Exxcellence pearls: contraceptive choices for medical problems Flashcards
For what medical condition is Mirena IUD relatively contraindicated?
History of breast cancer
What medical conditions make emergency contraception poorly indicated?
Virtually none. Emergency contraception is a category 1-2 method according to WHO guidelines for nearly all medical conditions.
How should women with obesity be counseled regarding contraceptive methods?
Hormones may be cleared more quickly and sequestered in body fat. OCP’s and implantable contraceptives have a higher failure rate. Depo-Provera, Mirena, ParaGard, and barrier methods have similar efficacy for non-obese women. Depo-Provera may cause weight gain.
How should women who have had bariatric surgery be counseled regarding contraception?
Weight loss leads to improved fertility. Malabsorptive procedures may compromise oral absorption of contraceptives. Implantable contraception should be used with caution until weight stabilizes.
What contraceptives are appropriate for women with poorly controlled hypertension?
Progestin only agents, implantables, and IUDs.
How should women taking anticonvulsants be counseled regarding contraceptives?
Anticonvulsants can induce liver enzymes which increase the clearance of hormones. High-dose pills have been recommended but there is little evidence to support this practice. Depo-Provera and IUDs are most highly recommended.
Can women with type 1 or type 2 diabetes safely take oral contraceptives?
Yes, provided they have no evidence of end-organ damage.
