Other Topics Flashcards
1
Q
barrier methods of contraception
A
- condoms, diaphragms, cervical caps
- protection against STIs: decreased risk HIV, gonorrhea, nongonococcal urethritis, herpes
- natural membrane condoms less effective than latex
- rare reports of toxic shock syndrome with diaphragm and contraceptive sponge
2
Q
sterilization
A
- reduces risk of ovarian cancer
- most commonly used method
- hysterectomy, BSO, tubal ligation, vasectomy
- NOT reversible
- 1.85% risk pregnanyc, 30% risk of ectopic pregnancy
- SE include functional ovarian cysts,
3
Q
Intrauterine Devices
A
- Advantages: high level of efficacy, no increased rate of pelvic infxn and infertility
- Skyla: good for 3y
- Mirena: good for 5y, good for women with menorrhagia
- ParaGuard: good for 10y
- Disadvantages: not for use in women at high risk for bacterial STI in last 3-6mo
- may not be effective in women with uterine leiomyomas because they alter the size or shape of the uterine cavity
- Side effects:
- ParaGuard - increased menstrual blood flow, dysmenorrhea
- Mirena: more frequent spotting up to 6mo after placement or amenorrhea (30% by 2y, 60% by 12y)
- expulsion duirng first year (likely in first month), 5%
- uterine perforation (0.1%)
- not associated iwht increased risk pelvic infxn for low-risk pts
4
Q
implanon
A
- advantages: up to 3y
- disadvantages: not for use in women who cannot tolerate unpredictable and irregular bleeding
- SE: causes irregular bleeding that doesn’t normalize over time
5
Q
OCPs
A
- Advantages: increased bone density, reduced menstrual blood loss (and anemia), low risk ectopic, improved dysmenorrhea from endometriosis, improved acne, decreased risk ovarian and endometrial CA and various benign breast dzs, prevention of atherogenesis, decreased activity of RA and incidence and severity of acute salpingitis
- disadvantages: user dependent, increased risk thromboembolism, contraindicated with hypercoagulable state (smoking >35, hx VTE), contraindicated in ER/PR pos breast CA
- SE: breakthrough bleeding, amenorrhea, mastalgia, weight gain, increased risk CV event
6
Q
LARCs
A
- long acting reversible contraceptives
- prevent pregnancy through primarily spermicidal effect caused by sterile inflammatory rxn
- if woman develops infxn with IUD in place, dont remove device, treat as STI
- if TOA forms, start IV abx and remove device immediately
7
Q
Copper containing (ParaGuard) MOA, Indications, Contraindications
A
- MOA: local inflammaatory response induced in uterus leads to lysosomal activation
- Indications: 10y
- Contraindications: pregnancy or suspicion of pregnancy, abnl uterus (i.e. fibroids), acute PID, postpartum endometritis or postabortal endometritis, known or suspected uterine or cervical CA, genital bleeding (unknown), mucopurulent cervicitis, Wilson dz
8
Q
Progestin releasing IUD (mirena - levonorgestrel releasing intrauterine system)
A
- MOA: progestin renders endometrium atrophic, stimulates cervical mucus thickening (blocks sperm penetration into uterus), decreases tubal motility (prevents ovum/sperm union), may inhibit ovulation
- indications: good for 5y
- Contraindications: preg, uterine anomaly, PID, postpartum endometritis or infected abortion in past 3 mos, uterine or cervical neoplasia/abnormal pap, genital bleeding (unknown orig), untreated cervicitis or vaginitis, acute liver dz or liver tumor, susceptibility to pelvic infxn, breast cancer, prior ectopic
9
Q
Implanon
A
- single rod, etonogestrel
- MOA: progestin continuously suppresses ovulation, increases cervical mucus viscosity, causes endometrial atrophy
- Indications: up to 3y
- Contraindications: preg, thrombosis or VTE, hepatic tumors, liver dz, undx abnormal genital bleeding, breast CA
10
Q
Most androgenic OCP
A
levonorgestrel
11
Q
least androgenic OCP
A
- desogestrel, gestodene, drospirenone
12
Q
OCP MOA, indications, contraindications, adverse effects
A
- MOA: suppression of hypothalamic GnRH, prevention of FSH and LH secretion, prevent menorrhagia, progestins inhibit ovulation
- Indications: 3wks each month
- Contraindications: preg, HTN, smoker >35yo, DM, thrombogenic cardiac valvulopathies, cerebrovascular or coronary artery dz, migraines, thrombophlebitis, hx VTE, undx abnl bleeding, breast CA, cholestatic jaundice of preg, hepatic adenomas or CA or liver dz, endometrial CA
- Adverse effects: breakthrough bleeding, amenorrhea, breast tenderness, weight gain, increased risk CV dz
13
Q
Progestin-only pill
A
- aka minipills
- MOA: progestins inhibit ovulation
- Indications: good for women at increased risk of CVD (HTN), hx of thrombosis, migraines, smoker >35yo, lactating women, reduced risk ovarian and endometrial CA
- Contraindications: unexplained uterine bleeding, breast CA, hepatic neoplasms or liver dz, pregnant
- Adverse effects: increased incidence irreg bleeding, higher preg rate
14
Q
depo-provera
A
- MOA: inhibits ovulation and prevents sperm implantation
- Indications: IM injection q3mos, given 5d after menses onset, does NOT suppress lactation, good for women for whom estrogen-containing contraceptive is contraindicated (migraine, sickle cell, fibroids), decreased risk of ovarian and endomet. CA
- Contraindications: unexplained uterine bleeding, breast CA, liver dz, preg, hx of VTE
- Adverse Effects: irreg bleeding, weight gain, breast tenderness, increased risk cervical CA, delay in return of fertility (12-18mo), shouldnt be used longer than 2y (d/t decreased bone mineral density)
15
Q
postcoital contraception
A
- Copper IUD insertion (up to 5d after, 99-100% efficacy)
- oral antiprogestins or mifepristone (within 72hrs or up to 120hrs after, 98-99% efficacy)
- Levonorgestrel (delays or prevents ovulation, within 72hrs, 60-94% efficacy)
