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Endo Repro Exam II > Contraception & Sterilization > Flashcards

Contraception & Sterilization Flashcards

1
Q

Hormonal contraceptives provide the most reversible contraception. What are the options?

A

OCPs

Injectables (DepoProvera)

Implantable (Nexplanon)

Hormone-containing IUDs (Mirena, Skyla, Liletta, Kyleena)

Contraceptive patches (OrthoEvra)

Contraceptive rings (Nuvaring)

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2
Q

MOA of combination OCPs

A

Suppression of hypothalamic GnRH with subsequent suppression of pituitary production of FSH and LH

The progesterone component is the major player — suppresses LH and therefore ovulation, as well as thickening cervical mucous

The estrogen component mainly improves cycle control by stabilizing the endometrium and allowing less breakthrough bleeding

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3
Q

MOA of progestin-only OCP

A

Primarily makes cervical mucous thick and impermeable

Ovulation continues in about 40% of users

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4
Q

In what pt populations are progestin-only OCPs used?

A

Breastfeeding women

Women with a contraindication to estrogen

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5
Q

Why must progestin-only OCPs be taken at the same time every day?

A

Because of the low dose — if pt is more than 3 hours late taking the pil then they should use a backup method for 48 hrs

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6
Q

Benefits of hormonal oral contraceptives

A

Menstrual cycle regularity

Improve dysmenorrhea

Decrease risk of iron deficiency anemia

Lower incidence of endometrial and ovarian cancers, benign breast, and ovarian disease (cysts)

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7
Q

Adverse effects of OCPs

A

Breakthrough bleeding (more likely in first 3 months, then it usually gets better)

Amenorrhea

Mild AEs include bloating, weight gain, breast tenderness, nausea, fatigue, headache

Serious AEs include venous thrombosis, pulmonary embolism, cholestasis and gallbladder disease, stroke and myocardial infarction, hepatic tumors

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8
Q

MOA of the OrthoEvra patch

A

Transdermal patch containing estrogen and progesterone — same effect as combination OCPs

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9
Q

In what pt populations should the patch be used with caution?

A

Women > 198 lbs

Those at risk of thrombosis

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10
Q

The patch as the same side effects and precautions as OCPs, except a greater risk of ______

A

Thrombosis

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11
Q

MOA of vaginal ring (nuvaring)

A

Combination estrogen and progesterone in ring inserted in vagina for 3 weeks, then removed for 1 week (greater compliance)

Can be removed for up to 3 hours without affecting efficacy

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12
Q

Why is the vaginal ring considered better tolerated than OCPs?

A

Not systemically absorbed through GI tract; also less breakthrough bleeding

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13
Q

What patient populations CANNOT use combination contraceptives?

A

Women >35 y/o who smoke cigarettes

Women with personal hx of thromboembolic event (pts with family hx need to be evaluated for inherited thrombophilia)

Women with hx of CAD, cerebral vascular disease, CHF, migraine with aura, uncontrolled HTN

Women with moderate to severe liver disease or liver tumors

Women with POORLY CONTROLLED diabetes, chronic HTN, systemic lupus erythematosus [may use if good control and adequate f/u]

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14
Q

The primary injectable hormonal contraceptive is an IM injection of depot medroxyprogesterone acetate every 11-13 weeks. This maintains contraceptive level of progestin for about 14 weeks. What is the MOA and efficacy?

A

Thickens cervical mucous, decidualization of the endometrium, blocks the LH surge and ovulation

Efficacy is roughly equivalent to that of sterilization and is not altered by weight

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15
Q

Black box warning associated with depo-provera

A

Alterations of bone metabolism d/t decreased estrogen levels — of particular concern in adolescents

If used for more than 2 years, should consider alternative method

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16
Q

AEs of depo-provera

A

Irregular bleeding (decreases with use, often become amenorrheic with time; can improve bleeding profile with short term use of estrogen add-on)

Menses can take up to a year to regulate after discontinuation (important consideration if pt wants to be able to get pregnant right away)

Weight gain

Exacerbation of depression

17
Q

Indications for use of depo-provera

A

Desire for effective contraception

Need a method with better compliance

Breastfeeding

Can use when estrogen is contraindicated

Women with seizure disorders

Sickle cell anemia (decreased number of crisis)

Anemia secondary to menorrhagia

Endometriosis

Decreased risk of endometrial hyperplasia

18
Q

Contraindications to use of depo-provera

A

Known or suspected pregnancy

Unevaluated vaginal bleeding

Known or suspected malignancy of breast

Active thrombophlebitis, or current/past hx of thromboembolic events or cerebral vascular disease

Liver dysfunction/dz

19
Q

Nexplanon is an etonogestrel-containing implant used for 3 years, preferred to be inserted in first 5 days of menses and if not, using back up contraception for 7 days after insertion. What is its MOA?

A

Thickens cervical mucous

Inhibits ovulation

20
Q

Side effects of nexplanon implant

A

Irregularly irregular vaginal bleeding

Headache

Vaginitis

Weight increase (3-5 lbs, which is less than that seen with depo provera injection)

Acne

Breast pain

21
Q

Indications for nexplanon implant

A

Desires convenient effective method of contraception

May be used in breastfeeding pts

22
Q

Contraindications of nexplanon implant

A

Known or suspected pregnancy

Current or past hx of thrombosis or thromboembolic disorders

Liver tumors or active liver disease (poorly metabolized)

Undiagnosed abnormal uterine bleeding

Known or suspected breast cancer (only absolute)

23
Q

Complications with nexplanon implant insertion

A

Infection, bruising, deep insertion (may lead to migration), persistent pain or paresthesia at insertion site

24
Q

Risks with IUDs

A

Increased risk of infection within first 20 days post-insertion

Increased risk of ectopic pregnancy

Risk of uterine perforation at time of insertion requiring laparoscopy for removal (more common in postpartum period)

Risk of malposition and necessitating hysteroscopy for removal

If pregnancy does occur, removal within first trimester to decrease risk of spontaneous abortion

25
Q

Contraindications to IUDs

A

Breast cancer (contraindication to levonorgestrel-containing only)

Recent infection — including puerperal sepsis, septic abortion, and/or cervical infection

Wilson’s disease (contraindication to copper T only)

Uterine malformations (uterine septums, fibroids, significant enlargement, etc.)

26
Q

What are the levonorgestrel IUDs and their overall efficacy?

A

Mirena/Kyleena may be used for 5 years

Liletta is used for 3 years

Skyla is used for 3 years and was designed originally for nulliparous women (smaller diameter)

Highly effective — pregnancy rate of 0.2%

27
Q

Benefits of hormonal IUDs

A

Decrease in menstrual blood loss (up to 50%)

Less dysmenorrhea

Protection of endometrial lining from unopposed estrogen

Convenient and long-term

28
Q

The Copper T IUD (paragard) can be used for up to 10 years. What is its MOA?

A

Copper interferes with sperm transport or fertilization and prevention of implantation

29
Q

Diaphragms are small latex covered dome shaped devices that must be used with ________; may be inserted up to 6 hours before intercourse and must be left for 6-8 hrs after (no more than 24 hrs). There are several sizes and they must be fitted by a healthcare professional. Women who use diaphragms are more likely to get ________

A

Spermicide; UTIs

30
Q

Smaller version of the diaphragm applied to the cervix itself, used with spermicide and left in place for 6 hours after intercourse; carries high risk of displacement and TSS

A

Cervical cap (Femcap)

31
Q

Small, pillow-shaped barrier containing spermicide with only one size that is more effective in nulliparous women, left in place for 6 hours but no more than 30 hours (risk of TSS)

A

Sponge

32
Q

What are the fertility awareness methods for contraception? (Natural family planning)

A

Calendar methods — calculation of fertile period and avoid sex during that time

Basal body temp method — check temp daily before getting out of bed and avoid sex for 3 days after 0.5 to 1 degree change

Cervical mucous method — avoid sex for 4 days after stringy changes noted

Symptothermal method — combines cervical mucous and basal body temp method

33
Q

MOA of emergency contraceptive pills

A

Prevent ovulation and fertilization

Plan B is progestin-only (levonorgestrel); must be used w/i 120 hours after unprotected intercourse

Ella is ulipristal acetate; indicated for up to 5 days after unprotected intercourse — postpones follicular rupture/inhibits or delays ovulation

34
Q

Method for male sterilization, including benefits and risks

A

Vasectomy - occlusion of the vas deferens

Benefits: safer, more easily performed, less expensive, and easier to reverse than female sterilization

Risks: postoperative complications like bleeding, hematomas, acute/chronic pain, local skin infection; also not immediately effective — complete azospermia typically obtained w/i 10 weeks

35
Q

Methods of female sterilization

A

Done by laparoscopy, mini-laparotomy, or hysteroscopy at time of c-section

[the mini-laparotomy is the most common approach throughout the world, uses small infra-umbilical incision in postpartum period or suprapubic incision as an interval procedure]

36
Q

Laparoscopic methods for female sterilization utilize small incisions and have a low rate of complications. They work by occluding the fallopian tubes — what are the different methods for doing this?

A

Electrocautery — fast, increase risk of thermal injury to surrounding tissues, poor reversibility, greater risk of ectopic if failure occurs

Clips — hulka clips are most reversible method but have greatest failure rate; filshie clips have lower failure rate d/t large diameter

Bands — intermediate reversibility and failure rate, higher incidence of postop pain, increased risk of bleeding

Salpingectomy — increasing in use d/t possibility of decreasing ovarian cancer risk

37
Q

The essure system utilized a ______ approach to tubal ligation that is no longer recommended d/t ______

A

Transcervical; post-op pain

Endo Repro Exam II (28 decks)

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