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Womens Health > E1: Contraception > Flashcards

E1: Contraception Flashcards

1
Q

What populations are at higher risk for unplanned pregnancy?

A
  • 18-24 years old
  • black or Hispanics
  • education less than high school diploma
  • low income
  • women who are cohabiting but never married
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2
Q

In order to start contraception, what must your confirm with your patient?

A

That they are NOT pregnant

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3
Q

Other than a pregnancy test, how can you confirm that your patient is not pregnant?

A
  • ≤ 7 days after start of normal menses
  • No sexual intercourse since the start of the last normal menses
  • Has been correctly and consistently using a reliable method of contraception
  • is ≤ 7 days after spontaneous or induced abortion
  • is w/in 4 weeks postpartum
  • is fully breastfeeding, is amenorrheic, AND < 6 months postpartum
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4
Q

What are the methods for natural family planning?

A
  • Standard days/calendar method
  • cervical mucous/two day method
  • basal body temp method
  • symptothermal method
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5
Q

What is the standard days/calendar method of family planning?

A
  • standard days: for women with menstrual cycles from 26-32 days long, abstain from sex on days 8-19
  • calendar: for women who dont have 26-32 cycle lengths, monitor cycles for 6 months.
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6
Q

How do you calculate the fertile period in the calendar method of family planning?

A

The first day of the fertile period is by taking the length of the shortest menstrual cycle ( the first day of period to the first day of the next period) and subtracting 18. The last days of the fertile period is by taking the length o the longest menstrual cycle and subtracting by 11. Avoid sex in the fertile period.

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7
Q

What is the basal body temperature method of natural family planning?

A

-check basal body temperature upon awakening every AM before getting out of bed. Rise in temp of 0.5-1 F indicated ovulation. Abstain from sex from end of menstrual period until 3 days after temperature increase

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8
Q

What is the symptothermal method of natural family planning?

A

A combination of cervical mucus and basal body temperature methods

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9
Q

What are the barrier methods of birth control?

A

Diaphragm, condoms, cervical caps, and cervical sponge

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10
Q

How is a cervical cap used?

A

May be left in for 48 hours, but must be left in for a minimum of 6 hours after sex

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11
Q

How is a diaphragm used?

A

Can be left in place for 24 hours, but must leave in for a minimum of 6 hours after sex
-increased risk of UTI

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12
Q

How does a cervical sponge work?

A
  • releases continual spermicide

- must leave in for a minimum of 6 hours after sex

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13
Q

How do spermicides work?

A
  • attacks sperm flagella and body, reducing motility

- immediately active

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14
Q

What are the two forms of EC?

A

Oral tablets and IUD insertion within 5 days of unprotected sex (paraguard interferes with implantation)

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15
Q

How are oral tablet EC used?

A

Two doses of contraceptive pills taken within 72 hours of unprotected sex

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16
Q

How does the EC Ulipristal acetate work?

A
  • Brand name Ella

- Selective progesterone receptor modulator, effective for up to 120 hours (5 days) post intercourse

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17
Q

What are the short acting or frequent use options for birth control?

A
  • oral contraceptive pills
  • Nuva ring
  • orthoevra patch
  • Depo
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18
Q

Who are the best candidates for short acting or frequent use birth control?

A
  • women who have a short interval prior to wanting a pregnancy
  • women who are not looking for long term pregnancy prevention
  • women using these methods for non contraceptive benefits
  • uninsured women with financial concerns
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19
Q

What are combination oral contraceptives (COCs)?

A
  • Combination of an estrogen and a progestin (progestin type differs in different pills)
  • main mechanism is ovulation suppression (inhibits GnRH, LH, and FSH)
  • Thickens cervical mucous and thins endometrial lining
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20
Q

What are monophonic combination pills?

A

-single dose of estrogen and progesterone for 21-24 days, and placebo pills for 4-7 days after

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21
Q

What are triphasic combination pills?

A

-differing dose of estrogen and progesterone throughout the course of the pack, plus placebo pills usually for 7 days

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22
Q

What are continuous combination pills?

A
  • usually monophonic

- packaged with 84 active pills and 7 placebo pills or 365 of active pills

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23
Q

What are the side effects of COCs?

A
  • unscheduled bleeding
  • nausea
  • breast tenderness
  • headache
  • intentional amenorrhea
24
Q

What are the advantages to using COCs?

A
  • reversible almost immediately
  • safe
  • can be used for extended periods
  • decreased blood loss and cramps
  • decreased acne
  • prevention of ovarian cysts
25
Q

What are the risks associated with COCs?

A
  • HTN
  • DVT
  • MI/Stroke
  • lipid changes
26
Q

What kind of medication are norethindrone and drospirenone?

A

Progestin only pills (POP) or the “mini pill”

27
Q

How do progestin only pills work?

A
  • thickens cervical mucous to prevent sperm entry, thins endometrium to inhibit implantation, slows sperm motility, and ovulation suppression in 50% of cycles
  • can be initiated at any time
28
Q

What are the advantages to progestin only pills?

A
  • Reversible
  • safe
  • may be used by women with contraindications to estrogen
29
Q

What are the side effects of POPs?

A

Increased posting and intermenstrual bleeding, intermittent amenorrhea

30
Q

What are the limitations to POPs?

A

-Limited window for missed pills (>3 hours late taking dose will decrease effectiveness)

31
Q

What are the contraindications for COCs?

A
  • Age ≥ 35 yers and smoking ≥ 15 cigs/day
  • uncontrolled HTN
  • Migraine with aura
  • DM of >20 yrs or with nephropathy, retinopathy, or neuropathy
  • VTE
  • Known ischemic disease
  • Hx of stroke
  • complicated valvular HD
  • Risk factors for arterial CVD
  • Breast CA
  • cirrhosis
  • Hepatocellular adenoma or malignant hepatoma
32
Q

What does it mean when a birth control is category 1?

A

There is no restriction for use of the contraceptive method for a women with that condition

33
Q

What does it mean if a birth control method is category 2?

A

Advantages of using the method generally outweigh the theoretical or proven risks

34
Q

What does it mean if a birth control method is category 3?

A

Theoretical or proven risks of the method usually outweighs the advantages- not usually recommended unless more appropriate methods are not available or acceptable

35
Q

What does it mean if a birth control method is category 4?

A

Unacceptable heart risk if the contraceptive method is used by a women with that condition

36
Q

What is the MOA of Depo Provera?

A

Supper ovulation, thin endometrial lining, and thicken cervical mucous

37
Q

What are the advantages of Depo Provera?

A
  • Reversible (but there can be a delay up to a year to resume ovulation)
  • safe for all ages
38
Q

What are the side effects of Depo Provera?

A
  • Changes in bleeding pattern (occasional heavy bleeding)
  • Weight gain
  • Decreased bone mineral density
39
Q

What are the transdermal birth control options?

A

Nuva ring, ortho Evra patch, and annovera

40
Q

What are the contraindications to transdermal birth control?

A

Same as COCs

41
Q

What hormones are in transdermal birth control?

A

Estrogen and progesterone

42
Q

What is the MOA for sub dermal implants?

A
  • Thickened cervical mucus and inhibits tubal motility

- inhibits follicular maturation and ovulation

43
Q

What kind of hormones are in the sub dermal implants?

A

Progestin only

44
Q

What are the advantages to sub dermal implants?

A
  • Long acting
  • reversible
  • safe
45
Q

What are the side effects of sub dermal implants?

A
  • unpredictable unscheduled bleeding or amenorrhea
  • weight gain
  • good for women with estrogen contraindications
46
Q

What is the MOA of Levonorgestreal IUDs?

A

Changes cervical mucous to become thicker, alteration of endometrium prevents implantation of fertilized ovum

47
Q

What are patients who are on Levonorgestrel IUDs at increased risk for?

A

-Increased likelihood of amenorrhea the longer the are on it, leading up to amenorrhea the will have increased spotting and increased risk of ovarian cysts

48
Q

Which IUD has been FDA approved for menorrhagia?

A

Mirena

49
Q

What is the MOA of copper IUDs?

A
  • Copper ions inhibit sperm motility so sperm rarely reach the Fallopian tubes and are unable to fertilize the ovum
  • Inflammatory reaction in the endometrium phagocytizes the sperm
50
Q

What are the side effects of Copper IUDs?

A

-May increase menstrual blood loss and dysmenorrhea

51
Q

What are the associated risks with all IUDs?

A

-increased risk of ectopic pregnancy, spontaneous abortion, and preterm delivery if become pregnant

52
Q

What are the 4 kind of progestin containing IUDs?

A

Mirena, Kyleena, Skyla, and liletta

53
Q

What are the options for female sterilization?

A
  • Laparoscopic or abdominal tubal ligation
  • Salpingectomy
  • and Hyesteroscopic sterilization (ensure, off market)
54
Q

What is the MOA of tubal ligation?

A

Interrupts Fallopian tube and prevents fertilization

55
Q

What the is the MOA of vasectomy?

A
  • Interrupts vas deferens preventing passage of spermatids into seminal fluid
  • alternative contraceptive needed until 2 consecutive sperm samples show no motile sperm

Womens Health (5 decks)

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