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Women's Health > Exam 1 - Contraception > Flashcards

Exam 1 - Contraception Flashcards

1
Q

In order to start contraception, a patient needs to meet reasonable certainty that she is not pregnant. What are the points that a women must meet at least one of?

A
  • 7 days or less 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 or less after spontaneous/induced abortion
  • Is within 4 days postpartum
  • Is fully or nearly fully breast feeding, is amenorrheic AND < 6 months postpartum
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2
Q

What are some advantages and disadvantages of using male condoms?

A

Advantages: reduces transmission/acquisition of STIs, readily available, usually inexpensive

Disadvantages: May break or fall off

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3
Q

How is a cervical cap used for contraception?

A
  • Can be left in place for 48 hours

- Must leave in for minimum of 6 hours after sex

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4
Q

How is a diaphragm used for contraception?

A
  • Can be left in place for 24 hours

- Must leave in for minimum of 6 hours after sex

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5
Q

How is a condom for women used for contraception?

A

Can be inserted up to 8 hours in advance

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6
Q

How does a sponge work for contraception?

A
  • Releases continual spermicide

- Must leave in for at least 6 hours after sex

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7
Q

How does a spermicide work for contraception?

A
  • Attacks sperm flagella and body, reducing their motility

- Can be used alone or with other barrier methods

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8
Q

What are some advantages versus disadvantages of using female controlled barriers?

A

Advantages: immediately active, no effect on menses/hormones

Disadvantages: UTI risk w/ diaphragm, no HIV protection

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9
Q

What are the emergency contraception options?

A
  • Plan B or Preven are available OTC and must be taken within 72 hours of unprotected intercourse
  • Paragard IUD must be inserted by HCP within 5 days of unprotected intercourse
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10
Q

What is the MOA of combined oral contraceptives?

A
  • Main: Inhibits GnRH, LH, FSH, and mid-cycle surge; ovulation suppression
  • Also thickens cervical mucous and thins endometrial lining
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11
Q

What should you test prior to prescribing combined oral contraceptives?

A

Test BP prior to starting to look for severe/uncontrolled HTN

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12
Q

What are some major risks of taking combined oral contraceptives?

A
  • Hypertension
  • Venous Thromboembolism
  • MI and Stroke
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13
Q

What are two names of progestin only oral contraception?

When is it typically used?

A

Norethindrone and drospirenone

Usually used in nursing mothers or if estrogen is contraindicated

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14
Q

What is the MOA of progestin only oral contraception?

A
  • Thickens cervical mucous to prevent sperm entry

- Thin endometrium

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15
Q

What are some side effects and limitations of progestin only oral contraception?

A

Side Effects:

  • Increased spotting/intermenstrual bleeding
  • Intermittent amenorrhea

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

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16
Q

What are absolute contraindications of combined oral contraceptives?

A
  • Age 35 or older and smoking 15 or more cigarettes per day
  • Uncontrolled HTN (SBP 160 or greater, DBP 100 or greater)
  • Migraine with aura
  • DM of > 20 years duration or with nephropathy, retinopathy, or neuropathy
  • VTE (unless on anticoagulation)
  • Known ischemic heart disease
  • History of stroke
  • Complicated valvular heart disease (pulmonary HTN, risk for A-fib, hx of subacute bacterial endocarditis)
  • Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and HTN)
  • Breast cancer
  • Severe cirrhosis
  • Hepatocellular adenoma or malignant hepatoma
17
Q

What is the MOA of Depo Provera?

A
  • Suppress ovulation

- Thin endometrial lining and thicken cervical mucous

18
Q

When can Depo Provera be started and does it require any form of backup?

How often must you receive the injections?

A

Can be started at any time. No back up needed if starting within first 7 days of bleeding.

Repeat injections every 13 weeks.

19
Q

What are advantages and side effects of Depo Provera?

A

Advantages: Reversible, safe for all ages including adolescents

Side effects: Changes in bleeding pattern (occasional heavy bleeding), weight gain, decreased bone mineral density (esp. in adolescents)

20
Q

What are the transdermal contraception options?

A
  • Nuva Ring
  • Ortho Evra Patch
  • Annovera
21
Q

What are contraindications of using transdermal contraception options?

A

Same as COC:

  • Age 35 or older and smoking 15 or more cigarettes per day
  • Uncontrolled HTN (SBP 160 or greater, DBP 100 or greater)
  • Migraine with aura
  • DM of > 20 years duration or with nephropathy, retinopathy, or neuropathy
  • VTE (unless on anticoagulation)
  • Known ischemic heart disease
  • History of stroke
  • Complicated valvular heart disease (pulmonary HTN, risk for A-fib, hx of subacute bacterial endocarditis)
  • Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and HTN)
  • Breast cancer
  • Severe cirrhosis
  • Hepatocellular adenoma or malignant hepatoma
22
Q

What is the MOA of the sub-dermal implants (Implanon, Nexplanon)?

A
  • Thickened cervical mucous and inhibit tubal motility

- Inhibits follicular maturation and ovulation

23
Q

What are advantages and side effects of using sub-dermal implants?

A

Advantages: long acting (up to 3 years), reversible, safe for all ages

Side effects: Unpredictable unscheduled bleeding, amenorrhea, weight gain (few pounds)

24
Q

What is the MOA of the Levonorgestrel IUD?

A
  • Changes cervical mucus to become thicker

- Alteration of endometrium prevents implantation of fertilized ovum

25
Q

What are advantages of Levonorgestrel IUD?

What is a specific advantage of Mirena?

A
  • Long acting (3-6 years of use)

- Mirena has been FDA approved to treat menorrhagia

26
Q

What are advantages and side effects of the Copper IUD?

A

Advantages: Long acting (10 years of use)

Side effects: May increase menstrual blood loss and dysmenorrhea

27
Q

What can occur if one becomes pregnant with an IUD?

A

Increased risk of pregnancy, spontaneous abortion, and preterm delivery

28
Q

What is the MOA of the Copper IUD (Paragard)?

A
  • Inhibits sperm motility so sperm rarely reach the fallpian tubes and are unable to fertilize the ovum
  • Inflammatory reaction in the endometrium phagocytizes the sperm
29
Q

What are the four types of progestin containing/Levonorgestrel IUD?

A
  • Mirena (5 years)
  • Kyleena (5 years)
  • Skyla (3 years)
  • Liletta (6 years)

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