Contraceptives Flashcards
Methods that contain combined estrogen and
progesterone formulations with different
delivery systems are known as:
Combined hormonal contraception
What is the mechanism of action of Combined Oral Contraception (COC)?
The effects of estrogen and progesterone suppress GnRH which suppresses FSH and LH
1- inhibiting ovulation
2- ovum transport
3- cervical mucus thickness is altered inhibiting sperm transport
4- implantation is inhibited by suppression and alteration of uterine secretion
What are the advantages of using a combined hormonal contraceptive? (15 items)
1- high rate of effectiveness
2- Controlled by women
3- easy and convenient
4- rapid return to fertility
5- improves menstrual characteristics
6- reduction in menstrual bleeding
7- protection against ovarian and endometrial cancer
8- lower incidence of ovarian cyst
9- prevention of ectopic pregnancy
10- lower incidence of endometriosis
11- treatment for PCOS
12- protection against loss of bone mineral density
13- lower incidence of benign breast cysts and fibroadenomas
14- reduction in vasomotor symptoms in perimenopausal women
15- association in mild improvement of acne
What are the current Combined Hormonal Contraceptives?
1- Combined Oral Contraceptives (COC)
2- Transdermal patch
3- Vaginal ring
The three estrogen compounds currently used in combined hormonal contraceptives are :
1- estradiol
2- estradiol valerate
3- menstranol
What are the disadvantages of Combined Hormonal Contraceptives? (8 items)
1- affects all body systems 2- Some forms require daily maintenance 3- some users experience undesirable side effects 4- should not be used when lactating 5- provide no protection against STDs 6- high cost for women 7- prescription needed 8- may interact with other drugs
What are some side effects associated with combined hormonal contraceptives?
1- Effects on Blood Lipids 2- Cardiovascular disease 3- Stroke 4- Carbohydrate metabolism 5- Risk of breast cancer
What are the advantages to using the transdermal contraceptive patch? (5 items)
1- hormonal levels remain therapeutic for 9 days after the application of the second patch, suggesting that ovulation inhibition would be maintained even if a scheduled patch change was missed for as long as 2 days
2- weekly regimen
3- easy verification
4- safe for women with latex allergy
5- delivery system avoids “first pass” effects on liver
What are the disadvantages to the transdermal contraceptive patch? (4 items)
1- decreased effectiveness of Ortha Evra patch for women weighing over 198lbs
2- must remember to change it weekly
3- skin reactions
4- breast tenderness
The transdermal contraceptive patch label indicates the higher exposure to estrogen however there is no increased risk of (3 items).
1- venous thrombosis
2- stroke
3- MI
What are the advantages of the Contraceptive Vaginal Ring? (5 items)
1- elimination of the need for daily pill taking
2- delivery system avoids the first pass effect on the liver
3- low incidence of break through bleeding
4- hormone levels remain therapeutic for at least 35 days, suggesting that the ovulation inhibition would be maintained even if a woman forgets to remove the ring up to 2 weeks late
5- safe for women with a latex allergy
What are the disadvantages to the Contraceptive Vaginal Ring? (5 items)
1- vaginal ring not recommended for women with uterine prolapse, lack of vaginal muscle tone or chronic constipation
2- women must be comfortable with the insertion and removal
3- Women may experience a foreign body sensation
4- side effects of headache, leukorrhea and vaginitis
5- back up contraception is needed for 7 days if ring is removed for 3 or more hours
What are some are some important education points for the patient when starting a Contraceptive Vaginal Ring? (3 items)
1- some women may experience increase in normal vaginal secretions
2- if woman finding it difficult to insert she can use an empty tampon applicator
3- if unpleasant feeling for woman or partner, it may be removed for up to 3 hours, cleansed with cool water and replaced in the vagina
What is the mechanism of action for Progestin-only pills (POPs)? (4 items)
1- Inhibits ovulation
2- increases cervical mucus to inhibit sperm penetration
3- causes the endometrium to become thin and atrophic
4- causes tubal changes to alter tubal transport, contractility and histology
Progestin-only pills are a good choice for women who: (6 items)
1- breastfeeding
2- need short term birth control that can be stopped at any time
3- cannot take estrogen (those who smoke, older than 35, long standing DM, heart disease, problems with blood clots, high blood pressure)
4- have migraines with aura
5- have heavy, painful menstrual periods
6- have anemia from heavy menstrual bleeding
What are the advantages to Progestin-only pills? (6 items)
1- no estrogen related side effects
2- overall safer than combined hormonal contraceptives
3- may be used in patients with prior history of thrombophlebitis
4- minimal effects on carbohydrate metabolism
5- rapid reversal after stopping
6- decreased cramping, lighter bleeding, shorter periods, decreased PMS symptoms, and lessened breast tenderness
What are the disadvantages to Progestin-only pills?
1- Must be taken with meticulous accuracy (no more than 27 hours between pills)
2- Slightly less effective than CHCs
3- May cause irregular bleeding with an unpredictable pattern
4- No protection against STDs
5- interaction with other drugs can decrease effectiveness
6- higher incidence of functional ovarian cyst
7- higher incidence of ectopic pregnancy
8- adverse effects on lipids causing an decrease in HDLs and increase in LDLs
Drugs whose effects may enhance in combination with contraceptives include: (6 items)
1- Tricyclic antidepressants 2- benzodiazepines 3- betablockers 4- corticosteroids 5- theophylline 6- troleandomycin
Drugs whose effects may be diminished in combination with contraceptives include: (4 items)
1- acetaminophen
2- oral anticoagulants
3- some benzodiazepines
4- oral hypoglycemic agents
Drugs that may diminish the effects of contraceptives include: (5 items)
1- Anticonvulsants 2- barbiturates 3- benzodiazepines 4- St. Johns wart 5- some antibiotics
Drugs that will interact with drospirenone- containing contraceptives to increase the risk of hyperkalemia include:
1- ACE-inhibitors 2- Angiotensin II Receptor Antagonist 3- Potassium Sparing Diuretics 4- Heparin 5- Aldosterone Antagonist 6- Daily NSAIDs
How long does the progestin implant Nexplanon provides coverage up to?
3 years
DMPA also known as Depo Provera (depot-medroxyprogesterone acetate) is the injection form of progestin only contraceptive that provides protection up to:
12 weeks
______ condoms are stronger than ____ condoms and they are thinner
Polyurethane
_____ condoms are made from animal membranes and may not protect against STDs
Lambskin
What are the 5 different types of Intrauterine devices and how long is their protection against pregnancy?
1- Skyla® (levonorgestrel 13.5 mg) up to 3 years.
2- kyleena (levonorgestrel 19.5mg) up to 5 years
3- Mirena (Levonorgestrel 52 mg) for up to 7
years
4- Liletta (Levonorgestrel 52 mg) for up to 5 years
(cheaper for patients without insurance
5- Paragard up to 12 years
What is the mechanism of action for LARCs (long acting removable contraception)? (3 items)
1- Suppresses ovulation
2- alters endometrial structure
3- changes cervical mucous to impede sperm penetration
What are the advantages to LARCs (8 items)?
1- ease of use 2- no attention from user required until time of removal 3- discreteness 4- no adverse affect on acne 5- relief of dysmenorrhea 6- relief of endometriosis symptoms 7- reduces risk of ectopic pregnancy 8- no estrogen
What are the disadvantages to LARCs? (7 items)
1- abnormal uterine bleeding
2- 10% discontinued due to unacceptable bleeding patterns
3- rare insertion complications
4- ovarian cyst
5- no protection against STDs
6- Drug interactions
7- possible increased thromboembolic risk
What is Nexplanon an example of
LARC (long acting removable contraception)
What is the mechanism of action of a copper intrauterine device?
inhibition of sperm migration and viability
What is the mechanism of action of a levonorgestrel intrauterine device? (4 items)
1- Thickening cervical mucous
2- suppression of the endometrium by reducing uterine artery blood flow
3- impairing sperm function by changing uterine immune microenvironment
4- may also impair ovulation
What are the advantages of IUDs? (7 items)
1- highly effective 2- continuously effective 3- allows for sexual spontaneity 4- cost-effective 5- returns to fertility immediately 6- can be used during lactation 7- protection against ectopic pregnancy
What are the disadvantages of IUDs? (7 items)
1- insertion only by a trained professional
2- may cause menstrual disturbances
3- pain and nausea during insertion
4- no protection against STIs
5- device can be expelled without user being aware
6- risk of perforation
7- infection of uterus on insertion
Progestin only pills are contraindicated in: (4 items)
1- history of functional ovarian cyst or ectopic pregnancy
2- inability to take pills consistently
3- hyperlipidemia
4- undiagnosed abnormal vaginal bleeding during the preceding 3 months
What are 2 examples of barriers methods for females?
Diaphragm and cervical cap
______ must be fitted and examined by a practitioner and a ______ _____ doesn’t have to be fitted
Diaphragm; cervical cap
What are the advantages to diaphragms and cervical caps? (8 items)
1- contraception needed on a irregular basis
2- doesn’t require partner involvement
3- considered medically safe
4- little danger or systemic effects
5- easily reversible
6- provides protection against STIs and PID
7- can be used during lactation
8- may provide some protection against cervical neoplasia
What are the disadvantages of diaphragms and cervical caps? (8 items)
1- may interfere with sexual spontaneity
2- learning insertion and removal techniques may be difficult for some
3- allergies
4- odor or discharge if left in for a few days
5- vaginal trauma
6- increased risk of UTI
7- potential for toxic shock syndrome
8- less effective in parous women
What are some disadvantages to female condoms? (7 items)
1- one time use 2- expensive for frequent use 3- can slip out 4- ring dangles out of vagina 5- may make noise during use 6- can break 7- cumbersome insertion
What is the mechanism of action for vaginal contraceptive sponge? (4 items)
1- barrier effect
2- spermicide
3- action of trapping and absorbing semen before sperm can enter the cervix
4- can be left in for 24 hours
What is a specific instruction that needs to be given to a woman who is using a vaginal contraceptive sponge?
must be left in for 6 hours after coitus (sexual intercourse)
What is an advantage of spermicides?
Provides protection for up to one hour after insertion
What is a disadvantage to spermicides? (4 items)
1- Does not provide protection against STD’s
2-may increase susceptibility of HIV due to vulvovaginal epithelial disruption
3- interferes with spontaneity
4- taste during oral sex
What are the directions given to people using suppository and film spermicide?
Must be inserted 15 minutes prior to intercourse to allow them to melt
Progesterone increases the body temp by ___-___ degrees indicating ovulation
0.4-0.8 degrees
The cervical fertility awareness method indicates that the peak day when cervical mucous resembles _____, indicates ovulation
egg-white consistency or mid-cycle spotting
What is the lactation amenorrhea contraceptive method?
First six months after pregnancy when menses has not returned and are consist with breast feeding
