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OBGYN > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

What is the purpose of contraception?

A

Contraception is used for voluntary control of fertility.

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2
Q

What factors should be considered when choosing a method of contraception?

A

1) Efficacy
2) Safety
3) Potential non-contraceptive benefits
4) Cost
5) Personal considerations

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3
Q

What are the characteristics of an ideal contraceptive?

A

1) Highly effective (100%)
2) No side effects or risks
3) Affordable
4) Independent of sexual intercourse
5) Require no regular action by the user
6) Non-contraceptive benefits
7) Acceptable to all cultures and religions
8) Easily distributed and administered by non-healthcare personnel
9) Completely reversible

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4
Q

Why is the reversibility of a contraceptive method important?

A

Because it allows a person to regain fertility if they decide to conceive.

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5
Q

Why do all contraceptive methods have a chance of failure?

A

Due to factors such as:
1) How the method works
2) How easy it is to use correctly and consistently

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6
Q

How can the effectiveness of a contraceptive method vary?

A

Due to poor use or user failure, such as forgetting to take pills in the case of oral contraceptives.

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7
Q

How is the efficacy of contraceptive methods measured?

A

By the long-term evaluation of a group of sexually active women using a method over a specified period to observe how frequently pregnancy occurs, often using the Pearl Index formula.

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8
Q

What is the Pearl formula?

A

A calculation of pregnancy rates per 100 women per year.

(Number of pregnancies/total number of months contributed by all couples) x 1,200

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9
Q

What are some types of contraception?

A

1) Natural methods
2) Combined contraception
3) Progestogen-only contraception
4) Barrier methods
5) Intrauterine devices
6) Emergency contraception
7) Sterilization

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10
Q

What is lactational amenorrhea?

A

Lactational amenorrhea is the natural postpartum infertility that occurs when a woman is fully breastfeeding and remains amenorrhoeic.

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11
Q

What is the natural method of contraception?

A

Abstinence from intercourse during the fertile period of the menstrual cycle

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12
Q

How is lactational amenorrhea related to contraception?

A

It delays the resumption of fertility and can be used as a natural contraceptive method, especially in areas where modern methods may be expensive.

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13
Q

How is the success of the natural method determined?

A

On the accurate prediction of ovulation

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14
Q

Why might some couples choose the natural method of contraception?

A

For cultural and religious reasons, as it may be the only type of contraception acceptable to them.

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15
Q

What does natural family planning involve?

A

1) Ovulation prediction
2) Monitoring changes in basal body temperature
3) Changes in cervical mucus
4) Tracking cycle days

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16
Q

What tools can assist with natural family planning?

A

1) Kits, such as Persona
2) Tracking urinary hormones

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17
Q

What hormones are found in combined hormonal contraception?

A

Estrogen (ethinyl estradiol) + Progestogen

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18
Q

What are the different generations of combined hormonal contraception?

A

1) Second
2) Third
3) Fourth

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19
Q

Which drugs are second generation combined hormonal contraceptives?

A

1) Nortestosterone
2) Levonorgestrel

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20
Q

Which drugs are third generation combined hormonal contraceptives?

A

1) Desogestrel
2) Gestodene

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21
Q

Which drugs are fourth generation combined hormonal contraceptives?

A

Anti-androgenics such as:
1) Drospirenone
2) Dienogest

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22
Q

What is the failure rate (FR) of combined hormonal contraception?

A

0.3%

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23
Q

What are some positive health benefits of using combined hormonal contraception?

A

1) Light pain-free regular bleeds
2) Improvement of premenstrual syndrome
3) Reduced risk of pelvic inflammatory disease (PID)
4) Long-term protection against ovarian and endometrial cancer
5) Treatment of acne
6) Reduction in the formation of benign ovarian cysts
7) Improvement of endometriosis.

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24
Q

What are the cardiovascular risks associated with combined hormonal contraception?

A

A 3-4 fold increase in venous thromboembolism (VTE)

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25
Q

When is the risk for VTE’s highest with combined hormonal contraception?

A

During the first year of use

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26
Q

Which factors increase the risk for VTE’s with combined hormonal contraception?

A

1) Obesity
2) History of pregnancy-induced hypertension (PIH) also increase the risk

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27
Q

How does combined hormonal contraception affect the risk of ischemic stroke?

A

Two-fold increase

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28
Q

How does combined hormonal contraception affect the risk of hemorrhagic stroke?

A

Unchanged

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29
Q

Arterial diseases associated with combined hormonal contraception are __(less/more) common but __ (less/more) serious.

A

Arterial diseases are LESS common but MORE serious

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30
Q

Arterial disease risks associated with combined hormonal contraception are related to:

A

1) Age
2) Smoking

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31
Q

Arterial disease risks associated with combined hormonal contraception are increased with which generation?

A

Second

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32
Q

True or False: Lower doses of estrogen do not increase the risk of arterial disease.

A

True

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33
Q

How does combined hormonal contraception affect the risk of breast cancer?

A

Small increase in breast cancer risk

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34
Q

How does combined hormonal contraception affect the risk of ovarian and endometrial cancer?

A

> 50% reduction in ovarian and endometrial cancer risk

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35
Q

Combined hormonal contraception’s protection against ovarian and endometrial cancer is related to ____ and lasts ___.

A

The duration of use; For 15 years after stopping the pill.

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36
Q

How does combined hormonal contraception affect the risk of cervical cancer?

A

Increased risk of cervical cancer due to greater sexual activity

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37
Q

What are additional risks associated with combined hormonal contraception?

A

2.8-fold increase in relative risk of persistent infection with HPV beyond 5 years.

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38
Q

What are some contraindications for using combined hormonal contraception?

A

1) Breastfeeding
2) Smoking
3) Age
4) Multiple risk factors for cardiovascular disease
5) Hypertension with readings of 160/100 or with vascular disease
6) Current or history of deep vein thrombosis
7) Major surgery with prolonged hospitalization

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39
Q

What are some absolute contraindications for combined contraception?

A

1) Past arterial or venous thrombosis
2) Focal migraine
3) Transient ischemic attack (TIA)
4) Thrombophilias
5) Active liver disease
6) Liver adenoma
7) Gallstones
8) Pregnancy
9) Estrogen-dependent neoplasm

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40
Q

Combined contraception can be continued until which age?

A

50 years in healthy women

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41
Q

Which medications are known to reduce the effectiveness of combined contraception?

A

Drugs that induce Cytochrome P450:
1) Anticonvulsants
2) Antifungals
3) Antiretrovirals
4) Antibiotics

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42
Q

What are some common side effects of combined oral contraceptives?

A

1) Breakthrough bleeding
2) Headache
3) Weight gain
4) Loss of libido
5) Fluid retention
6) Nausea and vomiting
7) Chloasma (Melasma)
8) Breast enlargement

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43
Q

What are the different methods of combined contraception available?

A

1) Oral pills
2) Transdermal patches (contraceptive patch)
3) Systemically administered methods (combined injectables)
4) Vaginal routes (contraceptive vaginal ring)

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44
Q

What are the different generations of synthetic progesterone in COCs and one of their benefits?

A

There are second-generation (nortestosterone and levonorgestrel), third-generation (desogestrel and gestodene), and fourth-generation (antiandrogenic - drospirenone, dienogest) COCs. For example, Dianeette contains antiandrogen, which is useful for acne treatment.

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45
Q

What are the different types of oral contraceptive pills and their dosing schedules?

A

There are monophasic pills where every pill contains the same dose of steroids, biphasic, triphasic, and tetraphasic pills where the dose of steroids changes during the cycle. They are usually taken for 21 days followed by a 7-day break. Newer brands may have different schedules like 24/4, 84/7, or continuous dosing of 365 days.

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46
Q

How do combined oral contraceptives (COCs) prevent pregnancy?

A

COCs work by inhibiting ovulation, suppressing follicular development through the inhibition of follicle-stimulating hormone (FSH), and preventing the luteinizing hormone (LH) surge which is necessary for ovulation.

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47
Q

What should a person do if they miss taking their COC pill according to the instructions provided?

A

If one pill is missed, it should be taken as soon as remembered and then continue taking the remaining pills as usual. If two or more pills are missed, the person should take one pill as soon as remembered and use additional contraceptive methods, such as condoms, for the next 7 days. If the missed pills are in the third week, the pack should be finished and a new pack started without taking the usual break.

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48
Q

What is the area size of a transdermal contraceptive patch?

A

The area size of a transdermal contraceptive patch is 20 cm².

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49
Q

How often should the transdermal patch be replaced?

A

Each transdermal patch lasts for 7 days, and there should be three patches used per month.

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50
Q

Can the efficacy of transdermal contraception be reduced in certain conditions?

A

Yes, the efficacy might be reduced by overweight.

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51
Q

How does the cost of transdermal contraception compare to oral contraception?

A

Transdermal contraception is more expensive than oral contraception.

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52
Q

What is a noted benefit of transdermal contraception regarding patient behavior?

A

There is better compliance with transdermal contraception.

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53
Q

What are the hormone dosages used in the vaginal ring, such as the NuvaRing?

A

The vaginal ring delivers 15 micrograms of ethinylestradiol (EE) and 20 micrograms of etonogestrel daily.

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54
Q

Describe the composition and application cycle of the vaginal ring.

A

It’s made of soft ethylene-vinyl-acetate copolymer and is used for 3 weeks followed by a 7-day ring-free interval.

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55
Q

How does the cost of the vaginal ring compare to other contraceptive methods?

A

The vaginal ring is more expensive than some other contraceptive methods.

56
Q

What are the advantages of progesterone-only contraception?

A

Advantages include no effect on venous thromboembolism (VTE), minimal impact on lipid profile, suitability for most people with cardiovascular diseases except those with severe arterial wall disease, and it can be used by lactating women. It also protects against endometrial cancer and provides symptomatic relief of dysmenorrhea.

57
Q

What are some disadvantages of progesterone-only contraception?

A

Disadvantages include menstrual disturbances, the risk of functional ovarian cysts, ectopic pregnancy, and potential side effects such as acne, headache, breast tenderness, and loss of libido.

58
Q

What is a contraindication for the use of progesterone-only contraception?

A

Current breast cancer is a contraindication for using progesterone-only contraception.

59
Q

What are the side effects of progestogen-only pills (POP)?

A

Side effects of POP include an increased risk of breast cancer (1.17% increase with injectables) and protection against endometrial cancer. There’s no data about the risk for ovarian and cervical cancer.

60
Q

What effects do progestogen-only contraceptives have on the body?

A

They result in cervical mucus modification, endometrial modification, and suppression of ovulation.

61
Q

What are the different types of progesterone contraception mentioned in the slide?

A

The types mentioned include progestogen-only pills (POP), injectables, implants, and intrauterine systems (IUS).

62
Q

How do old and new generation progestogen-only pills differ?

A

Old generation pills thicken the cervical mucus but do not inhibit ovulation, while new generation pills, like desogestrel (Cerazette), do inhibit ovulation.

63
Q

What is the efficacy rate of progestogen-only pills and how is it affected?

A

The efficacy of progestogen-only pills is largely dependent on compliance with the prescribed timing. The overall failure rate is 0.3-4 per hundred women-years (HWY).

64
Q

What is the mechanism of action for the contraceptive method mentioned?

A

This contraceptive method works locally by affecting cervical mucus and the endometrium, making it thin and atrophic. Higher doses of this method will inhibit ovulation.

65
Q

What are the particular indications for the use of this contraceptive method?

A

It is indicated for use in situations such as breastfeeding, old age, cardiovascular risk factors, smoking, and diabetes.

66
Q

What are the two types of injectable contraceptives mentioned?

A

The two types are Depo Provera 150 mg, which lasts for 12 weeks, and Noristerat (norethisterone enanthate 200 mg), which lasts for 8 weeks but is rarely used.

67
Q

What is Depo Provera, and how is it administered?

A

Depo Provera is depot medroxyprogesterone acetate, administered as a deep intramuscular (IM) injection of 150 mg every 12 weeks.

68
Q

What are the side effects of Depo-Provera?

A

The side effects include weight gain of 2-3 kg, a delay in the return of fertility for about 6-7 months, persistently irregular menstrual cycles with most becoming amenorrheic, and a small reduction in bone mineral density (BMD), which is recovered after discontinuation.

69
Q

What are the subdermal implants available and their characteristics?

A

Implanon is available, which is a single rod of 68 mg of etonogestrel inserted into the triceps of the non-dominant arm, lasting for 3 years. Norplant, a six rod system, is not available.

70
Q

What is the efficacy and compliance of subdermal implants?

A

The failure rate (FR) is less than 1 in 1000 over 3 years, and they are noted for having no compliance problems since they are a set-and-forget type of contraceptive.

71
Q

What is the IUS, and what is its use?

A

The IUS, specifically Mirena, contains 52 mg levonorgestrel and releases 20 micrograms per day for 5 years. It is used for the management of heavy menstrual bleeding and can achieve a 70-95% reduction in menstrual bleeding.

72
Q

What are the characteristics of intrauterine contraception?

A

The most commonly used reversible method, it involves a marked inflammatory reaction, increasing the concentration of macrophages and prostaglandins, and is toxic for sperm, ova, and interferes with sperm transport. It has a failure rate (FR) of less than 1%.

73
Q

What are the characteristics of IUCD, and why is it considered ideal?

A

The IUCD is ideal for medium to long-term contraception, is independent of intercourse, does not require regular compliance, and protects against intrauterine and ectopic pregnancy, although there is a higher chance than normal for ectopic pregnancies.

74
Q

What are the types and durations of intrauterine devices mentioned?

A

There are copper-framed or frameless (gynefix) IUDs with a surface area of copper ranging from 300-380 mm^2, which prevent fertilization and implantation, and can last from 5-10 years, with some being suitable for use until menopause.

75
Q

What is the duration of effectiveness for the Mirena IUD?

A

The Mirena IUD is effective for 5 years.

76
Q

What hormone does the Mirena IUD release, and what is its daily dosage?

A

The Mirena IUD releases levonorgestrel with a reservoir of 52 mg, providing a daily dosage of 20 micrograms over 5 years.

77
Q

How does the Mirena IUD work to prevent pregnancy?

A

The Mirena IUD works by releasing hormones that thicken cervical mucus, atrophy the endometrium to prevent implantation, and it is also used in the treatment of menorrhagia.

78
Q

What is a rare side effect of the Mirena IUD?

A

A rare side effect is low blood levels of LNG (Levonorgestrel).

79
Q

When can an IUCD be inserted after childbirth?

A

An IUCD can be inserted 4 weeks postpartum.

80
Q

What is the risk of IUCD expulsion after a second-trimester miscarriage?

A

After a second-trimester miscarriage, the risk of IUCD expulsion is higher.

81
Q

When should an IUCD be removed in menopausal women?

A

In menopausal women, an IUCD should be removed 1 year after the last menstrual period if they are more than 50 years old, or 2 years at 40 years or later.

82
Q

What are some contraindications for IUCD use?

A

Contraindications include a history of malignant trophoblastic disease, endometrial or cervical cancer, pelvic TB, current STI or pelvic inflammatory disease, unexplained vaginal bleeding, distorted cavity, and copper allergy.

83
Q

What is the rate of uterine perforation associated with IUCD use?

A

Uterine perforation occurs at a rate of 2 in 1000.

84
Q

What is the discontinuation rate due to menorrhagia from IUCD use?

A

What is the discontinuation rate due to menorrhagia from IUCD use?

85
Q

What should be done if there is no response to an IUCD after 48 hours?

A

The IUCD should be removed if there is no response within 48 hours.

86
Q

How common is spontaneous expulsion of an IUCD, and when does it most likely occur?

A

Spontaneous expulsion of an IUCD is common in the first year, and the risk is 1 in 20 during menstruation.

87
Q

What are barrier methods of contraception?

A

Barrier methods of contraception include physically interrupting the progress of sperm in the female reproductive tract, such as male condoms, occlusive pessaries, caps, sponges, and vaginal condoms combined with spermicides.

88
Q

What are the benefits of using condoms?

A

Condoms are one of the most popular barrier methods because they are made of fine latex rubber, come in various sizes and textures, are accessible and inexpensive, protect against STDs like HIV, and reduce the risk of carcinoma and premalignant disease of the cervix.

89
Q

What is a common ingredient in spermicides, and what forms does it come in?

A

Nonoxynol-9 is a common ingredient in spermicides, which can come in gel, cream, foam, or pessary form.

90
Q

What is a significant risk associated with frequent use of nonoxynol-9?

A

Frequent use of nonoxynol-9 might increase the risk of HIV transmission.

91
Q

What is a female condom made of and where is it placed?

A

A female condom is made of a polyurethane sheath and it is placed inside the vagina.

92
Q

What are some characteristics of the female condom?

A

It comes in one size, is for single use, is considered expensive, and is not very popular.

93
Q

How often can a female condom be used?

A

The female condom is for single use only.

94
Q

Who should fit a diaphragm?

A

A diaphragm should be fitted by trained personnel.

95
Q

Does the diaphragm protect against sexually transmitted diseases (STDs)?

A

No, the diaphragm does not confer the same degree of protection against STDs.

96
Q

What additional measure should be used with a diaphragm for maximum protection?

A

Spermicide should be used prior to intercourse to occlude the vagina for maximum protection.

97
Q

What are the advantages of using a cervical cap?

A

The cervical cap is made of silicone rubber, is easier to fit, less likely to slip, and may reduce the risk of urinary tract infections (UTIs).

98
Q

What are some disadvantages of the cervical cap?

A

It is rarely used because it can be difficult to insert and remove.

99
Q

When is emergency contraception used?

A

Emergency contraception is used after unprotected intercourse and before implantation, or after the failure of a barrier method or missed birth control pills.

100
Q

What are the three options for emergency contraception?

A

The three options are a pill containing a progesterone receptor modulator, a pill containing levonorgestrel, and an intrauterine device (IUD) used within 5 days of the estimated day of ovulation.

101
Q

How does LNG-EC work and when is it effective?

A

LNG-EC inhibits and delays ovulation if taken several days before ovulation and is not ineffective immediately before ovulation.

102
Q

What is the difference in efficacy between LNG and UPA in preventing pregnancy?

A

One randomized controlled trial (RCT) found that UPA prevented pregnancy in 85% of cases, while LNG prevented it in 69% of cases.

103
Q

What is the most effective method of emergency contraception?

A

The copper IUD is the most effective method and can be used within 5 days of unprotected intercourse.

104
Q

What is sterilization and who typically chooses this method?

A

Sterilization is a permanent, irreversible form of contraception typically chosen by older couples or those who have completed their family.

105
Q

Can sterilization be reversed?

A

Yes, sterilization can sometimes be reversed, but the subsequent pregnancy rate is only around 5%.

106
Q

What is female sterilization?

A

Female sterilization is a permanent form of contraception that involves blocking both fallopian tubes to prevent pregnancy.

107
Q

Does female sterilization alter the menstrual pattern?

A

No, it does not alter the menstrual pattern.

108
Q

What methods can be used to perform female sterilization?

A

Methods include laparoscopy, hysteroscopy, or minilaparotomy.

109
Q

What is important to discuss during counseling for female sterilization?

A

It is important to discuss that the procedure is irreversible, its failure rate is 1 in 200, and the potential for ectopic pregnancy.

110
Q

What are Filshie clips?

A

Filshie clips are the commonest form of mechanical device used in female sterilization.

111
Q

Where should Filshie clips be positioned on the fallopian tubes?

A

They should be positioned at a right angle to the tube, 1-2 cm from the cornua, covering the whole width of the tube.

112
Q

Is it necessary to use multiple Filshie clips on each fallopian tube?

A

No, using multiple clips is not necessary.

113
Q

What does the Pomeroy technique involve?

A

The Pomeroy technique involves tying and excising a loop of the fallopian tube, often performed via laparotomy.

114
Q

What are some complications associated with sterilization techniques like the Pomeroy technique?

A

Complications can include anesthesia problems, damage to intraabdominal organs, and the need for laparotomy, especially in cases of obesity or adhesions.

115
Q

What is hysteroscopic sterilization?

A

Hysteroscopic sterilization is a method of permanent birth control that involves placing implants inside the fallopian tubes without abdominal incisions.

116
Q

Who are the ideal candidates for hysteroscopic sterilization?

A

Ideal candidates include individuals with high BMI, medical illnesses, previous abdominal and pelvic surgery.

117
Q

What is the procedure for hysteroscopic sterilization?

A

A micro-insert is placed in the proximal section of the fallopian tube to induce inflammation, leading to fibrosis and scar formation, which blocks the tubes.

118
Q

What is the efficacy rate of Filshie clips?

A

The failure rate of Filshie clips is 2-3 per 1000 after 10 years, with a lifetime failure rate of 1 in 200.

119
Q

When should consent be obtained for a sterilization procedure?

A

Consent should be obtained one week prior to the procedure.

120
Q

When can sterilization procedures be performed?

A

They can be performed at any time during the menstrual cycle, with a pregnancy test conducted on the day of the operation.

121
Q

What are ADIANA and ESSURE?

A

ADIANA and ESSURE are types of hysteroscopic sterilization devices. ADIANA uses radiofrequency ablation with a silicone micro-insert, and ESSURE involves the insertion of an expanding spring.

122
Q

What are the adverse events associated with these hysteroscopic sterilization methods?

A

Adverse events can include tubal perforation, infection, device migration, device expulsion, and vasovagal attack and pelvic pain.

123
Q

What is male sterilization?

A

Male sterilization, or vasectomy, involves the division or removal of a piece of each vas deferens, which is a more cost-effective and simpler procedure than female sterilization.

124
Q

How is a vasectomy performed?

A

It is typically performed on an outpatient basis under local anesthesia.

125
Q

Is a vasectomy effective immediately after the procedure?

A

No, a vasectomy is not effective immediately. Contraception should be continued until there are two consecutive semen analyses showing azoospermia.

126
Q

When should the effectiveness of a vasectomy be tested?

A

The first test should be 8 weeks after the procedure, and the second after 2-4 weeks or 20 ejaculations.

127
Q

What is an advantage of a vasectomy?

A

An advantage of a vasectomy is the ability to check for its efficacy through semen analysis for sperm-free ejaculate (SFA).

128
Q

What is the failure rate of a vasectomy?

A

The failure rate is 1 in 2000.

129
Q

What are some common complications of a vasectomy?

A

Complications can include scrotal bruising, hematoma (1-2%), wound infection (up to 5%), anti-sperm antibodies, chronic testicular pain, granuloma formation, and potential links to atherosclerosis or testicular cancer.

130
Q

What is the frequency of failure rate and natural reversal in vasectomies?

A

The failure rate (FR) is 1 in 2000, and natural reversal is observed in 1 in 4000 cases.

131
Q

What is the success rate of vasectomy reversal?

A

The success rate of vasectomy reversal varies between 52-82%, depending on factors such as time since the vasectomy, type of vasectomy, technique of reversal, and surgical expertise.

132
Q

What is required before a vasectomy procedure in terms of consent?

A

Careful counseling and written consent are required. It must be clearly indicated that sterilization is a permanent procedure.

133
Q

Why is counseling important before sterilization?

A

Counseling is important as it helps ensure that individuals or couples are making an informed decision, as 10% may regret being sterilized later on, especially younger individuals, those who decide immediately after delivery or at the time of induced abortion. About 1% request reversal.

134
Q

What factors are considered during counseling for sterilization?

A

Factors considered include age, family size, problems with current contraception, partner’s opinion, stability of the relationship, failure rate of the procedure, risks, side effects, and reversibility.

135
Q

What is the success rate of reversal of sterilization and what are the associated risks?

A

Reversal of sterilization via laparotomy and microsurgery has a 70% success rate, with a 5% chance of ectopic pregnancy. For vasectomy reversals, the success rate is about 90%, and the pregnancy rate post-reversal is 60% in the presence of anti-sperm antibodies (ASA).

OBGYN (4 decks)

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