FAMILY PLANNING (CompreGyne) Flashcards
Among women who experience unintended pregnancy, what proportion are not using contraception?
More than half.
What are the most common contraceptive methods used in the U.S.?
Oral contraceptive pill (16%), female sterilization (15.5%), condoms (9.4%), LARC (7.2%), IUDs, and implants.
What are the two types of contraceptive effectiveness?
Typical use effectiveness and perfect use effectiveness.
What factors influence the difference between typical and perfect use effectiveness?
Complexity of correct use and user dependency.
What is ‘dual method use’ in contraception?
The use of two contraceptive methods for added protection.
What additional health benefit does combining a hormonal method with a condom provide?
Reduction of sexually transmitted infections (STIs).
What are Tier 1 contraceptive methods?
Highly effective methods with fewer than 1 pregnancy per 100 women per year, including IUDs, implants, and sterilization.
What does LARC stand for?
Long-acting reversible contraception.
What are the advantages of LARC methods?
Highly effective, reversible, minimal user error, high continuation rates, and cost-effective in the long term.
What types of LARC methods are available in the U.S.?
Etonogestrel subdermal implant (Nexplanon), Copper T380A IUD, and LNG-IUS.
Which contraceptive method is the most commonly used reversible method worldwide?
Intrauterine devices (IUDs).
What is the first-year failure rate for the Copper T 380A IUD and LNG-IUS?
Less than 1%.
What factors influence IUD pregnancy rates?
Skill of clinician inserting the device and correct high-fundal placement.
What is the cumulative pregnancy rate for the Copper T 380A IUD after 12 years?
1.7%.
What is the pregnancy rate for the LNG-IUS after 5 years of use?
About 1.1%.
What is the only copper-bearing IUD marketed in the U.S.?
Copper T 380A IUD (Paragard).
What is the approved duration of use for the Copper T 380A IUD in the U.S.?
10 years (effective for at least 12 years).
What is the daily release rate of levonorgestrel from the LNG-IUS (Mirena)?
About 20 μg per day.
What additional benefit does the LNG-IUS provide besides contraception?
Reduction of menstrual blood loss and treatment for excessive uterine bleeding.
What is the primary mechanism of action for all IUDs?
Inducing a local inflammatory reaction that creates a hostile environment for sperm.
How does the Copper IUD prevent pregnancy?
Increases inflammatory reaction, impairs sperm transport and viability, and prevents fertilization.
How does the LNG-IUS prevent pregnancy?
Thickens cervical mucus, decreases tubal motility, and creates a thin, inactive endometrium.
When can an IUD be safely inserted?
Any day of the cycle (if not pregnant), immediately postabortion, or immediately postpartum.
What is the risk of expulsion for an LNG-IUS inserted immediately postpartum following vaginal delivery?
Up to 24%.
Can the Copper IUD be used as emergency contraception?
Yes, within 5 days of unprotected intercourse.
What is the most common reason for discontinuing the Copper IUD?
Heavy or prolonged menses.
How does the LNG-IUS affect menstrual blood loss (MBL)?
Reduces MBL by 60%, with 50% experiencing amenorrhea after 24 months.
What is the risk of uterine perforation with IUD insertion?
1 in 1000 insertions.
What is the primary way to prevent uterine perforation during IUD insertion?
Straighten the uterine axis with a tenaculum and measure the cavity with a uterine sound.
What should be done if a patient with an IUD becomes pregnant?
Perform a pelvic ultrasound to confirm pregnancy location and remove the IUD if intrauterine.
Why should an IUD be removed in the case of an intrauterine pregnancy?
Leaving it increases the risk of spontaneous abortion threefold.
What is the increased risk of PID in the first 3 weeks after IUD insertion?
Six times higher than after 3 weeks.
Does routine use of prophylactic antibiotics before IUD insertion prevent PID?
No, studies show no significant change in infection risk.
What should be done if an IUD user tests positive for gonorrhea or chlamydia?
Treat the infection; IUD removal is usually unnecessary unless symptoms persist.
What are the six absolute contraindications to IUD insertion?
Pregnancy, acute PID, postpartum endometritis, suspected malignancy, unexplained bleeding, and an unretrieved previous IUD.
What historical event led to a decline in IUD use in the 1970s?
The complications associated with the Dalkon Shield.
What organization recommends LARC as first-line contraception?
The American Congress of Obstetricians and Gynecologists (ACOG).
What is the relationship between IUD use and the risk of endometrial or cervical carcinoma?
“IUD use is not associated with an increased incidence of endometrial or cervical carcinoma; rather it is associated with a reduction in risk.”
What potential fertility-sparing use does the LNG-IUS have?
“It has promising data for use as a fertility-sparing treatment for early-stage endometrial cancer.”
What is the most common contraceptive implant used in the United States?
“Nexplanon, which contains 68 mg of etonogestrel (ENG) and is approved for up to 3 years.”
What is the main mechanism of action of the Nexplanon implant?
“Ovulation, inhibition additional thickening of cervical mucus.”
How long is ovulation completely inhibited after Nexplanon insertion?
“At least 30 months.”
What is the most common reason for discontinuation of Nexplanon?
“Bleeding irregularities , accounting for about 60% of early removals.”
What are the different bleeding patterns observed with Nexplanon use?
“Amenorrhea (20%) , infrequent bleeding (27%), prolonged bleeding (12%), and frequent bleeding (6%).”
What is the most effective method of contraception among subdermal implants, IUDs, and sterilization?
“Subdermal implants are as effective or even superior to sterilization and IUDs.”
What is the most cost-effective contraceptive method?
“Vasectomy.”
How long after a vasectomy does it take for the ejaculate to become sperm-free?
“About 13 to 20 ejaculations.”
What is the success rate of vasectomy reversal (vas reanastomosis)?
“Approximately 50%.”
What is the most common method of contraception used by U.S. women over the age of 30?
“Female sterilization.”
What is the five-year cumulative failure probability of transabdominal sterilization according to the CREST study?
“13 per 1000 procedures.”
What female sterilization method had the lowest 10-year cumulative risk of failure in the CREST study?
“Postpartum partial salpingectomy (7.5 per 1000 procedures).”
What is the main advantage of vasectomy over tubal sterilization?
“Lower cost, can be performed in an office setting, and does not require entry into the peritoneal cavity.”
What is the only injectable contraceptive available in the United States?
“Depo-Provera (DMPA) , given as 150 mg IM or 104 mg SC every 3 months.”
What are the three mechanisms of action of DMPA?
“1) Inhibits ovulation , 2) Thickens cervical mucus, 3) Alters the endometrium causing atrophy.”
What is the typical failure rate of DMPA?
“Around 6%.”
What is the median delay to conception after discontinuing DMPA?
“9 to 10 months.”
What is the major side effect of DMPA?
“Changes in menstrual cycle, with irregular bleeding initially and amenorrhea over time.”
What percentage of DMPA users experience amenorrhea after one year?
“About 55%.”
What effect does DMPA have on bone mineral density (BMD)?
“It decreases BMD during use but the loss is reversible after discontinuation.”
What noncontraceptive health benefits does DMPA provide?
“Reduces iron deficiency anemia , PID, endometrial cancer risk, dysmenorrhea, ovulation pain, functional ovarian cysts, and may reduce seizure frequency in epilepsy patients.”
What must be done before confirming sterility after a vasectomy?
“A semen analysis must confirm absence of sperm.”
Which contraceptive method has been associated with a reduced risk of ovarian cancer?
“Tubal ligation.”
What is the most common method of laparoscopic sterilization?
“Bipolar cautery, clip, or Silastic band (Falope ring).”
What is the mechanism of action of the Essure device?
“It causes tissue ingrowth leading to permanent tubal occlusion.”
When should a hysterosalpingogram be performed after Essure insertion?
“Three months after insertion to confirm tubal occlusion.”
What is the recommended backup contraception duration after Essure placement?
“Until tubal occlusion is confirmed, typically three months.”
What anesthesia options are available for transcervical sterilization?
“Local anesthesia , IV sedation, or general anesthesia.”
What are the key clinical recommendations for DMPA use?
“Can be started anytime if pregnancy is ruled out , requires backup contraception if started >7 days into the cycle, and should be preceded by counseling on menstrual changes.”
How soon after DMPA discontinuation do serum etonogestrel levels become undetectable?
“Within one week.”
What are some alternative sterilization techniques used worldwide but not available in the U.S.?
“Jadelle (two-rod system , 75 mg levonorgestrel, 5 years), Sino-implant (two-rod system, 75 mg levonorgestrel), and Norplant (six-rod system, 216 mg levonorgestrel, 7 years).”
What is the failure rate of transcervical sterilization based on a model predicting pregnancy probability?
“57 per 1000 in the first year.”
What is the primary method of sterilization performed postpartum?
“Partial salpingectomy via infraumbilical minilaparotomy.”
How soon can Nexplanon be inserted in relation to a woman’s menstrual cycle?
“Anytime, as long as she is not pregnant.”
What effect does DMPA have on migraine headaches?
“No evidence suggests it increases the incidence or severity of migraines.”
What is the most common side effect leading to discontinuation of DMPA?
“Irregular bleeding.”
What is the major contraceptive effect of the progestin component in combination oral contraceptives?
Inhibition of ovulation
What are the secondary contraceptive actions of progestins in combination oral contraceptives?
Thickening of cervical mucus and thinning of the endometrium
What is the main role of estrogen in combination oral contraceptives?
Maintaining the endometrium and preventing unscheduled bleeding
What is the main mechanism by which combination oral contraceptives suppress ovulation?
Inhibition of gonadotropin-releasing hormone (GnRH) release from the hypothalamus
What effect does estrogen have on follicle-stimulating hormone (FSH)?
Prevents a rise in FSH
What effect does progestin have on luteinizing hormone (LH)?
Inhibits the LH surge
What are the three major types of oral contraceptive formulations?
Progestin-only pills (POPs), monophasic combination pills, multiphasic combination pills
How do monophasic and multiphasic combination pills differ?
Monophasic pills contain the same hormone dose each day, while multiphasic pills contain varying doses
What is the most widely used type of oral contraceptive?
Combination oral contraceptives (estrogen + progestin)
What is the failure rate of oral contraceptives with perfect use?
0.01
What is the failure rate of oral contraceptives with typical use?
0.08
What is the most important pill to take in an oral contraceptive cycle?
The first pill of each cycle
What should a woman do if she misses two or more oral contraceptive pills?
Take emergency contraception and use backup contraception
What type of oral contraceptive regimen results in withdrawal bleeding only four times a year?
Extended cycle regimens (84 active pills followed by a 7-day hormone-free interval)
What is the primary contraceptive mechanism of progestin-only pills (POPs)?
Thickening of cervical mucus and thinning of the endometrium
Why must progestin-only pills (POPs) be taken at the same time every day?
To maintain effective blood levels and prevent ovulation
What metabolic side effect of oral contraceptives is commonly reported but not supported by research?
Weight gain
What is the primary risk associated with estrogen-containing oral contraceptives?
Increased risk of venous thromboembolism (VTE)
Why should women with a history of idiopathic venous thromboembolism avoid estrogen-containing oral contraceptives?
Because estrogen increases VTE risk threefold
What are absolute contraindications to oral contraceptive use?
History of thromboembolism, vascular disease, uncontrolled hypertension, active liver disease, hormone-sensitive cancers, smoking over age 35
What are the two cancers that oral contraceptives significantly reduce the risk of?
Endometrial cancer and ovarian cancer
Which type of cancer has a slight increased risk with prolonged oral contraceptive use?
Breast cancer (risk disappears after stopping use)
What effect do oral contraceptives have on cervical cancer risk?
Prolonged use may slightly increase the risk of cervical cancer
What effect do oral contraceptives have on acne?
They reduce acne by lowering androgen levels
What effect do oral contraceptives have on menstrual blood loss?
They reduce blood loss, lowering the risk of iron deficiency anemia
What is the term for bleeding that occurs when active oral contraceptive pills are taken?
Breakthrough bleeding
What is the term for bleeding that occurs during the hormone-free interval?
Withdrawal bleeding
What is the recommended action if a woman experiences prolonged breakthrough bleeding on continuous oral contraceptive use?
Discontinue active pills for 3 days, then restart
Why should women over 35 who smoke avoid combination oral contraceptives?
Increased risk of myocardial infarction
When should combination oral contraceptives be initiated postpartum in non-breastfeeding women?
No sooner than 6 weeks postpartum due to thromboembolism risk
Why should women with migraines with aura avoid combination oral contraceptives?
Increased risk of stroke
What are some non-contraceptive benefits of oral contraceptive use?
Reduced acne, decreased menstrual bleeding, reduced risk of ovarian and endometrial cancer
How do oral contraceptives affect fertility after discontinuation?
Fertility returns quickly with no long-term effects on conception
What cancer risk is significantly decreased in long-term oral contraceptive users?
Colorectal cancer
What component of oral contraceptives is responsible for increasing the risk of venous thromboembolism (VTE)?
Estrogen
Which group of women should be screened for coagulation deficiencies before starting oral contraceptives?
Women with a family history of thrombotic events
How does obesity affect the risk of venous thromboembolism in oral contraceptive users?
Obesity increases the risk of VTE, and extreme obesity (BMI >40) is a relative contraindication
How do oral contraceptives affect prolactin-secreting adenomas?
They may mask symptoms, so OCs should not be used until a diagnosis is made
What hormones does the contraceptive patch contain?
Ethinyl estradiol (75 μg) and norelgestromin (6 mg).
How often should the contraceptive patch be applied?
One patch per week for 3 consecutive weeks, followed by 1 patch-free week.
What are the four recommended application sites for the contraceptive patch?
Buttocks, upper outer arm, lower abdomen, upper torso (excluding breasts).
What is the primary mechanism of action of the contraceptive patch?
Inhibition of gonadotropin release and prevention of ovulation.
How does the contraceptive effectiveness of the patch compare to oral contraceptives?
Similar contraceptive effectiveness and metabolic effects as combination oral contraceptives.
What is a potential concern regarding contraceptive patch effectiveness in overweight women?
Effectiveness may be slightly lower in women over 90 kg (198 lbs).
How effective was the patch in the heaviest women in clinical trials?
Even in the heaviest women, the patch was 90% effective.
What hormones does the contraceptive vaginal ring contain?
Ethinyl estradiol (2.7 mg) and etonogestrel (11.7 mg).
How is the contraceptive vaginal ring used?
Inserted into the vagina for 21 days, removed for up to 7 days for withdrawal bleeding, then a new ring is inserted.
What is the primary mechanism of action of the contraceptive vaginal ring?
Inhibition of gonadotropins and prevention of ovulation.
What happens if the contraceptive vaginal ring is left in place beyond 21 days?
It can still inhibit ovulation for up to 6 weeks.
How does bleeding control with the vaginal ring compare to oral contraceptives?
Less irregular bleeding than with oral contraceptives.
What is the reported expulsion rate of the contraceptive vaginal ring?
Expulsion is uncommon.
How do partners typically report acceptability of the vaginal ring?
High acceptability from both partners.
Does obesity affect the efficacy of the contraceptive vaginal ring?
No significant difference in efficacy, with sufficient hormone levels to inhibit ovulation in obese women.
