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Clin Med > OBGYN: Contraception and Menopause > Flashcards

OBGYN: Contraception and Menopause Flashcards

1
Q

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
A

Sterilization
Nexplanon
IUD

Depo shot
Combined pill

Male condom
Withdraw/Pull out
Rhythm/Calendar method

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2
Q

list the top tier methods

A

IUD
Implants like Nexplanon
Sterilization

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3
Q

Second tier methods

A

Pill
Depo or IM shots
Patches
transvaginal rings

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4
Q

list the third tier methods

A

condoms
withdrawl method
rhythm/calendar method

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5
Q

three goals of all contraceptive methods

-list ex for each

A
  1. inhibit development and release of egg/prevent ovulation—>OCPs, patch, ring, progestin injections
  2. Imposing mechanical, chemical or temporal barrier b/w sperm and egg–>condom, diaphragm, IUD, rhythm/calendar method
  3. altering ability of fertilized egg to implant and grow–>IUD, EC,
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6
Q

two main types of birth control

A

hormonal and non-hormonal

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7
Q

MC birth control methods?

A

barrier methods

  • condoms
  • diaphragm
  • cervical cap
  • sponge
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8
Q

pros to barrier methods

A

inexpensive
most dont require HC visit
some protect against STIs

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9
Q

cons to barrier methods

A

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

-higher failure rates

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10
Q

two main hormones used in hormonal contraception

A 
Ethinyl estradiol (estrogen)  
19-nortestosterones (progestin)
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11
Q

roles of estrogen

A

-control bleeding: makes shorter/more predictable periods

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12
Q

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

A

estrogen

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13
Q

contraindications for combined hormonal BC (6)

A

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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14
Q

list the three types of bith control containig estrogen

A

patch
ring
OCPs combo

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15
Q

Pros to OCCs

A

cheap
easy to take
fairly easy to obtain
helps with acne

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16
Q

cons to OCCs

A

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

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17
Q

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

A

progestin– there are 19 different progestins

18
Q

main way hormonal contraceptives prevent pregnancy

A

prevent ovulation

estrogen supresses FSH
progestin supresses LH

19
Q

estrogen supresses? stabilizes?

A

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

20
Q

Progestins supress?

-what does it cause that prevents pregnancy

A

suppresses LH

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

21
Q

phasic forumaltions

  • leads to?
  • associatd with?
  • often called?
A
  • 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

22
Q

how to begin COCs

A
  1. quick start method: pill started on any day of the cycle
  2. Sunday start/more traditional
    * start first sunday following onset of menses
23
Q

what to tell patient if:

  1. she missed 1 pill
  2. she missed 2 pills
A
  1. take two pills the following day and finish the rest of pack normally
  2. two pills are taken + add extra contraceptive method for 7 days
24
Q

Patch

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

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

25
Q

Transvaginal ring

  • name
  • how does it work
  • hormones
  • how long can it be taken out at a time without effecting efficacy?
A

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—

26
Q

Mini pills or Progestin only pills

  • how does it work
  • timing of admin
  • when do you need to use back up method?
  • cons
  • pros
A

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
27
Q

what must you warn PT about when starting estrogen BC?

A

“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

28
Q

failure rate of withdraw as a BC method?

A

25%

29
Q

after how many days PP can a woman start using COCs

A

> 21 days

30
Q

Effects of Progestin (3)

A
  1. increases sebum
  2. incrs facial and body hair
  3. induce smooth muscle relaxation
31
Q

effects of estrogen

A

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

32
Q

Benefits of combined estrogen/progestin OCPs

A

-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
-

33
Q

Injectable BC

  • hormones
  • how does it work
  • risk of? /SEs
  • length of administration
A

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

34
Q

Implantable BC

  • name?
  • hormones
  • how does it work and for how long
A

PROGESTIN only
Nexplanon

*continuous release of small amount of progestin over 3 years

35
Q

list the IUDs and time lines

how do they work

A 
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

36
Q

list the three types of EC

A
  1. Paraguard–IUD copper
  2. Ulipristal acetate (ella) Pill
  3. Levonorgestrel (Plan B, Next step)
  4. can do high-dose estrogen-progesterin
37
Q

Paragaurd as EC

-when can it be inserted

A

inserted up to 5 days after unprotected sex

**Most effective EC

38
Q

Levonorgestrel EC

  • hormone?
  • names
  • how to take it
A

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***

39
Q

Ulipristal Acetate or Ella

  • hormone
  • how does it work
A

Progestin-receptor modulator

single pill taken up to 5 days

this pill delays ovulation

40
Q

what is the most effective EC?

A

Copper IUD and Ulipristal acetate or Ella (progestin recptoer modulator

Clin Med (52 decks)

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