Contraception L3-4 LARCs Flashcards
3 actions of LNG-IUS
thins lining, inhibits sperm movement, thickens cervical mucus
T or F: IUDs prevent ovulation
F
list 4 uses of LNG-IUS
contraception
treatment of heavy or abnormal uterine bleed
dysmenorrhea
provide endometrial protection from estrogens (from those who can not tolerate progesterone)- not an approved indication
which is larger? the mirena or kyleena
mirena
the mirena initially releases ___/day, which reduces to ___ /d by 5yrs
20 to 10
the Kyleena initially releases ___/day of levonorgestrel, which reduces to ___ by 2 mths, then ___ by 5 yrs
17-15-7
T or F: majority of pts with LNG-IUS experience reduced vaginal bleeding, with amenorrhea common
T
list 3 AEs of LNG-IUS
irregular bleeding- spotting common in first 3-6mths
pain with placement in abdomen/ pelvis
systemic LNG levels may result in mood eff, breast tenderness, headache
malposition
expulsion
with the LNG-IUS, when is irregular bleeding most likely to happen?
first 3-6mths
how does the copper IUD prevent fertilization
copper ions inhibit sperm movement and ability to fertilize ovum
duration of Cu-IUD
5-10yrs
which is cheaper, Cu-IUD or LNG-IUS
Cu-IUD
Cu-IUD AEs
irregular bleeding/ BTB
dysmenorrhea/pelvic pain/ cramps
which has more BTB and dysmenorrhea/ pelvic pain/ cramps
1. LNG-IUS
2. Cu-IUD
Cu-IUD
how long does it take for hormonal IUDs to start working?
7d, unless inserted within 7 days of start of period (check with yuksul)
advantages of Cu-IUD over hormonal
cheaper, no hormonal SEs, may be alt for choosing nonhormonal option
IUD contraindications include
pregnancy
current PID
current/hx breast cancer (PR +)-LNG-IUD only
liver disease- LNG-IUD
undiagnosed abnormal uterine bleeding
pueperal sepsis
cervical or endometrial cancer
postpartum =>48hrs to <4wks
how long after delivery can you get an IUD inserted
must be either <48hrs since delivery or >4wks
T or F: misoprostil administration prior to insertion is usually necessary
F- do not always need to soften cervix for IUD penetration
can you keep an IUC in when being treated for STI
yes
4 main risks with IUD
expulsion, uterine perf, PID, vasovagal/fainting with insertion
rank the following based on most common to least when using IUC
PID, uterine perf, expulsion, fainting
expulsion > perforation > PID >fainting
expulsion of IUD is most common in
the first year
risk factors for uterine perf with IUD
inexperienced inserter, postpartum or breastfeding women
RF for PID
risk in first mth of insertion
higher if BV, cervicitis, contamination with instrument
risks factors for fainting with IUD insertion
previous vasovagal rxn
cervical stenosis
what chemical does the subdermal progestin implant contain
etonogestrel 68mg
duration of subdermal implant
3yrs
where is the progestin implant placed
under skin of upper arm
the progestin implant releases ___mcg etonogestrel daily for the first mth, then decreases down to ___mcg daily at the end of 3 yrs of use
60mcg
30mcg
AEs of contraceptive implant
irregular bleeding, BT, spotting
progestin related AEs
most common AE of implant
irregular bleeding
interactions with implant include
CYP3A4 inducers
how to switch from CHC oral/ patch/ ring to LNG-IUS or implant
continue CHC for 7 dyas after insertion for LNG-IUS or implant
how to switch from depot to LNG-IUS or implant
insert LNG-IUS or implant no later than 13wks after last inj (around wk 12-13)
T or F: hormonal contraceptives can be safely used in those with seizure disorders
T
if an individual is on an anticonvulsant that induces enzymes for hormonal contraceptives, options include
use IUDs
use CHC with min 30-35mcg EE and progestins with longer half lives
list 3 progestins with a longer half life
levonorgestrel, desogestrel, drospirenone
T or F: migraines with neuro/ aura are a CI for POP, IUDs, implant
F- can have all of those, can’t have CHC
how to regimen CHC if migraine without aura
identify if migraines are due to fluctuations in hormones = use continuous CHC or estrogen in HFI
the transdermal patch is not recommended for __kg
> 90kg
what is a concern for CHC in obesity? what can be used instead
VTE
use IUDs (including LNG-IUS) instead
T or F: breastfeeding delays return of ovulation
T
what OC should be considered if <6wks postpartum and breastfeeding?
avoid CHC
try POP
what OC to use if 6wks-6mths postpartum and breastfeeding
POP over CHC
what OC to use postpartum if not breastfeeding
if <3wks postpartum and not breastfeeding = avoid CHCs due to hypercoagulable state (if risk for VTE = wait 6wks)
POP good for any stage of repro cycle
