Contraceptives

Question 1

Effectiveness of contraceptives:

no method
period abstinence

diaphragm
male condom

OCP
patch
ring

depo-provera
levonorgestrel implanon

levonorgestrel Mirena IUD
copper paragard

female sterilization
male sterilization

Answer 1

Implanon

Male sterilization, Levonorgestrel Mirena IUD

Perfect use depo-provera, ring, patch, OCP

Female sterilization, Copper paragard

Actual use depo-provera, ring, patch, OCP

male condom, diaphragm, periodic abstinence

no method

Question 2

Mech? Best suited for? contraindications and disadvantages?

barriers like diaphragm, cervical caps and condoms

Answer 2

mechanical obstruction

for patients wanting protection from STIs and not wanting hormones

not for patients wanting spontaneity, allergies, POP, prone to UTIs

Question 3

Mech? Best suited for? contraindications and disadvantages?

Combined hormones like OCP, patch and ring

Answer 3

inhibits ovulation, alters uterine and fallopian motility, thins endometrium, thickens cervical mucous

for patients w/ anemia, dysmenorrhea, ovarian cysts and endometriosis

not for patients w/ thrombogenic problems, CV/migraines w/ aura/CAD/uncontrolled HTN, smoking @ >35yo, diabetic retinopathy/nephropathy/PVD, estrogen-dependent cancers (breast, endometrial), undiagnosed vaginal bleeding, liver issues

OCP - remember daily pill
Patch - more nausea
Ring - vaginal irritation and discharge

Question 4

Mech? Best suited for? contraindications and disadvantages?

Pregestin-only pill like minipill

Answer 4

alters uterine and fallopian motility, thins endometrium, thickens cervical mucous

for patients who are breast-feeding

not for patients w/ poor compliance (very dependent on 1 pill a day @ the same time)

Question 5

Mech? Best suited for? contraindications and disadvantages?

injectables like depo-provera

Answer 5

inhibits ovulation, thins endometrium, thickens cervical mucous

for patients who have sickle cell disease, epilepsy, desires long-term contraception, breast feeding, anemia, dysmenorrhea, ovarian cysts, endometriosis

not for patients who are depressed, have osteopenia/osteoporosis, fears weight gain

Question 6

Mech? Best suited for? contraindications and disadvantages?

implants like levonorgestrel Implanon

Answer 6

inhibits ovulation, thins endometrium, thickens cervical mucous

for patients who desire long-term contraception (3 yrs), breast feeding, anemia, dysmenorrhea, ovarian cysts, endometriosis

not for patients who fear irregular vaginal bleeding, have thrombotic tendencies, liver disease, undiagnosed vaginal bleeding, estrogen-dependent cancer (breast), allergies

Question 7

Mech? Best suited for? contraindications and disadvantages?

Levonorgestresl Mirena IUD

Answer 7

thins endometrium, thickens cervical mucous

for patients who desire long-term contraception (5yrs), stable monogamous relationship, menorrhagia and dysmenorrhea

not for patients w/ current/recent STD, unexplained vaginal bleeding, malignant gestational trophoblastic disease, cancer (breast, endometrial, cervical), anatomical abnormalities

Question 8

Mech? Best suited for? contraindications and disadvantages?

Copper Paragard IUD

Answer 8

inhibits sperm and ovum

for patients wanting long-term contraception (10yrs), in stable monogamous relationship who cannot take hormones

not for patients w/ Wilson disease, may cause more bleeding/dysmenorrhea, current/recent STI, unexplained vaginal bleeding, malignant gestational trophoblastic disease, cancer (endometrial, cervical), anatomical abnormalities

Question 9

Mech? Best suited for? contraindications and disadvantages?

permanent sterilization

Answer 9

mechanical obstruction

for patients who no longer want more children

not for patients who are unsure about children or cannot undergo surgery

Question 10

Best emergency contraception

Answer 10

copper IUD

Question 11

Dosing? Formulation? # of days after intercourse? Tolerated?

Plan B

Answer 11

traditional - 2x @ 12hrs, levonorgestrel 750mcg
one-step - 1x, levonorgestresl enteric coated

72hrs

well tolerated

Question 12

Dosing? Formulation? # of days after intercourse? Tolerated?

ulipristal (Ella)

Answer 12

1x

progesterone modulator 30mg

5d

Frequent n/v

Question 13

Dosing? # of days after intercourse?

copper paragrad

Answer 13

one insertion

7d

Question 14

Dosing? Formulation? # of days after intercourse? Tolerated?

Combination Preven

Answer 14

2x @ 12 hrs

estradiol 200mcg and levonorgestrel 1mg

72h

rarely used 2/2 n/v

Question 15

form of contraception w/ highest risk of DVT

Answer 15

patch