Male & Female Health: Contraception & Infertility Flashcards
How do pregnancy tests work
detect Human chorionic gonadotropin (hCG), which is released when fertilized egg attaches to lining of uterus
detecting hCG in urine = pregnancy
urine test can detect sooner if first urine of morning
folate recommendation for pregnant women
600mcg/day
which reversible contraceptive has delay to fertility?
Medroxyprogesterone injection
which condoms dont protect against STD?
“natural” sheep skin ones
How do hormonal contraceptives work?
inhibiting production of FSH and LH, preventing ovulation
Monophasic contraceptives have….
same dose of estrogen and progestin throughout the pill pack
Bi-tri- and quad- phasic contraceptives….
mimic estrogen and progesterone lvls during a menstrual cycle.
prefix indications how many times they have changes in hormones.
Progestin only pills
28 days of active pills in each pack
prevent pregnancy by suppressing ovulation, used primarily in those breastfeeding because estrogen decreases milk production
How soon after delivery can progestin only pills be restarted
3-6 wks
sooner than estrogen containing due to inc risk of thrombosis
Who should patches not be used in?
anyone with high clotting risk ( > 35 + smoke, cerebrovascular disease or past blood clots, post partum) women BMI > 30
“Lo” indicates
< 35mcg of estrogen, less estrogen = less estrogenic side effects
“Fe” indicates
contains iron supplement
“24” indicates
24 active + 4 placebo
Side effects of estrogen
Nausea
Breast tenderness/fullness
bloating
weight gain
inc blood pressure
Melama = dark skin patches, most often on face
Serious adverse side effects of estrogen
thrombosis = rare inc as women age and have higher clot risk ie diabetes/hnt/smoking
higher estrogen = higher risk
Progestin side effects
breast tenderness
headache
fatigue
depression
Drospirenone side effects
slightly higher risk of clotting, dont use in women with clotting risk
can cause inc potassium, dont use with kidney, liver or adrenal gland disease
check potassium lvls in cases
Medroxyprogesterone shot side effects
can cause loss in bone mineral density
calcium + vit D supplement recommended
Break through bleeding and what to do
usually resolves in 2-3 months, if continue then……
taking < 30mcg estrogen daily then increase estrogen
taking > 30mcg estrogen daily then try different progestin
if want to avoid monthly cycle, have patient take
extended or continuous formulations
If having breakthrough bleeding,
if mid cycle = inc estrogen
if later in cycle = inc progestin
Using contraceptive postpartum
dont use 3wks, or 6wks if risk factor for VTE
progestin only or nonhormonal methods
if HTN, use
progestin only or non-hormonal
if breast feeding or estrogen CI, use
progestin only
Which contraceptives indicated for heavy menstrual bleeding
Natazia
IUD Mirena
oral with only 4 placebo pills will also decrease bleeding time
Mavyret couldn’t be used with ethinyl estradiol due to
inc risk of liver toxicity
“Quick start”method
start today, req back up for 7 days while starting
“Sunday start” method
starts Sunday after onset of menstration
require back up for 7 days
If start contraceptive within first 5 days after menses start then do you need backup?
No
Starting progestin only pills?
use another form of birth control for 48hrs
Late or missed birth control pills
take as soon as remember
if missed more than 1, need to use back up method
If miss in 3rd week of cycle, skip hormone free week and start next pack without skipping any days. need back up for 7 days
Progestin only missed pills
if > 3 hrs since supposed to take need back up for 48hrs
Cooper IUD
Paraguard
good for 10yrs
causes heavier bleeding/cramping
can be inserted within 5 days for emergency contraception
Emergency contraceptives
Ulipristal (Ella) = less effective if > 195lbs or BMI > 30 use within 5 days
Plan B (Levonorgestrel) = less effective if > 165lbs or BMI > 25 use within 3 days
If vomit within 2 hours of taking planB, pt should…
take again
How many times per cycle can Ella be used?
only once per cycle
Drugs that can be used to induce ovulation
Clomiphene (SERM) and Letrozole (aromatase inhibitor) and Gonadotropins
