Contraception Options Flashcards
When you think of risks vs benefits on contraception. What is the big complication to consider?
The woman’s risk for cardioembolic events.
They are: HTN, age>35, and smoker
What are some excessive estrogenic effects that may result from taking contraception?
Dysmenorrhea Nausea Cholasma CVA DVTR Thromboembolic disease PE Telangiectasias Hepatic adenoma/adenocarcinoma Cervical changes Breast tenderness (secondary to increased size)
What are some excessive progestational effects?
Breast tenderness Transient HTN Depression Fatigue Decreased libido Decreased duration in menstrual bleeding Increased appetite
What are some excessive androgenic effects?
Hirsutism Acne Oily skin Edema Increased libido
If you had a patient deficient in estrogen, when would you expect them to have?
What about if she was deficient in progesterone?
Deficient ESTROGEN: continuous spotting/bleeding, atrophic vaginitis, no withdrawal bleeding, decreased duration in menstrual bleeding, breakthrough bleeding on days 1-9 of cycle
vs.
Deficient PROGESTERONE: Breakthrough bleeding on days 10-21 of cycle and delayed menses
You have a patient who is on a combination pill and she comes to see you complaining of menorrhagia, N/V, headache, bloating, and irritability. What do you do?
You know these symptoms indicate she is getting too much estrogen and too little progesterone so you lower her dose of estrogen and increase her dose of progesterone.
Who are the best candidates for progestine-only OCPs?
Those with migraine headaches and who are breastfeeding… or who have some contraindication for combined OCPs
True or False. It is okay for women with a family history of breast CA to take a combination OCP?
FALSE!
What should you know about OCPs and antibiotics, anticonvulsants, warfarin, and certain oral hypoglycemic agents?
Antibiotics and anticonvulsants decrease the efficacy of OCPs
OCPs decrease the efficacy of warfarin and hypoglycemic agents (oral and insulin)
True or False. OrthoEvra releases 60% more estrogren than OCPs?
True.
**Increased risk of serious cardioembolic events
Ortho Evra Patch Typical failure rate? MOA? Advantages? Disadvantages? Management/Prescriptive guidelines?
**<1-2%
**Prevents ovulation, similar to OCPs
**Once per week for 3 weeks, easily reversible
**Site reactions, prog/estrog S/Ss, no STI protection
**Reduced effectiveness in women >198 lbs/90 kg
**Same contraindications as OCPs
**If off for >24 hrs, need to restart 4-week cycle and use
back up method
When would you instruct your patient to start/place the OrthoEvra patch?
On the first day of her menstrual cycle or the Sunday after the first day of her menstrual cycle
What do you tell the patient if she patch falls off/or is off for more than 24 hours?
Put on a new patch (start the 4 week calendar over again) and use a backup method
Which contraceptive method decreases HDL, has the potential to reduce bone density with long-term use, when discontinued may have a delayed return of fertility of up to 1 year, and may be helpful in reducing pain from endometriosis?
Depo-Provera (long-acting reversible contraceptive/LARC)
If pregnancy planned within a year, should not be given
There is a 2 week grace period for injections. If longer than 2 weeks, pregnancy test needs to be done.
Which contraceptive methods require informed consent?
Implanon and IUDs
Which IUD can remain in the uterus for 10 years?
ParaGard/Copper IUD
Which IUD can remain in the uterus for 5 years?
Mirena/Progestin-only IUD
What are the two absolute contraindications to use of an IUD
Pregnancy
Active, recurrent, or recent PID including gonorrhea and
chlamydia
*An IUD can be inserted 4-8 weeks postpartum
What do you do if a patient tells you she can’t find her string?
Abdominal US to ensure IUD is still in place
