Family Planning (Contraceptive Options) Flashcards
What percentage of the 213 million pregnancies in 2012 were unintended?
40%
- 50% end in abortion
- 13% end in miscarriage
- 38% results in unplanned births
What oral contraceptive works by the suppression of ovulation by inhibition of GnRH, LH, FSH, and the mid-cycle LH surge?
Combined oral contraceptives (COC)
True or False
Combined oral contraceptives prevents folliculogenesis by the suppression of FSH
True
Combined Oral Contraceptives
These are some of the specific effects of what?
- effects endometrium rendering unsuitable for implantation
- thickening of cervical mucus to prevent penetration by sperm
- impairment of normal tubal motility and peristalsis which alters ovum transport
Progestin specific effects
What is the perfect use failure rate of combined oral contraceptives?
0.3%
What is the typical use failure rate for combined oral contraceptives?
8%
True or False
If combined oral contraceptives are started on any day other than the first day of the cycle, a back up method should be used for the first month
True
Combined Oral Contraceptive
If an active pill is missed at any time, and no intercourse occurred in the past ___ days, ____ pills should be taken immediately, and a backup method should be used for ____ days
- 5 days
- two pills
- 7 days
These are some advantages to what oral contraceptive?
- Lighter menses
- improvement of dysmenorrhea symptoms
- decreased risk of ovarian and endometrial cancer
- improvement in acne
- functional ovarian cysts less likely
- frequency of developing myomas lower
- beneficial effect on bone mass
Combined Oral Contraceptive (COC)
These are contraindications of what oral contraceptive?
- pregnant/breast feeding
- Thromboembolic events
- stroke or coronary artery disease, or HTN >160 systolic OR 100 diastolic
- Cancer of the breast
- Undiagnosed vaginal bleeding
- over 35 and a smoker
- migraine with aura
Combined Oral Contraceptive (COC)
What other oral contraceptive has efficacy and a method of use similar to that of COC but is highly dependent on the consistent use?
Progestin Minipill
What oral contraceptive must be taken with precise accuracy, within the same 3-hour window every day, it is begun on the first day of a menstrual cycle and then taken continuously for as long as desired?
Progestin Minipill
Is there a “placebo week” with the progestin minipill?
No
These are advantages to what oral contraceptive?
- low dose progestin and absence of estrogen makes it safe during lactation
- safe for patients over 35 (lack Cardiovascular side effects of combo pills)
- Benefits outweigh risks in patients who:
a. smoke
b. over 35
c. pts with:
1. DVT
2. known thromboembolic disorders
3. DM w/ vascular disease
Progestin mini pill
What are some contraindications for the progestin minipill ?
- Bleeding irregularities
- ectopic pregnancies more frequent
- weight gain
- mild headache
The mechanism of action, advantages, and contraindications for what contraceptive method is similar to that of the progestin minipill?
Contraceptive Injections and Implants (long acting progestins)
What form of contraceptives has been associated with bone mineral loss that is reversible after discontinuation?
Injectable contraceptives
Users of what contraceptives commonly have irregular bleeding initially and then subsequently develop amenorrhea?
Injectable contraceptives
What is the frequency of injectable progestin-DMPA?
every 3 months (11-13 weeks)
What contraceptive is a single rod progestin implant (etonogestrel) that is inserted in the proximal aspect of the nondominant arm?
Nexplanon
Is there noted to be any delay in fertility after discontinuation of nexplanon?
no
What is the most common reason for discontinuation of nexplanon?
irregular bleeding
The transdermal contraceptive patch (Ortho Evra) is a combined estrogen and progestin contraceptive that is applied to the body for ____consecutive week(s), followed by ____ week(s) without the patch.
- 3 weeks
2. 1 week
True or False
MOA, side effects, and efficacy of the Ortho Evra are similar to those associated with oral contraceptives, although compliance may be better. However, discontinuation for side effects is more frequent
True
The contraceptive vaginal ring (Nuva Ring) is soft and flexible and is placed in the upper vagina for ____ week(s), removed, and replaced ___ week(s) later, or can be removed and replaced after ___ week(s) for continuous cycling, similar to oral contraceptives
- 3 weeks
- 1 week
- 4 weeks
Nuva ring users may experience an increased incidence of what?
Vaginal discharge
What contraceptives are highly effective, with failure rates similar to those achieved with surgical sterilization?
Intrauterine devices
Which type of intrauterine device causes thickening of cervical mucus, preventing endometrial thickening and can inhibit ovulation?
Levonorgestrel (LNG) – releasing intrauterine device
What type of intrauterine device reduces cramping and menstrual flow and may have a protective effect against upper tract infection similar to that of the oral contraceptive?
Levonorgestrel (LNG) – releasing intrauterine device
What intrauterine device is thought to have a mechanism of action that involves either spermicidal or inhibitory effects on sperm capacitation and transport?
Copper bearing (Paragard) intrauterine device
Can a copper IUD be an emergency contraceptive?
Yes, a copper IUD can be placed within 5 days following a single episode of unprotected coitus as postcoital contraceptive
True or False
Women using an IUD who become pregnant should have the IUD removed if the string is visible
True
There is an increased risk for what during the first month following insertion of an IUD?
pelvic infection
Which intrauterine device can cause:
- heavier menstrual periods
- bleeding between periods
- more cramping
- generally not suitable for women who already suffer from these problems
Copper IUD
True or False
If transcervical strings cannot be visualized on pelvic exam there is a concern for unnoticed expulsion or mitigation through the uterus into the abdomen and may require a pelvic ultrasound and a gynecology referral
True
What is the failure rates among couples who use condom perfectly and only what percentage become pregnant after 1 year?
- 18%
2. 2%
Female condoms have a fail rates ranging from ____ to ____%
5-21%
In what contraception is it based on awareness of fertility periods, unprotected intercourse is avoided from shortly after the menstrual period, when fertile mucus is first identified, until 48 hours after ovulation, as identified by a sustained rise in temperature and the disappearance of clear elastic mucus?
Symptothermal Natural Family Planning
What method of contraception based on awareness of fertility periods is focused on the length of the menstrual cycle being observed for at least 8 months, then calculations are made to determine the fertile period; relies on strict documentation and regular predictable periods?
Calendar method
Basal Body Temperature Method
A slight drop in temperature often occurs ___ to ___ hours before ovulation
12-24hrs
Basal Body Temperature Method
A rise in body temperature of about ___ occurs 1-2 days after ovulation
0.4 degrees celsius
Elevated temp continues throughout remainder of the cycle
True or False
Basal Body Temperature Method
Risk of pregnancy increases starting 5 days prior to the day of ovulation, peaks on the day of ovulation, then rapidly decreases to zero by the day after ovulation
True
Emergency contraceptives should be started as soon as possible and within how many hours after unprotected coitus?
120hrs (5 days)
What form of emergency contraceptives has a 1% failure rate when taken within ___ hrs but is effective up to ___ hrs after intercourse?
- Levonorgestrel (Plan B) 1.5mg PO single dose
- 72 hours
- 120 hours
The combination oral emergency contraceptive contains Ethinyl estradiol (at least 100mcg per dose) and Levonorgestrel (at least .50 mg per dose) and can be given twice in 12 hours, if used within 72 hours what is the failure rate of this medication?
3%
What emergency contraceptive is more effective than levonorgestrel, especially when used between 72-120 hrs, particularly among over weight women?
Ulipristal (Ella) 30mg PO single dose
What is the premature expulsion of products of conception from the uterus, can be spontaneous (miscarriage) or induced (electively performed)?
Abortion (usually before 20th week)
What are the Navy instructions regarding abortion?
- BUMEDINST 6300.16 series
2. OPNAVINST 6000.1 series
The DoD prohibits the use of DoD facilities and funds to perform abortions except when?
- life of SM would be endangered if fetus were carried to term
- cases in which the pregnancy is the result of an act of rape or incest
What is a safe, simple procedure in which the vas deferens is severed and sealed through a scrotal incision under local anesthesia?
Vasectomy
follow up semen analysis at 3 months post procedure
Female sterilization is most often achieved with what?
Tubal ligation
What form of female sterilization prevents an ovulated ovum from reaching the uterus and prevents sperm from reaching the unfertilized ovum?
Tubal ligation
Tubes can be clipped, clamped, cauterized, tied, and/or cut
