Office- Contraception, Depression, Hormone therapy Flashcards
What is the mechanism of action of copper IUD?
Prevents fertilization through
Inhibition of sperm migration and viability
Cytotoxic to endometrium preventing implantation
What is the mechanism of action of levonorgestrel IUD?
Endometrial suppression
Thickens cervical mucus making sperm impenetrable
altered tubal motility
What are side effects of progetin IUD?
Headache
Breast tenderness
Nausea
Depression
abnormal uterine bleeding
What are side effects of copper IUD?
Menorrhagia Dysmenorrhea
What are indications for IUD placement?
- Wants most reliable contraception
- Wants longterm contraception
- Medical contraindications to OCPs
What are contraindications to IUD use?
Active STD
PID
Pregnancy
Undiagnosed vaginal bleeding
Genital tract malignancy
Uterine anomalies
PP endometritis or septic abortion in last 3 months
What are benefits of mirena IUD?
Decreases blood flow in patients with idiopathic HMB
Amenorrhea seen in 20-80% of patients
May help to treat endometrial hyperplasia
What are the noncontraceptive benefits of OCPs?
Decrease dysmenorrhea
Decrease heavy menstrual bleeding
Regulates menstrual cycle
Decrease risk of ovarian and endometrial cancer
Decreases risk of ovarian cysts and benign breast disease
Treats endometriosis
Decreases iron deficiency anemia
How long can you use OCPs?
Age 50-55
What should you know about OCP use in regards to hypertension?
Not recommended for BP 140/90 or greater
Contraindicated for BP 160/100 or greater
What should you know about OCP use in regards to Lipid disorder?
Low dose OCP is okay if lipid disorder is well controlled
What should you know about OCP use in regards to diabetes?
OCP okay unless has had diabetes for 20+ years or microvascular disease
What should you know about OCP use in regards to migraine with aura?
Stroke risk is increased and should not be used
What should you know about OCP use in regards to rifampin?
Contraindicated
What should you know about OCP use in regards to fosamprenavir?
Contraindicated
What should you know about OCP use in regards to anticonvulsants?
Decreased efficacy. Estrogen decreases lamotrigine level. Not recommended
What are the absolute contraindications for OCP use?
Breast cancer
Estrogen sensitive tumor
Pregnancy
Unexplained vaginal bleeding
Known inherited thrombophilia
Thrombosis
Smoker over age 35
Liver disease
CHD/CVA
How does the extended OCP work?
84 days of active pill and 7 days of placebo
Menstrual cycle every 3 months
Contains ethinyl estradiol and levonorgestrel
What is the recommendation regarding depression screening in pregnancy?
Everyone should be screen once during the pregnancy and postpartum period
What is the most common depression screening tool?
Edingburgh postnatal depression scale
What is the indication for hormone replacement therapy?
Moderate to severe vasomotor symptoms
What are the risks of hormone replacement therapy?
VTE
Breast cancer
What are contraindications to hormone replacement therapy?
Pregnancy
Breast cancer
Estrogen sensitive tumor
Undiagnosed vaginal bleeding
Severe liver disease
History of DVT
What are the benefits of hormone replacement therapy?
Improves hot flashes
Slows progression of osteoporosis
Improves dyspaurenia
Improves urinary incontinence
Improves memory
What is the difference between combined hormonal replacement therapy and estrogen replacement therapy?
Combined HRT= increase risk of CHD, stroke and invasive breast cancer
Estrogen replacement therapy= Increase risk of stroke
What are non pharmalogical options to reduce vasomotor symptoms?
Keeping sleep/living area cool
Avoid hot food/beverages, spicy food, alcohol, caffeine
Exercise
Increase water consumption
What are non estrogen alternatives for medical therapy of vasomotor symptoms?
Paroxetine
Fluoxetine
Venlafaxine
Gabaentin
Clonidine
What is the recommendation fo bioidentical hormones?
Conventional hormone therapy preferred due to concerns of under or over dosage
Failure rate for copper IUD in first year?
0.8%
Failure rate of Levongestrel IUD in the first year?
0.2%
Failure rate of implant in the first year?
0.05%
Failure rate of combined hormonal contraceptives in the first year?
9%
Failure rate of postpartum tubal ligation in the first year?
1.2/100
Failure rate of interval tubal in the first year?
7.3/100
Failure rate of vasectomy in the first year?
1.5/100
How long is the copper IUD approved for?
10 years
How long is the mirena IUD approved for?
8 years
How long is the liletta approved for?
8 years
How long is the kyleena approved for?
5 years
How long is Skyla approved for?
3 years
What is the size of the mirena IUD?
32x32mm
What is the size of the lilletta IUD?
32x32mm
What is the size of the kylena IUD?
28x30mm
What is the size of the Skyla IUD?
28x30mm
Why may a kyleena or Skyla IUD be easier to place than a mirena or liletta IUD?
Because the diameter of the kyleena and Skyla is smaller at 3.8mm versus 4.8mm of mirena/liletta
What is the management of abnormal uterine bleeding with levongesterel IUD in place?
Step 1= evaluate for malposition, expulsion, pregnancy, infections, cervical dysplasia
Step 2= offer treatment with NSAIDS, combined contraceptives, TXA or progestin only pills
