Oral Contraceptives Flashcards by Caitlin Dale

What question should you always ask women ages 15-55?

What are your plans for pregnancy in the next yr?

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5 birth controls that work best

IUD - mirena

IUD - paraguard

IUD - skyla

implant - Nexplanon

Sterilization (men and women)

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4 birth controls that work “okay”

pill

patch

ring

depo

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4 birth controls that do not work well

withdrawal

diaphragm

fertility awareness (natural family planning)

condoms

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oral emergency contraception

two doses of contraceptive pills taken within 72 hours of unprotected intercourse

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old school emergency contraception versus current emergency contraception (pill)

old - estrogen/progesterone based on estrogen dose of 200 mcg

now - plan B

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other form of emergency contraception (besides pills)

IUD insertion within 5 days of unprotected sex - paraguard

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Selective progesterone receptor modulator used for emergency contraception

Ella (ulipristal acetate)

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Differences between Ella and plan B

elle - selective progesterone receptor modulator AND effective for up to FIVE days after unprotected sex

plan B - only effective up to THREE days after unprotected sex

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IUD insertion can be emergency contraception if placed ____ days after unprotected sex

UP TO FIVE DAYS

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Short acting or frequent use contraception (4)

pill

nuva ring

patch

depo

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methods that require increased frequency of use have _____ proportionate efficacy

inversely - anytime you add in USER ERROR, efficacy decreases

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who are the best candidates for short acting or frequent use contraceptives

women who have short interval prior to wanting a pregnancy (exception to this is depo shot)

women not looking for long term pregnancy prevention

women using methods for non-contraceptive benefits

uninsured women with financial concerns

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what three things do oral contraceptives do

suppress ovulation

thicken cervical mucos

thins the endometrial lining

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what two things do progestin ONLY oral contraceptives do

thicken cervical mucus AND thins endometrial lining

DOES NOT SUPPRESS OVULATION

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when do you use mini pill “progestin only”

when estrogen is contraindicated - thrombosis, CAD, HTN, diabetes

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____ helps with cycle regulation

estrogen or progesterone

estrogen

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three types of combination pills

monophasic

triphasic

continuous

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single dose of estrogen and progesterone for 21-24 days with placebo pills for 4-7 days

monophasic pills

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differing dose of estrogen and progesterone throughout course of the pack + placebo pills

tend to have lower dose of estrogen

triphasic pills

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which has lower dose of estrogen - monophasic or triphasic

triphasic

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continuous pills - monophasic or triphasic

monophasic

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why would you use continuous pills?

anemia

people with painful periods

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what medical conditions should combination hormonal contraceptives (including ring and patch) be used WITH CAUTION

HTN

Smoking (+ under age 35)

Common migraine headaches

liver disease

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What conditions are ABSOLUTE contraindications with combination estrogen/progestin contraceptives?

uncontrolled HTN CAD uncontrolled DM Complex migraines (with aura) hx of thromboembolism hormone sensitive cancers (breast) smoking + age of 35+

which is more likely to fail if not taken properly - combo or progesterone only

progesterone only - due to inadequate ovulation suppression due to non-therapeutic levels

which has more breakthrough bleeding - combined oral contraceptives or progesterone only?

progesterone only

4 progesterone only options

progestin only pills (mini pill) depo implant (nexplanon) IUD (mirena, skyla, liletta, kyleena)

what is the ONLY progesterone only option that does not allow for immediate pregnancy after removed/stopped talking?

depo!

contraindications to estrogen

immediate postpartum period (increased risk of VTE) early lactation can be suppressed hx of thrombophelias hx of CVD older women who are smokers (over 35) classic migraines liver dysfunction

5 things to consider when choosing a pill

lifestyle (breastfeeding) health hx existence of dysmenorrhea, acne, menorrhadia desire for suppression of menses cost (if uninsured)

non-contraceptive benefits of oral contraceptive pills (6)

cycle regulation tx of heavy menses tx of acne tx of dysmenorrhea prevention of functional ovarian cysts prevention of ovarian, COLON, and endometrial cancers

when can you start a new birth control pill

IF YOU KNOW YOU ARE NOT PREGNANT

6 ways you can tell a woman is not pregnant

has not had intercourse since last period has been correctly and consistently using reliable method of contraception is within first seven days after menses is within four weeks postpartum for nonlactating women is within first seven days postabortion/miscarriage is fully or nearly fully breastfeeding, amenorrhoeic and less than 6 months postpartum

TIME you can start ANY contraceptive method

Does not matter as long as you are not pregnant

additional contraception needed with copper-containing IUD

NONE

additional contraception needed with progesterone releasing IUD

if more than 7 days since menses started use back-up or abstain for 7 days

additional contraception needed with implant

if more than 3 days since menses started, use back up for 7 days

additional contraception needed with injectable

if more than 7 days after menses started, back up needed for 7 days

additional contraception needed with combined hormonal contraceptive

if more than 5 days after menses started, use back up for 7 days

additional contraception needed with progestin-only pill

if more than 5 days since menses started, use back up for 2 days

tests/exams needed before combined hormonal contraception

blood pressure

tests needed before IUDs (copper and progestin)

bimanual pelvic and cervical

drug name in depo

medroxyprogesterone acetate

should you be cautious with depo and DM, HTN, and heart disease

YES - not absolute contraindication but be careful

side effects of depo (3)

irregular cycles amenorrhea (or irregular bleeding) bone

BLACK BOX WARNING on Depo

LOSS OF BONE MINERAL DENSITY can be reversed do weight-bearing exercise + calcium and vit D

if depo is started during menses, what kind of back up is needed

none

if depo is started over 7 days after menses, use back up for how long

7 days

what kind of back up method should be used with depo

barrier

transdermal failure rates are due to what?

user dependent

transdermal - combined or progesterone only

combined

transdermal (2 names)

nuva ring ortho evra patch

contraindications fot transdermal bc

same as combined oral contraceptives

what back up methods are used with combined contraception and when

barrier if started over 5 days after menses, use back up method for 7 days

4 types of barrier methods

diaphragm condoms cervical caps cervical sponge

benefit of barrier methods

lower risk of STD transmission

contraindications of barrier methods

allergic to materials

should always talk to women about what kind of birth control

long acting reversible contraceptives

types of subdermal implants what kind - combo or progesterone only

implanon or nexplanon both only progesterone nexplanon can see on radiographs if they get lost

contraindications for subdermal implants

allergies to material

contraindications for intrauterine devices

active infection sensitivity to copper uterine anomaly (perforation risk) untreated cervical disease

4 types of IUDs

mirena skyla liletta paraguard - copper

what kind of IUD would you give someone who has follicular cysts

PARAGUARD

what kind of IUD would you NOT give someone with follicular cysts

progestin containing

what kind of IUD would you NOT give to someone who has painful periods

copper

what kind of IUD would you give to someone with painful periods

progestin containing

what progesterone is in progestin-only IUD

levonorgesterol (spelling error)

only FDA approved IUD to tx menorrhagia

mirena (but they all do)

how much of their reproductive life is spent trying to avoid unintended pregnancy?

3 decades

most common method of sterilization

laparoscopic

contraindications for sterilization

surgical restrictions not done having babies

non-contraceptive benefits of sterilizations

decreased ovarian cancer risk (not definite yet)

3 ways of female sterilization

removal clip band

most common female sterilization

laparoscopic

male sterilization

vasectomy

best birth control for married 40 y/o woman with well controlled HTN and on ACE-I

IUD - no effect on HTN

best birth contro l for 14 y/o non-sexually active girl wit irregular menses

oral contraception - not having sex so don't worry about user error

best birth control for 30 y/o breastfeeding twins at 3 mos postpartum

IUD - no effect on milk and no follow-up (like you would need with depo)