OBGYN: Contraception and Menopause Flashcards
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
list the top tier methods
IUD
Implants like Nexplanon
Sterilization
Second tier methods
Pill
Depo or IM shots
Patches
transvaginal rings
list the third tier methods
condoms
withdrawl method
rhythm/calendar method
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,
two main types of birth control
hormonal and non-hormonal
MC birth control methods?
barrier methods
- condoms
- diaphragm
- cervical cap
- sponge
pros to barrier methods
inexpensive
most dont require HC visit
some protect against STIs
cons to barrier methods
highly dependent on proper use before or at the time of sex
-higher failure rates
two main hormones used in hormonal contraception
Ethinyl estradiol (estrogen) 19-nortestosterones (progestin)
roles of estrogen
-control bleeding: makes shorter/more predictable periods
if a PT has heavy or painful periods, need a BC with what in it?
estrogen
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
list the three types of bith control containig estrogen
patch
ring
OCPs combo
Pros to OCCs
cheap
easy to take
fairly easy to obtain
helps with acne
cons to OCCs
small risk of blood clots, have to remeber to take everyday, have to refill often
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)
- increases sebum
- incrs facial and body hair
- 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
- Paraguard–IUD copper
- Ulipristal acetate (ella) Pill
- Levonorgestrel (Plan B, Next step)
- 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:
- first is taken within 72 hours unprot sex but can be taken up to 5 days after
- 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
