Contraception & Infertility

Question 1

Why is progesterone needed when estrogen is being used

Answer 1

to prevent endometrial hyperplasia

Question 2

If a women does not have a uterus does she need progesterone when using estrogen?

Answer 2

No, estrogen causes cell hyperplasia in the uterus leading to uterine cancer, but if there is no uterus progesterone is not needed to prevent the cell hyperplasia

Question 3

Estrogen is used for?

Answer 3

Hot flashes, bone health

Question 4

Which phase does menses occur during

Answer 4

follicular phase

Question 5

What occurs during follicular phase

Answer 5

follicle stimulating hormone spurs follicle development and causes estrogen to surge. estrogen peaks by the end of phase the surge in estrogen causes luteinizing hormone and FSH to increase

Question 6

What occurs during the ovulatory phase

Answer 6

the LH surge triggers ovulation 24-36 hours later.

Question 7

What occurs during the luteal phase

Answer 7

the start of ovulation begins the luteal (last) phase which lasts ~14 days. progesterone is dominant in this phase

Question 8

Which hormone causes release of the oocye (egg)

Answer 8

luteinizing hormone

Question 9

What is released from the body when a fertilized egg attaches to the lining of the uterus

Answer 9

human chorionic gonadotropin (hCG)

Question 10

how do hormonal contraceptives work

Answer 10

inhibit the production of FSH and LH which prevents ovulation

Question 11

List progestin in oral contraceptives

Answer 11

northindrone
levonorgestrel
drospirenone

Question 12

what is monophasic oral contraceptives

Answer 12

have the same dose of estrogen and progestin throughout the pill pack

Question 13

unique property of drospirenone

Answer 13

is a mild potassium-sparing diuretic which decreases bloating

Question 14

primary use of progestin only contraceptives

Answer 14

women who are lactating b/c estrogen decreases breastmilk

Question 15

major counseling point for progestin only pills

Answer 15

must have good adherence b/c must be taken within 3 hours of scheduled time

Question 16

patch contraindications

Answer 16

anyone with clotting risk factors b/c patch has higher estrogen exposure

Question 17

What does “Lo” mean in a birth control name

Answer 17

< 35 mcg of estrogen

Question 18

What does “Fe” mean in a birth control name

Answer 18

contains iron supplement

Question 19

What does “24” mean in a birth control name

Answer 19

24 active pills and 4 placebo

Question 20

SE of estrogen

Answer 20

nausea
breast tenderness
bloating
weight gain 
elevated BP

Question 21

insufficient estrogen can lead to?

Answer 21

spotting in early to mid cycle

Question 22

insufficient progestin can lead to?

Answer 22

spotting in late cycle

Question 23

BC for acne

Answer 23

lower androgenic activity (ortho-cyclen)

no androgenic activity (Yaz)

Question 24

BC for breastfeeding

Answer 24

progestin only

Question 25

BC for estrogen contraindications

Answer 25

progestin only

Question 26

BC for migraines

Answer 26

if aura-progestin only

no aura-any

Question 27

BC for fluid retention

Answer 27

drospirenone

Question 28

BC for heavy menstrual bleeding

Answer 28

NAtazia
levonorgestrel-releasing IUD mirena
COC with only 4 placebo pills

Question 29

BC for HTN

Answer 29

if uncontrolled progestin only

Question 30

BC for mood changes or disorder

Answer 30

monophasic COC
extended cycle
continuous with drospirenone

Question 31

BC for nausea

Answer 31

take at night with food

decreasing estrogen

Question 32

BC for overweight

Answer 32

any

avoid DMPA

Question 33

BC for postpartum

Answer 33

do not use CHC for 3 weeks or 6 weeks if increased VTE risk

use progestin only

Question 34

BC for PMDD

Answer 34

Yaz

antidepressant

Question 35

BC for spotting

Answer 35

usually resolve in 3-6 months

Question 36

MOA of plan B

Answer 36

preventing or delaying ovulation and thickens cerviacal mucus

Question 37

First line treatment for irregular or absent menstrual cycles

Answer 37

clomiphene

Question 38

clomiphene MOA

Answer 38

SERM: selective estrogen receptor modulator which is an estrogen agonist will cause LH and FSH surge to trigger ovulation

Question 39

gonadotropin MOA

Answer 39

trigger ovulation by acting like endogenous gonadotropins FSH or LH