Incomplete - 206 - Use of Hormonal Contraception in Women with Coexisting Medical Conditions Flashcards

1
Q

MEC categories and meaning

A

1 - no restrictions
2 - benefits > risks
3 - risks > benefits
4 - unnaceptable

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2
Q

Which coagulation factors does estrogen increase?

A

VII, X and fibrinogen

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3
Q

Risk of estrogen contraception in causing VTE compared to pregnancy

A

1/2 the risk

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4
Q

What is the MEC for estrogen contraception if previous provoked DVT

A

3

could also use if risk of recurrence but for example on anticoagulation and getting hemorrhagic cysts

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5
Q

How long does it take to reverse the hypercoaguable state induced by combined contraception?

A

4-6 weeks.

It is category 4 if there is a major surgery planned with prolonged immobilization

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6
Q

What is the amount of ethinyl estradiol in patch compared to pills?

A

More total in patch but lower peaks

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7
Q

Factors making COC category 3 or 4

A
  • smoking over 35yo
  • <21 PP or 21-42d PP with other RF (>35yo, thrombophilia, prior VTE, immobility, transfusion at delivery, peripartum cardiomyopathy, BMI >30, PPH, post-cesarean, PEC, smoking
  • major surgery of prolonged immobilization
  • hx DVT/PE
  • IBD with active or extensive disease, surgery, immobilization, steroids, vitamin deficiencies, or fluid depletion
  • SLE with positive of unknown antiphospholopid antibodies
  • superficial venous thrombosis (now or hx)
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8
Q

At what level of ethinyl estradiol does VTE risk decrease?

A

50mcg

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9
Q

What is the difference between old progestins (levonorgestrel, norethindrone) and new progestins (desogestrel, drospirenone) on VTE risk?

A

Same

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10
Q

Which progestin only method is category 3 for hx of IHD or stroke and why?

A

DMPA due to hypoestrogenic effects and increased total cholesterol levels

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11
Q

MEC of progestin only for hx VTE?

A

2 for initiating

3 for continuing if VTE, ischemic cardiac event, or stroke occur while on them

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12
Q

MEC for COC and P-only contraception with inherited thrombobphilias

A

COC - 4

P only - 2

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13
Q

For breast-feeding exclusive mothers, how long can lactational amenorrhea be considered a method of contraception?

A

6 months

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14
Q

How soon after birth can non-breastfeeding mothers ovulate?

A

3 weeks (usually 6+)

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15
Q

MEC for COC use in SLE by risk factors:

A
  • Antibody positive = 4

- plt <50k or immunosuppression = 2 (unless CV risk factors)

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16
Q

Risk of MI in SLE patients?

A

50x baseline

17
Q

MEC for progestin contraception in SLE by risk factors:

A
  • antibody positive = 3

- Plt <50k or immunosuppression = 2 ***(except INITIATION of DMPA = 3 for low plt due to risk of irregular bleeding)

18
Q

What should you do for SLE pts before initiating contraception?

A

Check antibodies