OBGYN: Contraception and Menopause Flashcards by Caroline Bouillon

list in order most effective to least effective contraception methods:

Rhythm/Calendar method
Sterilization
Combined pill
Male Condom
IUD
Depo shot
Nexplanon
Withdraw/Pull out

Sterilization
Nexplanon
IUD

Depo shot
Combined pill

Male condom
Withdraw/Pull out
Rhythm/Calendar method

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list the top tier methods

IUD
Implants like Nexplanon
Sterilization

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Second tier methods

Pill
Depo or IM shots
Patches
transvaginal rings

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list the third tier methods

condoms
withdrawl method
rhythm/calendar method

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three goals of all contraceptive methods

-list ex for each

inhibit development and release of egg/prevent ovulation—>OCPs, patch, ring, progestin injections
Imposing mechanical, chemical or temporal barrier b/w sperm and egg–>condom, diaphragm, IUD, rhythm/calendar method
altering ability of fertilized egg to implant and grow–>IUD, EC,

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two main types of birth control

hormonal and non-hormonal

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MC birth control methods?

barrier methods

condoms
diaphragm
cervical cap
sponge

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pros to barrier methods

inexpensive
most dont require HC visit
some protect against STIs

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cons to barrier methods

highly dependent on proper use before or at the time of sex

-higher failure rates

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two main hormones used in hormonal contraception

Ethinyl estradiol (estrogen)  
19-nortestosterones (progestin)

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roles of estrogen

-control bleeding: makes shorter/more predictable periods

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if a PT has heavy or painful periods, need a BC with what in it?

estrogen

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contraindications for combined hormonal BC (6)

a. Uncontrolled HTN
b. Known thrombogenic mutations
c. Smoker + over 35 years old
d. History of DVTs, MI, stroke
e. Migraines with focal neurologic deficits (auras)
f. Lupus with antiphospholipid antibodies

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list the three types of bith control containig estrogen

patch
ring
OCPs combo

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Pros to OCCs

cheap
easy to take
fairly easy to obtain
helps with acne

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cons to OCCs

small risk of blood clots, have to remeber to take everyday, have to refill often

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when a patient doesnt like how they feel on the pill, which hormone is the main culprit?

progestin– there are 19 different progestins

main way hormonal contraceptives prevent pregnancy

prevent ovulation

estrogen supresses FSH
progestin supresses LH

estrogen supresses? stabilizes?

supresses: FSH
Stabilizes: endometrium to prevent intermenstrul bleeding aka breakthrough bleeding

Progestins supress?

-what does it cause that prevents pregnancy

suppresses LH

-thickens cervical mucus to restrict sperm passage and makes endometrium unfavorable for implantation

phasic forumaltions

leads to?
associatd with?
often called?

slight decrease in total dose of hormone used/month
assoc with higher rates of bleeding b/w periods (CON)

Often called TRI-phasic bc three weeks of active hormones

how to begin COCs

quick start method: pill started on any day of the cycle
Sunday start/more traditional
* start first sunday following onset of menses

what to tell patient if:

she missed 1 pill
she missed 2 pills

take two pills the following day and finish the rest of pack normally
two pills are taken + add extra contraceptive method for 7 days

Patch

name?
hormones in it
how does it work
where to apply it and where to avoid
who shuld not use it

Ortho Evra is only one
-estrogen + progestin

effective for 7 days
new patch used every week X3 weeks
then 1 week w.o patch

Apply: Buttock, upper outer arm, lower abdomen, upper torso
AVOID: breasts

CONTRA in women over 200 pounds bc not effective

Transvaginal ring - name - how does it work - hormones - how long can it be taken out at a time without effecting efficacy?

NuvaRing +estrogen +progestin * placed in vagina * left for 3 weeks * removed for 1 week up to 3 hours at a time w/o effecting efficacy--so take it out for sex--- but then put it back in---

Mini pills or Progestin only pills - how does it work - timing of admin - when do you need to use back up method? - cons - pros

no estrogen!!!! * ovulation occurs in 40% * higher failure rate * HAS TO BE TAKEN EXACT SME TIME EVERYDAY bc of the low dose progestin * if a woman is more than 3 hours late, a backup method has to be used for 48 hours PROS: - no estrogen (no clots, good for BF) - cheap - easy to take - easy to obtain CONS: - has to be exact sme time every day - back up method if 3 hrs late

what must you warn PT about when starting estrogen BC?

"ACHES" i. Abdominal Pain—can be mesenteric ischemia from a clot ii. Chest pain—PE iii. Headaches—stroke iv. Eye/vision problems—retinal vein thrombosis v. Severe leg pain—DTV

failure rate of withdraw as a BC method?

25%

after how many days PP can a woman start using COCs

>21 days

Effects of Progestin (3)

1. increases sebum 2. incrs facial and body hair 3. induce smooth muscle relaxation

effects of estrogen

lipid metabolism, potentiate sodium + water retention, increases renin and can reduce anti-thrombin III -also reduces breast milk production BUT reduces incidence of endometrial and ovarian CA

Benefits of combined estrogen/progestin OCPs

-acne improvement -improved bone density -prevention of atherogenesis -fewer premenstrual complaints -inhibition of hirsutism -decr risk of ectopic preg -decr RA activity -red menstrual blood loss + anemia -improved dysmenorrhea from endometriosis -decr risk of endometrial and ovarian CA -

Injectable BC - hormones - how does it work - risk of? /SEs - length of administration

medroxyprogesterone acetate aka Depo Provera PROGESTIN ONLY *shot every 3 MO SE: * incr risk of decrease bone density from alteration in bone metabolism---PT are encouraged to take Vit D and CA supplements with Depo * since progestin only--- incr in irreg menstrual bleeding BBW for extended use after 2 years due to decrease bone mineral density ---only use for 2+ years if every other BC method is inadequate

Implantable BC - name? - hormones - how does it work and for how long

PROGESTIN only Nexplanon *continuous release of small amount of progestin over 3 years

list the IUDs and time lines how do they work

``` MEDICATED: Mirena--5 yrs Liletta--5 yrs Skyla--3 yrs Klyeena--5 yrs ``` COPPER Paragard---10 years The Hormonal IUDs work by: -rendering intratuterine envi hostile by means of "sterile" inflammatory response to the foregin IUD--- makes a spermicidal environment COPPER IUD works by: -copper + copper salts released enhance the inflammatory response

list the three types of EC

1. Paraguard--IUD copper 2. Ulipristal acetate (ella) Pill 3. Levonorgestrel (Plan B, Next step) 4. can do high-dose estrogen-progesterin

Paragaurd as EC | -when can it be inserted

inserted up to 5 days after unprotected sex **Most effective EC

Levonorgestrel EC - hormone? - names - how to take it

Progestin only Plan B, Next Step TWO PILLS: 1. first is taken within 72 hours unprot sex but can be taken up to 5 days after 2. second pill taken 12 hours after first pill Plan B on step--- single pill--ideally take within 72 hours but can be up to 5 days or 120 hrs ******does not work as well if you are overweight*******

Ulipristal Acetate or Ella - hormone - how does it work

Progestin-receptor modulator single pill taken up to 5 days this pill delays ovulation

what is the most effective EC?

Copper IUD and Ulipristal acetate or Ella (progestin recptoer modulator