lecture 2: contraceptives, wooton

Question 1

MOA estrogen and progesterone pills

Answer 1

suppress hypothalamic gonadotropin releasing factors

progest suppresses LH so no ovulation

Question 2

MOA progestin only pill

who uses

timing

Answer 2

make cervical mucous thick and impermebale

used in breastfeeding women and women who can’t use estrogen

must be taken at same time every day

Question 3

benefits of hormonal oral contraceptives

Answer 3

menstrual cycle regularity

improve dysmenorrhea

decrease risk of iron deficiency anemia

lower endometrial and ovarian cancers, and benign breast and ovarian disease

Question 4

side effects of OCs

Answer 4

breakthrough bleeding
amenorrhea
bloating, weight gain, breast tenderness, nausea, fatigue, HA

Question 5

serious AEs of OCs

Answer 5

DVT

PE

Question 6

transdermal patch MOA and AE

how to use

Answer 6

estrogen and progesterone
AEs are same as OCs but greater risk of thrombosis

apply 1 patch weekly for 3 weeks

Question 7

the vaginal ring MOA

Answer 7

combined estrogen and progesterone

insert for 3 weeks

Question 8

who cannot use combo contraceptives

Answer 8

women over 35 who smoke
women with past history thromboembolic event
women with history CAD, CVD, CHF, or migraine with aura
women with mod to severe liver disease

Question 9

depo provera
(depot medroxyprgoesterone)
MOA
how long does it last

Answer 9

thickening cervical mucous
decidualization of endometrium
blocks LH
14 weeks

Question 10

AE depo-provera

Answer 10

bone loss, reversible
-dont use for more than 2 years

irregular bleeding
-menses can take 1 yr to 18 months to become normal, so have to wait that long for pregnancy
weight gain
exacerbation of depression

Question 11

depo and endometrial hyperplasia

Answer 11

decreases risk for it

Question 12

contraindications of depo provera

benefit vs risk in one

Answer 12

known or suspected preg
unevaluated vaginal bleeding
known or suspected malignancy of breast

active thrombophlebitits or past history of heart and vascular disease (sometimes still used bc benefits can outweight risks)

liver dysfunction

Question 13

implantable hormonal contraceptives names

Answer 13

esonogestrel implant- nexplanon

Question 14

nexplanon MOA and how long does it last

can it be used in breast feeding pts?

Answer 14

3 yrs

thickens cervical mucous
inhibits ovlulation

yes

Question 15

AE of implantable hormonal contraceptive

Answer 15

irreg vaginal bleed
HA
vaginitis
weight increase
acne
breast pain

Question 16

contraindications of implant

Answer 16

known or suspected preg
current or past thrombosis (consideration)
liver disesae
undiagnosed AUB
known or suspected breast cancer (absolute)

Question 17

paragard
mirena/liletta
skyla

Answer 17

IUDs
paragard is copper T 
mirena- 5 yrs
Liletta- 3 yrs 
skyla last 3 years

Question 18

Risks with IUD

Answer 18

increased risk infection
increased risk ectopic preg if somehow pregnancy occurs with it in
uterine perforation at time of insertion
risk malposition

Question 19

benefits of IUD

Answer 19

decrease in menstrual blood loss
less dysmenorrhea
protects endometrial lining from unopposed estrogen
long term use

Question 20

copper T MOA

Answer 20

copper interferes with sperm transport or fertilization and prevention of implantation

Question 21

diaphragms must be inserted up to ___ hrs before intercourse and be left for ____ hours after

AE with it

Answer 21

6 hrs
6-8 hrs
UTI

Question 22

cervical cap high risk

Answer 22

of displacement and toxic shock syndrome

Question 23

fertility awareness methods

Answer 23

calendar method
basal body temp method (.5-1 degree change in temp when get out of bed in morning)
cervical mucus method
symptothermal method
-combines cervical mucus and basal body temp and other signs like cramping

Question 24

plan B

Answer 24

progetin only, take 2 pills 12 hrs apart

must be within 120 hrs

Question 25

ella

Answer 25

ulipristal acetate
up to 5 days after unprotected sex
postpones follicular rupture

Question 26

how long after vasectomy until completely sterile

Answer 26

10 weeks

Question 27

female sterilization

Answer 27

laparoscpoy, occlude tubes

• clips
  
  • hulka, most reversible but greatest fail rate
  • filshie, lower fail rate
• bands
• salpingectomy
• electrocautery, poor reversibility

Question 28

most common approach to sterility throughout world

Answer 28

mini-laparotomy

Question 29

contraindications of hysteroscopy

Answer 29

nickel or contrast allergy
active pelvic infection
suspected pregnancy

Question 30

what is essure system

Answer 30

hysteroscopy