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General Medicine & Family Medicine > Family Planning/ Contraception# > Flashcards

Family Planning/ Contraception# Flashcards

1
Q

How does progesterone work as a contraceptive?

A
  • suppresses LH to prevent ovulation
  • atrophies endometrium to prevent ovum implantation
  • thickens the cervical mucus to prevent sperm transport
  • inhibits peristalsis of fallopian tubes
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2
Q

How does estrogen work as a contraceptive?

A
  • suppresses FSH to prevent emergence of a dominant follicle
  • provides stability to the endometrium to prevent breakthrough bleeding
  • potentiates the action of progesterone
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3
Q

How many weeks postpartum should a woman wait before resuming intercourse?

A

6 weeks

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4
Q

Which hormone should be avoided during exclusive breastfeeding because it decreases milk production?

A

Estrogen

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5
Q

What are birth control options for a breastfeeding woman?

A
  • barrier methods
  • progesterone-only pill (POP)
  • depomedroxyprogesterone (DMPA) injection
  • intrauterine device (IUD)
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6
Q

In a nonlactating woman, how early postpartum can you start an estrogen-containing contraceptive without increased risk of thrombosis?

A

3 weeks

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7
Q

If a woman using hormonal contraception prefers not to have her menses every month, what can you instruct her about timing of her pack/patch/ring?

A
  • Skip the 1 week of active pills or break from the patch or ring and immediately start the next pack/patch/ring
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8
Q

Do women have to take “breaks” from being on hormonal birth control?

A

No. Women who are healthy and do not smoke can use hormonal birth control continuously from menarche until menopause.

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9
Q

What percentage of sexually active women using no birth controll will experience an unintended pregnancy in 1 year with typical use?

A

85%

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10
Q

What percentage of sexually active women using male comdoms will experience an unintended pregnancy in 1 year with typical use?

A

15%

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11
Q

What percentage of sexually active women using period abstinence will experience an unintended pregnancy in 1 year with typical use?

A

25%

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12
Q

What percentage of sexually active women using OCPs, patch, or contraceptive ring will experience an unintended pregnancy in 1 year with typical use?

A

8%

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13
Q

What percentage of sexually active women using depot-medroxyprogesterone acetate (DMPA) injections will experience an unintended pregnancy in 1 year with typical use?

A

3%

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14
Q

What percentage of sexually active women using IUD will experience an unintended pregnancy in 1 year with typical use?

A

< 1% ( ParaGard 0.8%, Mirena 0.1%)

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15
Q

Is male or female sterilization more effective?

A
  • Male, although the failure rate is low for both (male—0.15%, female—0.5%)
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16
Q

In which group of women is a cervical cap most effective?

A

Nulliparous women

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17
Q

Which lubricants are safe to use with latex condoms?

A

Water-based or silicone gels

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18
Q

Condoms are effective at preventing or reducing the transmission of which sexually transmitted infections?

A
  • HIV
  • Gonorrhea
  • Chlamydia
  • Trichomonas
  • syphilis
  • Herpes
  • HPV
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19
Q

Which birth control methods contain progesterone, but no estrogen?

A
  • Progesterone-only pills (micronor)
  • DMPA injection
  • Mirena IUD
  • single-rod implantable device (implanon)
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20
Q

Which cancers have a proven associated decreased risk with combined oral contraceptive (COC) use?

A
  • Endometrial cancers
  • ovarian cancers
  • colorectal cancers
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21
Q

What are medical benefits do COCs offer?

A
  • reduced risk for certain cancers e.g. endometrial cancer
  • reduced risk of ectopic pregnancy and PID
  • treatment for acne, hirsutism, and androgen excess
  • reduced vasomotor symptoms in perimenopausal women
  • increased bone mineral density
  • decreased risk of hemorrhagic corpus luteum cysts
  • reduction in benign breast disease
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22
Q

What risks are associated with COCs?

A
  • increased risk of cervical adenocarcinoma (rare) and hepatic adenoma
  • increased risk of venous thromboembolism
  • increased risk of myocardial infarction (MI) and stroke in smokers over 35 years old or patients with a history of HTN
  • diabetes, hyperlipidemia, obesity
  • severe migraines
  • reversible HTN
  • Cholelithiasis
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23
Q

What class of COC may offer increased benefit to women with acne, hirsutism, or evidence of polycystic ovarian syndrome?

A

Drospirenone-containing pills (eg, yaz, yasmin)

24
Q

Patients who have had a history of bariatric surgery should avoid what forms of contraception?

A

Oral pills—due to difficulties with malabsorption

25
What are contraindications to the use of COCs?
* smoker over the age of 35 * uncontrolled HTN * migraine headaches with aura * SLE with antiphospholipid antibodies * hypercoagulable state * seizure disorder (on medication that induces hepatic enzymes) * history of VTE * diabetes with complications * history of breast or endometrial cancer * prolonged immobilization * liver disease
26
What side effects might COC users experience?
* headaches * spotting * nausea * vomiting * breast tenderness * varicosities * VTE * stroke * MI Average weight gain is no more than in placebo users
27
How does DMPA affect menstruation?
* Irregular menstruation during first several months and then possible amenorrhea, thereafter
28
What are some possible side effects of DMPA use?
* weight gain * acne * hirsutism * hair loss * mood changes * decreased bone mineral density
29
How often do DMPA injections need to be given for effective contraception?
Every 3 months
30
How often do the Ortho Evra patch and NuvaRing have to be changed?
* Ortho Evra patch: once a week * NuvaRing: once a month
31
How does the ParaGard copper T (IUD) work?
Copper ions inhibit sperm motility and a sterile inflammatory reaction created in the endometrium kills the sperm.
32
For how long after insertion is the ParaGard copper T (IUD) effective?
12 years (approved for 10 years)
33
How does the Mirena IUD work?
Contains progesterone which thickens cervical mucus, alters endometrium, changes uterotubal fluid to impair sperm migration, and sometimes causes anovulation
34
For how long after insertion is the Mirena IUD effective?
At least 5 years
35
Who are candidates for an IUD?
Women in stable mutually monogamous relationships (low STI risk) who want reversible long-term contraception
36
What are side effects of an IUD?
* Increased dysmenorrhea and blood loss (during first few months and more often with ParaGard) * amenorrhea (after 1 year with Mirena)
37
A levonorgestrel-containing intrauterine contraceptive system (Mirena) can also be used in the treatment of what conditions?
* chronic pelvic pain * menorrhagia * endometriosis
38
The single-rod implantable contraceptive device containing etonogestrel (implanon) is effective for how many years?
3 years
39
The Implanon a good contraceptive option for women with what conditions?
* hypertension * diabetes * VTE * cardiovascular disease * migraine headaches * sickle cell disease * HIV infection * seizure disorder
40
The implanon can be beneficial for women with what conditions?
Dysmenorrhea
41
What contraceptive method can cause reversible bone mineral density loss?
DMPA
42
What contraceptive method has been shown to decrease sickling or painful crises in sickle cell disease?
DMPA
43
Approximately what percentage of pregnancies in the United States are unintended?
About 50%
44
What options are available for a woman who has just discovered she has an unintended pregnancy?
* continuation of pregnancy * adoption * elective abortion (some states require parental notification and/or consent for teens)
45
What is emergency contraception?
High-dose hormones given to prevent pregnancy after a contraceptive fails or after unprotected sex
46
What is the name of the only Food and Drug Administration (FDA)-approved emergency contraception pill being sold in the US today?
Plan B
47
Plan B is the name of an FDA-approved emergency contraception pill being sold in the US. How does this work?
* stops ovulation * may prevent fertilization * may prevent implantation
48
Do the 0.75-mg Plan B pills used for emergency contraception need to be taken separately?
No. They can be taken one time in a dose of 1.5 mg.
49
What other hormonal options are there for emergency contraception?
* 0.1 mg ethinyl estradiol and 1.0 mg DL-norgestrel * two doses 12 hours apart starting within 72 hours of unprotected sexual intercourse
50
Who may purchase Plan B(emergency contraception pil) over-the-counter?
* Men and women over the age of 18 years (women under 17 need a prescription)
51
How long after unprotected intercourse should plan B(emergency contraception pill) be taken?
Up to 120 hours, but it is more effective when taken as early as possible
52
How can nausea and vomiting be decreased when taking emergency contraception?
Take antiemetic 1 hour before the first dose.
53
What is the advantage of the progestin-only emergency contraceptive?
decreased nausea, dizziness and fatigue
54
What is the only contraindication to the oral combination method of emergency contraception?
Pregnancy
55
What is an alternative to hormonal methods for emergency contraception?
* Insertion of the ParaGard IU up to 5 days after unprotected intercourse
56
How often after taking emergency contraception can a patient resume hormonal contraception?
Immediately after taking emergency contraception

General Medicine & Family Medicine (150 decks)

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