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Women's health trigger > Lecture 7: Contraception > Flashcards

Lecture 7: Contraception Flashcards

1
Q

How common are unintended pregnancies?

A

45%

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2
Q

What is the main cause of 40% of unwanted pregnancies?

A

Not using birth control

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3
Q

what are reasons for using contraception (5)

A
  1. dont want kids
  2. space out children
  3. limit family size
  4. avoid effects of pre-existing illness on pregnancy
  5. endometriosis, PCOS, PMDD tx.
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4
Q

Top 3 reasons for not using contraception

A
  1. They dont care if they get pregnant
  2. Worried about the side effects
  3. Did not think they’d get pregnant

MC nonuse in low income, uninsured, nonmarried, and zero/1 parity

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5
Q

What is the general consensus regarding contraceptives in adolescents?

A

Give it to them!

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6
Q

What other disorders may use contraceptives as a form of tx? (3)

A
  1. Endometriosis
  2. PCOS
  3. Premenstrual dysphoric disorder (PMDD)
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7
Q

What are the 4 most effective contraceptive methods?

A
  • Implant (F)
  • Vasectomy (M)
  • Tubal occlusion (F)
  • IUD (F)
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8
Q

What methods are considered the worst for contraception?

A
  • Coitus interruptus (pull-out method)
  • Postcoital douche
  • Periodic abstinence
  • Lactational amenorrhea

Not using any birth control products

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9
Q

When is it appropriate to restart contraceptives after delivery?

A

3 months after

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10
Q

What is the most effective determinant of periodic abstinence?

A

Serum LH peak

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11
Q

What is the MC method of periodic abstinence?

A

Calendar method
avoid coitus 2 days prior to ovulation until 2 days after ovulation

It is also the least reliable 35% fail rate/yr

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12
Q

What is the billings method/cervical mucus method for periodic abstinence?

A
  • Checking ovulation by checking cervical mucus
  • Thin/watery = right before ovulation
  • Thicker = rest of cycle

Thin/watery = you are about to ovulate

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13
Q

What is the likely most effective method for periodic abstinence?

A

Symptothermal: Cervical mucus + temperature

thick mucus + 3rd day after elevated temp should be safe?

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14
Q

How does temperature vary in ovulation?

A
  • Drops slightly 24-36 hrs before ovulation
  • 3rd day after onset of elevated temp = fertile period over
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15
Q

List the periodic abstinence methods in order of most to least efficacious

(symtpthermal,cervical mucous, combined temp/calendar, temp, calendar, serum LH)

A
  1. serum LH
  2. symptothermal
  3. combined temp+calendar. cervical mucus.
  4. temp alone
  5. calendar alone.
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16
Q

what is the difference between COCs and POPs

A
  • COC - combination oral contraceptives. contains an estrogen and a progesterone. (used interchangeably w OCPs)
  • OPO - progesterone only pills.
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17
Q

what is the efficancy of OCPs

A
  • user-dependent
  • ranges from 3-9 pregnancies per 100
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18
Q

What is in COC (combination oral contraceptives)?

A
  1. Estrogen: ethanyl estradiol (MC), mestranol, 17b-estradiol, or estradiol valerate
  2. Progestin: norethindrone, levonorgestrel, desogestrel, norgestimate, drosperinone
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19
Q

Which progestin ingredient is a spironolactone analogue?

A

Drosperinone, which is less androgenic but higher VTE risk.

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20
Q

what is the difference between multiphasic and monophasic COCs

A

monophasic - same dose of hormones daily
Multiphasic - different doses of hormones during cycle.

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21
Q

What is the cycle of COCs?

A
  • 21 days of active hormones
  • 7 days of placebo

Newer is 24-4 (can also be 84-7 or just 365)

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22
Q

What should patients expect after stopping active COCs?

A

Withdrawal bleed 2-5 days after

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23
Q

What are the 3 ways of beginning the administration of COCs?

A
  • Ideal: first day of menstrual cycle
  • Traditional: first sunday following menses
  • Quickstart: day you get it

encourage regular routine of pill taking

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24
Q

what is the protocol for missed pills in COCs?

A
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25
Q

What is the MOA of COCs?

A

Suppression of ovulation (estrogen)

Alters consistency of mucus
Makes endometrium less receptive to implantation

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26
Q

what drugs interact w COC’s

A
  1. Anticonvulsants (MC)
  2. Abx (controversial) - macrolides, PCNs, rifampin
  3. other - warfarin, tylenol, SSRIs
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27
Q

What are the benefits of using COCs? (8)

A
  1. Reduced ovarian cx
  2. Reduced endometrial cx
  3. Improved bone mass
  4. Decreased progression of RA
  5. Improves acne
  6. Lower risk of ectopic + PID
  7. Decreased risk of benign fibrocystic breast dz
  8. Improvement in dysmenorrhea and premenstrual s/s
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28
Q

What are the major SEs of COCs? (6)

A
  • VTE
  • MI
  • Stroke
  • Liver dz
  • Cervical dysplasia/cancer
  • Breast cancer (controversial)

clotsx3, liver + cervix

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29
Q

CIs to COCs (8)

A
  • Pregnant
  • Undxd vaginal bleeding
  • Migraine w/ aura
  • Prior hx of VTE/MI/Stroke
  • Increased risk for CV issues (SLE, DM, HTN uncontrolled)
  • Smoking over 35
  • Current/hx of breast cx
  • Active liver dz

Bottom 5 are all things it enhances

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30
Q

What should we keep in mind regarding POCs (progestin-only contraceptives)?

A

Does not suppress ovulation

Estrogen suppresses ovulation by inhibiting FSH

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31
Q

what is the pregnancy risk of POCs? what is the MOA

A
  • approx 2-7 pregnancies per 100
  • MOA - unknown but theorized to make cervical mucus less permeable.
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32
Q

Why would someone take POCs?

A
  • No estrogen effects
  • No special sequence for pill-taking
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33
Q

Cons of using POCs? (3)

A
  • Must take at same time daily
  • Higher rates of irregular bleeding
  • High overall bleeding rate
34
Q

CIs to POCs (5)?

A
  • Unexplained uterine bleeding
  • Breast cx
  • Hepatic neoplasms
  • Pregnancy
  • Active liver dz

Primarily liver issues

35
Q

What are the 3 methods for emergency contraception?

A
  • Yuzpe method
  • Levonorgestrel
  • Copper IUD

After you have unprotected sex or misused contraceptive

36
Q

Describe the Yuzpe method, including dosages and dosing

A
  • COCs containing levonorgestrel
  • 100mcg ethinyl estradiol + 500-600mcg levono
  • 2 doses, 12 hrs apart
  • 1st dose must be taken within 72 hrs of sex
37
Q

Main SEs of Yuzpe method (2)

A

N/V, recommended to premedicate.

38
Q

Describe levonorgestrel/Plan B/Aftera, including dosages and dosing

A
  • Single dose of 1500mcg of levono or 2 12hrs apart
  • Take within 72hrs
  • Prevents LH surge

Single doseor double if you want

Yuzpe is double

39
Q

Describe Ulipristal/Ella, including dosages and dosing

A
  • Single dose of 30mg
  • Within 72 hrs of sex
  • Prevents LH surge/may delay ovulation post LH surge

Single dose, similar to levono/plan B

Yuzpe is the only 2 pill emergency

40
Q

When does a copper IUD need to be inserted to be used as emergency contraception?

A

5-7 days from the time of sex

41
Q

When does a levono IUD for emergency contraception need to be implanted relative to last time of intercourse?

A

5 days from the time of sex

42
Q

Why are IUDs preferred for emergency contraception? (3)

A
  1. Better efficacy
  2. No drop in efficacy if BMI increases
  3. Left in place
43
Q

When are vaginal rings worn?

Nuvaring/Eluryng/annovera

A
  • 3 weeks a month
  • Designed to be left in place
  • Can be disposable or reusable
44
Q

How often are transdermal patches applied for birth control?

A

New patch Q 3 weeks

Same schedule as vaginal ring

45
Q

If a contraceptive patch becomes detached, how long do you have to apply it back?

A

< 24 hrs

Otherwise, use a backup method for 1 week and then new patch.

46
Q

Compared to COCs, what SEs are transdermal patches more likely to have?

A
  • Breast symptoms
  • Dysmenorrhea
  • Higher failure rate if obese
47
Q

How often is a Depo Shot given?

A

Progesterone shot IM Q 3 mo

48
Q

Major SE of Depo Shots?

A

Decreased bone density

49
Q

What is contained within the nexplanon implant?

A

Progesterone

50
Q

How long does nexplanon work?

A

approved for 3 yrs

May work up to 5

Small rod, small time

51
Q

MC SEs of nexplanon (3)

A
  • Irregular menses
  • Wt gain
  • HA
52
Q

How long is a copper IUD good for?

A

10 years

53
Q

CIs to Copper IUD (5)

A
  • Intrauterine contents: Pregnancy/displaced uterus
  • Infections
  • Uterine/cervical cx (known or suspected)
  • Wilsons
  • Allergy
54
Q

How long does a levono IUD last?

A

8 years

Mirena

55
Q

How does usage of a levono IUD work initially?

Mirena

A
  • First causes irregular menses for 3-4 months
  • Decreases menorrhea after
  • Then improves
56
Q

How long do kyleena and skyla, the lower dosage levono IUDs, last?

A
  • Kyleena: only up to 5 yrs
  • SKYla: only up to 3 yrs

Kyleen is sky’s big sister

57
Q

What are the 2 main benefits of Mirena over Kyleena and Skyla?

A
  • Longer lasting (up to 8y)
  • Can also be used to treat heavy menses or dysmenorrhea

Mirena is kyleen’s older sister

58
Q

CIs to progesterone IUDs

A
  • Intrauterine contents
  • Infections
  • Cancer (uterine/cervical/breast)
  • Acute liver dz
  • HSR
  • Prior ectopic
59
Q

How do you check if an IUD is still in place?

A

Check if the string is still hanging out

60
Q

What is the primary ingredient of most spermicides?

A

Nonoxynol-9 (destroyer of sperm): much cheaper

61
Q

What is the alternative, more expensive option to nonoxyl-9 for spermicide?

A

Phexxi, which is acid based and lowers vaginal pH.

Also makes a physical barrier

PHexxi = affects pH

62
Q

Patient education regarding using spermicides (5)

A
  • Place right before sex: lasts 1 hr
  • Avoid douching for 6 hrs after
  • They suck(mostly because ppl suck at using them tho)
  • DO NOT PROTECT AGAINST STDs
  • Can cause local inflammation
63
Q

What is a contraceptive sponge?

A

Sponge impregnated with nonoxyl-9

Leave in for 6 hrs after, but you can place it 24 hrs prior

For if you’re not sure if you’re doin it

64
Q

What are condoms generally made of?

A

Latex

65
Q

Which condom material is permeable?

A

Lamb’s cecum

66
Q

What might an internal/female condom might be useful for?

A

Reducing risk of HIV

67
Q

What are the components of a diaphragm + spermicide?

A
  • Physical barrier
  • Spermicide on cervical side
68
Q

What are the issues with a diaphragm + spermicide setup? (2)

A
  • Need spermicide to work
  • Need to fit them

6 hours prior, 6-24 after

69
Q

What is a cervical cap?

A
  • Literally a cup for your cervix
  • Can put spermicide in it
  • Gotta check after sex everytime
70
Q

What is the MC method of contraception worldwide for women?

A

Sterilization

71
Q

Who legally cannot get permanent contraception?

A
  • Pts < 21 (for most states)
  • Mentally incompetent
72
Q

4 methods for female tubal sterilization

A
  1. Electrocoagulation (low failure, high complication)
  2. Mechanical tubal occlusion (favorable long-term)
  3. Ligation of tube with suture material
  4. Salpingectomy (complete removal, estimated high efficacy)
73
Q

Which female tubal sterilization technique is most associated with ectopic pregnancy?

A

Electrocoagulation

The one with high complication rate

74
Q

Why do we not use chemical tubal occlusion?

A

Carcinogenesis and toxigenesis

75
Q

Why is male sterilization preferable?

A
  • Easier to reverse
  • Much lower failure rates and postop complications
76
Q

Safest and most effective method for abortion?

A

Suction curettage

12 wks or less gestation

77
Q

What are the 4 combinations used for medical abortion? MC and effective among them?

A
  1. Mifepristone (mifeprex) + Misoprostol (Cytotec): MC and effective (mi & mi)
  2. Methotrexate + misoprostol
  3. Misoprostol alone
  4. Oral anti-progestin followed by misoprostol 48h after

Primarily used in 1st trimester, < 49d from FDLMP

Cytotec is in ALL 4 METHODS

78
Q

After the 1st trimester, what are some of the abortion methods? (3)

A
  1. Intra-amniotic instillation (replacement of amniotic fluid with hypertonic saline)
  2. Dilation and evacuation (MC): modified suction curettage
  3. Hysterectomy/hysterotomy (cervical stenosis)
79
Q

When is menstrual regulation used primarily?

A

Lack of access to pregnancy tests

80
Q

What is the MOA of cytotec/misoprostol?

A

Synthetic PGE1

Causing contractions and ripening

81
Q

When are we concerned about long-term for abortion sequelae?

A

2 or more procedures (increased risk of mid-trimester loss)

82
Q

After abortion, how long should intra-vaginal products be avoided?

A

2 weeks

Including sex

Women's health trigger (23 decks)

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