Gynecology CIS 1: intro and contraception (Dunn) Flashcards

Question

Copper IUDs – menstrual changes

Answer 1

Increased menstrual flow - Increased amount and duration - Usually no change in hemoglobin Increased dysmenorrhea Management - Patience and reassurance - NSAIDS around clock, start 1 day before menses

Answer 2

Hormonal side effects are rare & not more common than in general population Nonetheless, they are reasons given for discontinuation No weight gain

Answer 3

1970 Introduced 1973 High incidence of PID recognized 1975 Removed from market 1983-1988 No IUDs sold in U.S.

Answer 4

Re-analysis excluding the Dalkon Shield and addressing bias = no increased risk 3 types of bias in observational studies: - Inappropriate comparison groups - Over diagnosis of PID among IUD users - Inability to control for confounding factors WHO analysis of 22,900 women over 8 yrs - Increased risk in first 20 days after insertion - No increased risk with continued use

Answer 5

NO association with past use of Copper IUD

Answer 6

Prior STI or PID: NOT a contraindication - Contraindicated: current PID or within the past 3 months / Current cervicitis High risk women: screen for infection with GC or CT prior to insertion Adolescence and nulliparity are not contraindications CDC category 2 for age < 20 years & nulliparity

Answer 7

150 mg of depot medroxyprogesterone acetate; administered deep intramuscular or 104 mg subcutaneous Q 3 months Initiate anytime in cycle; rule out pregnancy Back up method for 7 days if injection is not within 5 days of start of menses

Answer 8

``` Benefits: Highly effective: 96% Little compliance required Easily concealed No decreases in efficacy in overweight women ``` ``` Risks and Side Effects: Bleeding irregularities Delayed return of fertility Weight gain Decrease in bone mineral density ```

Answer 9

Irregular bleeding 70% in the first year; 10% thereafter Usually light; hemoglobin levels rise Most common reason for discontinuation Up to 25% in the first year of use Management Similar to management with Implanon Bleeding and spotting decrease progressively with each reinjection Amenorrhea: 55% at one year 70% at 2 years 80% at 5 years

Answer 10

Adult women: 4.3 kg increase over 5 years Compared to 1.8 kg increase in copper IUD users Early weight gain may predict excessive gain Weight gain greater in adolescents who are overweight (BMI >30) when initiating DMPA 20 lb weight gain over 18 months in obese teens

Answer 11

Use of DMPA is associated with loss of BMD After stopping, recovery of BMD is seen return to baseline in 1-4 years No data on fracture risk in women who have used DMPA in the past

Answer 12

``` Similar to progestin implant Severe hypertension (>160/>100) Diabetes with vascular disease and / or > 20 years disease ```

Answer 13

``` Women desiring effective, confidential, method and who can return for injections Women who cannot use estrogen Tolerant of irregular bleeding Special populations - Sickle cell disease - Epilepsy ```

Answer 14

Safe for most young women Added benefit of regulation of menses “Typical-use” effectiveness ~ 92% (Do not quote perfect use ~ 99%) Commonly reported as most effective method Poor continuation

Answer 15

Weekly transdermal patch 20 mcg EE + 150 mcg norelgestromin daily Continuous delivery Area “under the curve” is 60% > in a 35 mcg pill Possible increase in estrogen side effects such as VTE Less effective if body weight > 90 kg

Answer 16

``` 3 weeks with 1 week ring-free interval or 24-4, or continuous Lowest ethinyl estradiol dose (15 mcg EE, 120 mcg etonorgestrel daily) Continuous dosing Use back-up method if out for > 3 hours ```

Answer 17

Compliance -Patch > pill in some studies…but not in others Satisfaction -No consistent differences Side effects -Ring with some improvement in nausea and cycle control Continuation and efficacy

Answer 18

no link to weight gain

Answer 19

``` Common reason for discontinuation With time, improved with extended regimens Higher rates in women - who smoke - with cervical infections ``` Management: - If near end of cycle, discontinue early - If severe, consider exogenous estrogen

Answer 20

All pills studied reduced acne compared to placebo No consistent results regarding different types of progestins - Cyproterone (pregnane) may be better than LNG - LNG may be better than desogestrel (!)

Answer 21

``` History of a venous thromboembolism Known thrombogenic mutations Migraines with aura* Hypertension, esp. if poorly controlled Lupus with antiphospholipid antibodies ```

Answer 22

``` Safe for all young women Only method that offers PROTECTION FROM STIs Not effective enough for contraception Typical-use failure is 15% Counsel for dual protection from pregnancy & STIs ```

Answer 23

Unplanned pregnancy is common The implant and IUDs provide greater: - Convenience - Efficacy Discontinuation of all methods is high Counseling in advance is vital