Monday, 2-27-Contraception and sterilization (Wootton) Flashcards
__ contraceptives provide the most effective reversible contraception
hormona
-includes OCs, injectables, implantables, IUD, patches, rings
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
progesterone
estrogen
MOA of progestin-only OCs? who uses them?
primarily making cervical mucous thick and impermeable
mainly used in breastfeeding women and women who have contraindication to estrogen
benefits of OCs?
- mentrual cycle regularity
- improve dysmenorrhea
- decrease risk of Fe-deficiency anemia
- lower incidence of endometrial and ovarian ca, benign breast and ovarian disease
side effects of OCs?
- breakthroug bleeding
- amenorrhea
- mild –> bloating, perceived weight gain, breast tenderness, nausea, fatigue, headache
serious side effects of OCs?
Mainly venous thomrbosis and PE
can get cholestasis and GB disease, stroke & MI, hepatic tumors
contents of the transdermal patch? side effects? caution in who?
estrogen and progesterone
same effects as OCs except GREATER RISK OF THROMBOSIS
caution with women >198 lbs
benefits of vag ring?
greater compliance d/t 1xmonth use
better tolerated since does not go through GI and less breakthrough bleeding
who cant use OCs?
- 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
MOA of IM injx of Depo medroxyprogesterone acetate (Depo provera)? efficacy?
thickens cervical mucous, decidualizes endometrium, blocks LH surge and ovulation
efficacy roughly equivalent to that of sterilization and not altered by weight
black box warning of depo provera?
if used for >2 yrs, should consider alternative method d/t bone density issues (particular concern in adolescents)
side effects of depo provera?
- irregular bleeding (25% discontinue w/in 1 yr)
- WEIGHT GAIN (makes you hungry)
- EXACERBATION OF DEPRESSION
contraindications for depo provera?
- known or suspected pregnancy
- unevaluated vag bleeding
- known or suspected breast malignancy
- active thrombophlebitis
- liver dysfunction
MOA of Nexplanon?
-rod-shaped implant used for 3 yrs
MOA: thicken cervical mucous, inhibit ovulation
side ffects of nexplanon (implant)?
- irregular vag bleeding
- HEADACHE
- vaginitis
- WEIGHT GAIN
- acne
- BREAST PAIN
the ONLY absolute contraindication for the implant?
known or suspected breast cancer
complications with insertion of implant?
- INFX
- bruising
- DEEP INSERTION
- migration
- PERSISTENT PAIN OR PARASTHESIA AT INSERTION SITE
risks with IUDs?
- 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
contraindications for IUDS/
- breast CA-levonorgestrel containing only
- recurrent puerperal sepsis
- recent septic abortion
- active cervical infx
- Wilsons disease- Copper T only
- uterine malformations
How long does Mirena IUD last? Liletta? Skyla?
how effective are these Levonorgestrel IUDs?
mirena=5 yrs
liletta=3 yrs
skyla=3 yrs
pregnancy rate=0.2%
benefits of Levonorgestrel IUDs?
- decrease in menstrual blood loss
- less dysmenorrhea
- protection of endometrial lining from unopposed estrogen
- convenient and long term
how long does Copper T last? MOA? contraindications?
10 yrs
Cu interferes with sperm transport or fertilization and prevention of implantation
same contraindications.insertion issues as mirena
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%
Plan B-Levonorgestrel
this emergency contraceptive is indicated for up to 5 days after unprotected sex, postpones follicular rupture/inhibit or delay ovulaton
Ella-Ulipristal acetate
vasectomy is occlusion of the __.
benefits of vasectomy?
post-op complications?
immediate effectiveness?
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
methods of female sterilization?
laparoscopy, mini-laparotomy, hysteroscopy, and at time of C-section
most common female sterilization approach around the world?
mini-laparotomy
contraindications for hysteroscopy? who is it good for?
contraindications: nickel or contrast allergies, active pelvic infx, suspected pregnancy
good for obese pts that might not be good candidates for other methods
biggest risk for a young pt with respect to permanent sterilization?
regret
