Monday, 2-27-Contraception and sterilization (Wootton)

Question 1

__ contraceptives provide the most effective reversible contraception

Answer 1

hormona

-includes OCs, injectables, implantables, IUD, patches, rings

Question 2

regarding OCs:

the __ component is the major player-suppresses LH and ovulation as well as thickening cervical mucous, inhibiting sperm migration and creating unfavorable atrophic endometrium for implantation

the __ component mainly improves cycle control by stabilizing the endometrium and allows less breaktrhough bleeding

Answer 2

progesterone

estrogen

Question 3

MOA of progestin-only OCs? who uses them?

Answer 3

primarily making cervical mucous thick and impermeable

mainly used in breastfeeding women and women who have contraindication to estrogen

Question 4

benefits of OCs?

Answer 4

• mentrual cycle regularity
• improve dysmenorrhea
• decrease risk of Fe-deficiency anemia
• lower incidence of endometrial and ovarian ca, benign breast and ovarian disease

Question 5

side effects of OCs?

Answer 5

• breakthroug bleeding
• amenorrhea
• mild –> bloating, perceived weight gain, breast tenderness, nausea, fatigue, headache

Question 6

serious side effects of OCs?

Answer 6

Mainly venous thomrbosis and PE

can get cholestasis and GB disease, stroke & MI, hepatic tumors

Question 7

contents of the transdermal patch? side effects? caution in who?

Answer 7

estrogen and progesterone

same effects as OCs except GREATER RISK OF THROMBOSIS

caution with women >198 lbs

Question 8

benefits of vag ring?

Answer 8

greater compliance d/t 1xmonth use

better tolerated since does not go through GI and less breakthrough bleeding

Question 9

who cant use OCs?

Answer 9

• women over 35 who smoke
• women with hx of thromboembolic event
• women with hx of CAD, CVD, CHF, or migraine with aura, uncontrolled HTN
• women with moderate to severe liver disease

Question 10

MOA of IM injx of Depo medroxyprogesterone acetate (Depo provera)? efficacy?

Answer 10

thickens cervical mucous, decidualizes endometrium, blocks LH surge and ovulation

efficacy roughly equivalent to that of sterilization and not altered by weight

Question 11

black box warning of depo provera?

Answer 11

if used for >2 yrs, should consider alternative method d/t bone density issues (particular concern in adolescents)

Question 12

side effects of depo provera?

Answer 12

• irregular bleeding (25% discontinue w/in 1 yr)
• WEIGHT GAIN (makes you hungry)
• EXACERBATION OF DEPRESSION

Question 13

contraindications for depo provera?

Answer 13

• known or suspected pregnancy
• unevaluated vag bleeding
• known or suspected breast malignancy
• active thrombophlebitis
• liver dysfunction

Question 14

MOA of Nexplanon?

Answer 14

-rod-shaped implant used for 3 yrs

MOA: thicken cervical mucous, inhibit ovulation

Question 15

side ffects of nexplanon (implant)?

Answer 15

• irregular vag bleeding
• HEADACHE
• vaginitis
• WEIGHT GAIN
• acne
• BREAST PAIN

Question 16

the ONLY absolute contraindication for the implant?

Answer 16

known or suspected breast cancer

Question 17

complications with insertion of implant?

Answer 17

• INFX
• bruising
• DEEP INSERTION
• migration
• PERSISTENT PAIN OR PARASTHESIA AT INSERTION SITE

Question 18

risks with IUDs?

Answer 18

• increased risk of infx within 1st 20 days post-insertion
• increased risk of ectopic pregnancy if pregnancy does occur
• risk of uterine perforation at time of insertion requiring laparoscopy for removal
• risk of malposition and necessitating hysteroscopy for removal

Question 19

contraindications for IUDS/

Answer 19

• breast CA-levonorgestrel containing only
• recurrent puerperal sepsis
• recent septic abortion
• active cervical infx
• Wilsons disease- Copper T only
• uterine malformations

Question 20

How long does Mirena IUD last? Liletta? Skyla?

how effective are these Levonorgestrel IUDs?

Answer 20

mirena=5 yrs
liletta=3 yrs
skyla=3 yrs

pregnancy rate=0.2%

Question 21

benefits of Levonorgestrel IUDs?

Answer 21

• decrease in menstrual blood loss
• less dysmenorrhea
• protection of endometrial lining from unopposed estrogen
• convenient and long term

Question 22

how long does Copper T last? MOA? contraindications?

Answer 22

10 yrs

Cu interferes with sperm transport or fertilization and prevention of implantation

same contraindications.insertion issues as mirena

Question 23

this emergency contraceptive is progestin only, 2 pills taken 12 hrs apart, OTC for women > 17 yrs old, must be used within 120 hrs after unprotecteed sex, and failure rate is 1.1%

Answer 23

Plan B-Levonorgestrel

Question 24

this emergency contraceptive is indicated for up to 5 days after unprotected sex, postpones follicular rupture/inhibit or delay ovulaton

Answer 24

Ella-Ulipristal acetate

Question 25

vasectomy is occlusion of the __.

benefits of vasectomy?

post-op complications?

immediate effectiveness?

Answer 25

vas deferens

safer, more easily performed, less expensive, easier to reverse

bleeding, hematomas, acute/chronic pain, local skin infx

not immediately effective-compelte azoospermia usually obtained within 10 weeks

Question 26

methods of female sterilization?

Answer 26

laparoscopy, mini-laparotomy, hysteroscopy, and at time of C-section

Question 27

most common female sterilization approach around the world?

Answer 27

mini-laparotomy

Question 28

contraindications for hysteroscopy? who is it good for?

Answer 28

contraindications: nickel or contrast allergies, active pelvic infx, suspected pregnancy

good for obese pts that might not be good candidates for other methods

Question 29

biggest risk for a young pt with respect to permanent sterilization?

Answer 29

regret