Contraceptives (2) Flashcards
Method failure rate vs typical failure rate
Method: rate if method is used correctly
Typical: rate when method is used by pt
What form of contraception provides the most effective reversible variant?
HC (hormonal contraception)
What does estrogen and progesterone do in combination OCs?
Progesterone: suppresses LH and thus ovulation, thickens cervical mucous inh sperm migration, creates atrophic endometrium (not good for implantation)
Estrogen: improves cycle control by stabilizing the endometrium > less breakthrough bleeding
Progestin-only OC do primarily what? What scenario are they used in?
Make cervical mucous thick and impermeable
Breast feeding women (estrogen limits milk production) and women contraindicated to estrogen
Benefits of OCs?
Menstrual cycle regularity
Improved dysmenorrhea
Dec risk of Fe-def anemia (shorter and less heavy cycles)
Lower CA risk (ovarian, breast)
SE’s of OCs include:
Breakthrough bleeding Nausea Fatigue HA Venous thrombosis PE
Wt pain is only perceived
What’s included in the transdermal patch? How often is it applied? What’s the wt limit? SEs?
Estrogen and progesterone
Once a week for 3 weeks
198lbs
Greater risk of thrombosis
What’s the vaginal ring consist of? What’s a large advantage regarding pharmacokinetics? How often is it replaced? Can it be removed?
Estrogen and progesterone
No first pass metabolism through the liver
Once a month (insert for 3 weeks)
Yes, for 3 hours, but don’t recommend to pt
Who can’t use HC?
Women > 35 who smoke
H/o thromboembolism, FH needs to be looked at thoroughly
H/o CAD, CVD, CHF, migraine w/ aura, uncontrolled HTN
H/o mod/sev liver dx or liver tumors
How long does MPA work for? What is it? What does it do? What isn’t there? How effective is it? SEs?
14 weeks but prescribe injections every 11-13
IM injection of progestin
Lowers E levels, thickens cervical mucous, decidualization (blocks LH surge and ovulation)
Wt limit
Efficacy roughly equivalent to that of sterilization
Reversible dec bone density d/t dec E levels (caused by high P, consider changing to diff tx after 2 years), irregular bleeding (goes away), wt gain (P makes one hungry), exacerbation of depression
What are some long term issues w/ stopping MPA tx?
Menses can take a year to regulate after d/c
Depression may linger
These are d/t the drug staying within the system for long periods of time after MPA is d/c
Can MPA be used during breast feeding? When estrogen is contraindicated? In seizure disorders?
What are its effects on sickle cell? Endometrial hyperplasia?
Yes
Yes
Yes
Can dec sickle cell crises
Can lower endometrial hyperplasia
What are some SEs and risks of MPA?
Shouldn’t be used during preg or in a female suspected to be preg, unevaluated vaginal bleeding, known or suspected breast malignancy, active thromboembolic events, liver dx
What does LARC stand for? What are they?
Long-Acting Reversible Contraceptive
Implants and IUDs
How long does a rod LARC last? When should it be implanted? MOA?
3 years
Within the first 5 days of menses
Thickens cervical mucous, inh ovulation
What are some risks associated w/ a LARC?
Irregular bleeding (goes away!), HA, vaginitis, wt inc, acne, breast pain
Can a LARC be used during breastfeeding?
Yes
Contraindications to the implant? Complications?
Known or suspected preg
H/o thromboebolic event or disorder
Liver tumors or active liver dx
Abnormal undiagnosed uterine bleeding
Deep insertion, migration, infection, bruising, persistent pain
What’s the IUD expulsion rate? Where’s insertion done?
1-5%
In the office!
Risks w/ IUDs?
Inc infection risk
Inc risk of ectopic preg
Risk of uterine perforation at time of insertion which then req surgery
Risk of malposition that requires hysteroscopy for removal
Contraindications for IUDs include:
B-CA (levonorgestrel only)
Recent sepsis or septic abortion
Active cervical infection
Wilson’s dx (Copper T only)
Uterine malormations
What are the 3 levonorgestrel IUDs and how long do they last? How effective are they?
Mirena = 5 years Liletta = 3 years Skyla = 3 ears
Very, 0.2% pregnancy rate
What are the benefits of IUDs?
Decrease in menstrual blood loss (50%)
Less dysmenorrhea
Convenient and long-term
Protects endometrium against estrogen
How long do Cu IUDs last for? How?
10 years
Cu interferes w/ sperm transport and prevents implantation
Pros and cons to barrier methods.
Pros: inexpensive, little to no medical consultation, condoms protect against STDs
Cons: higher failure rate, still requires proper use
What’re the directions for diaphragms? What’s a common risk?
Must be used w/ spermicide
Can be inserted up to 6 hours prior to intercourse, must be left in 6-8 hours afterwards (but no more than 24h)
Inc risk of UTIs d/t poor vaginal low and obstruction of urethra > urinary retention
How long must vaginal liners be left in after intercourse?
6-8 hours
Risks of cervical caps (smaller diaphragms)? How long are they left in for and where are they applied?
Displacement, toxic shock syndrome (TSS)
6 hours post-intercourse, no more than 48h
Applied to cervix
How long are sponges left in for after intercourse?
6h but no more than 30 (or inc risk of toxic shock syndrome)
What does E-contraception do? Contraindications? How many pregnancies could it yearly prevent if used regularly?
Prevents ovulation and fertilization
No contraindications
1.5 million
What’s Plan B?
Levonorgestrel
2 pills taken 12 hours apart
OTC for women older than 17
Must be taken within 120h, more effective if before 72h
What is the most frequent method of BC in the US?
Surgical sterilization
1/3 couples
Considered a permanent method
Is a Vasectomy immediately effective? What is the benefit of a salpingectomy?
No, complete azoospermia usually comes after 10 weeks
Dec risk of ovarian CA
What’s a contraindication for hysteroscopy/the Essure system?
Nickel or contrast allergies, acute pelvic infection, suspected preg
