lecture 2: contraceptives, wooton Flashcards
MOA estrogen and progesterone pills
suppress hypothalamic gonadotropin releasing factors
progest suppresses LH so no ovulation
MOA progestin only pill
who uses
timing
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
benefits of hormonal oral contraceptives
menstrual cycle regularity
improve dysmenorrhea
decrease risk of iron deficiency anemia
lower endometrial and ovarian cancers, and benign breast and ovarian disease
side effects of OCs
breakthrough bleeding
amenorrhea
bloating, weight gain, breast tenderness, nausea, fatigue, HA
serious AEs of OCs
DVT
PE
transdermal patch MOA and AE
how to use
estrogen and progesterone
AEs are same as OCs but greater risk of thrombosis
apply 1 patch weekly for 3 weeks
the vaginal ring MOA
combined estrogen and progesterone
insert for 3 weeks
who cannot use combo contraceptives
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
depo provera
(depot medroxyprgoesterone)
MOA
how long does it last
thickening cervical mucous
decidualization of endometrium
blocks LH
14 weeks
AE depo-provera
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
depo and endometrial hyperplasia
decreases risk for it
contraindications of depo provera
benefit vs risk in one
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
implantable hormonal contraceptives names
esonogestrel implant- nexplanon
nexplanon MOA and how long does it last
can it be used in breast feeding pts?
3 yrs
thickens cervical mucous
inhibits ovlulation
yes
AE of implantable hormonal contraceptive
irreg vaginal bleed HA vaginitis weight increase acne breast pain
contraindications of implant
known or suspected preg
current or past thrombosis (consideration)
liver disesae
undiagnosed AUB
known or suspected breast cancer (absolute)
paragard
mirena/liletta
skyla
IUDs paragard is copper T mirena- 5 yrs Liletta- 3 yrs skyla last 3 years
Risks with IUD
increased risk infection
increased risk ectopic preg if somehow pregnancy occurs with it in
uterine perforation at time of insertion
risk malposition
benefits of IUD
decrease in menstrual blood loss
less dysmenorrhea
protects endometrial lining from unopposed estrogen
long term use
copper T MOA
copper interferes with sperm transport or fertilization and prevention of implantation
diaphragms must be inserted up to ___ hrs before intercourse and be left for ____ hours after
AE with it
6 hrs
6-8 hrs
UTI
cervical cap high risk
of displacement and toxic shock syndrome
fertility awareness methods
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
plan B
progetin only, take 2 pills 12 hrs apart
must be within 120 hrs
ella
ulipristal acetate
up to 5 days after unprotected sex
postpones follicular rupture
how long after vasectomy until completely sterile
10 weeks
female sterilization
laparoscpoy, occlude tubes
- clips
- hulka, most reversible but greatest fail rate
- filshie, lower fail rate
- bands
- salpingectomy
- electrocautery, poor reversibility
most common approach to sterility throughout world
mini-laparotomy
contraindications of hysteroscopy
nickel or contrast allergy
active pelvic infection
suspected pregnancy
what is essure system
hysteroscopy
