg pain)
what lab may need to be reviewed for a patient taking drospirenone
potassium (can inc levels)
DMPA may have what side effect
loss in bone mineral density
which contraceptive product is best for a patient with acne or hirsutism
combination OC with progestin that has lower androgenic activity (drospirenone)
which contraceptive product is best for a patient who is breastfeeding
progestin only product or nonhormonal
which contraceptive product is best for a patient with a contraindication to estrogen
progestin only product or nonhormonal
which contraceptive is best for a patient who experiences migraine
if aura then progestin only or nonhormonal; if no aura then any product
which contraceptive is best for a patient with HTN
progestin only or nonhormonal
which contraceptive is best for a patient who has mood changes/disorders
monophasic combination OC or continuous drosperinone
which contraceptive is best for a patient experiencing nausea
dec estrogen dose, progestin only, nonhormonal
which contraceptive is best for a patient who is overweight
Any (but not the patch in obese patients, and no DMPA if planning to lose weight
which contraceptive is best for postpartum patient
nonhormonal (wait at least 3 weeks or 6 weeks with VTE risk factors to start hormonal therapy)
which contraceptive is best for PDD
drospirenone
early spotting may be fixed by increasing
estrogen
late spotting may be fixed by increasing
progestin
rifampin use may require patient to have backup contraceptive method for how long
6 weeks
what drugs may interact with hormonal birth control
anticonvulsants, St John’s wort, tobacco, ritonavir, colesevelam, byetta
liver toxicity may occur in patients taking oral contraceptives with
Mavyret
How many days does it take hormonal pills to achieve contraceptive efficacy
7 days
No backup birth control method is needed if hormonal oral contraceptive is started when
Within 5 days after the start of the period
How many days does it take for progestin only pills to achieve contraceptive efficacy
2 days
Back contraception is needed for patients taking combined OC if they miss
2 pills
Progestin only pills require backup method if missed dose is
> 3h past scheduled time
Para guard can be used for up to
10 years
Paraguard may have what side effects
Heavy bleeding and cramping
Nexplanon is used up to
3 years
Copper iud can be used as an emergency contraceptive if used within
5 days
Ella (does/ does not) require a prescription
Does
Ella can be be effective up to how many days after sex
5 days
Plan B can be effective up to how many days after sex
3 days
paragard is the brand name for
copper iud
primary side effect of levonorgetrel
nausea
diaphragms should be left in for how long
6-24 hours after intercourse
diaphragms can be reused for up to how long
2 years
sponge should be left in for how long
6-24 hours after intercourse
patients on medroxyprogesterone should have a daily recommended intake of
calcium, vitamin D
what treatment choices are available for infertile women with absent ovulation
clomiphene, letrozole
gonadotropins may be used in infertility in which situations
intrauterine insemination or in vitro fertilization
how is a gonadotropin administered
IM injection
