Primer 19 - Birth Control And Menopause

Question 1

What are the benefits of hormonal birth control?

Answer 1

Regulation of menses, Decrease in dysmenorrhea/menorrhagia, Decrease in acne, Decrease in ectopic pregnancy, Decrease in pelvic inflammatory infections, Decrease in endometrial and ovarian cancer.

Question 2

What are the disadvantages of hormonal birth control?

Answer 2

Compliance (daily dosing), Increased coagulability (DVT/PE), Hypertension, elevated triglycerides, GI/Nausea, Mood changes, depression, Weight gain due to water retention (rare).

Question 3

What are two contraindications of hormonal birth control?

Answer 3

1. Smokers > 35 y.o., 2. Migraines with aura.

Question 4

What are the symptoms of estrogen toxicity?

Answer 4

Blood clots, Hypertension, cardiac disease, stroke, and abnormal bleeding.

Question 5

What does Diethylstilbestrol cause in utero?

Answer 5

Association with clear cell adenocarcinoma of the vagina. Malformations of the genitalia, cervix, and vaginal wall.

Question 6

What is the progesterone used in the Depo-Provera shot?

Answer 6

Medroxyprogesterone.

Question 7

What is the form of delivery for Depo-Provera shot?

Answer 7

IM injection dosed q3m.

Question 8

What type of contraception would be a good choice for patients with Mental retardation?

Answer 8

Depo-Provera (Medroxyprogesterone).

Question 9

What is an important side effect of Depo-Provera?

Answer 9

It is associated with bone mineral density loss especially if long-term, therefore not ideal for more than 2 years of use.

Question 10

What is the contraindication for itrauterine device (IUD)?

Answer 10

If there is a high risk of STD.

Question 11

What does the Intrauterine device “Paragard” have and how long is it good for?

Answer 11

It is made of copper and lasts for 10 years.

Question 12

What does the Intrauterine device “Mirena” have and how long is it good for?

Answer 12

It has progesterone and lasts for 5 years.

Question 13

What does the Mirena IUD do inside the Uterus?

Answer 13

Reduces cramping and has anti-inflammatory properties that is good for menorrhagia and chronic pelvic pain.

Question 14

What is the cause of menopause?

Answer 14

It is the reduction of production of estrogen due to atresia of the ovarian follicles.

Question 15

What are the side effects of menopause?

Answer 15

[HHAVOC]

Hirsutism (relative increase androgens), Hot flashes, Atrophy of the Vagina, Osteoporosis, Coronary artery disease.

Question 16

What are the symptoms of menopausal hot flashes?

Answer 16

Occur in 75% of menopausal women, it starts in face/chest then generalizes. It lasts for 2-4 minutes and it causes diaphoresis and palpitations, followed by chills and shivering. Can cause sleep disturbances.

Question 17

What are the treatments for menopausal hot flashes?

Answer 17

Estrogen replacement > SSRI or SNRI (venladazine) > clonidine or gabapentin.

Question 18

What are herbal treatments for menopausal hot flashes?

Answer 18

Soy isoflavones, red clover, black cohosh, vitamin E.

Question 19

Why is progesterone used in combination with estrogen during estrogen replacement?

Answer 19

Unopposed estrogen increases the risk of endometrial cancer.

Question 20

What hormonal changes are seen during menopause?

Answer 20

Decrease in estrogen.

Increase in GnRH, FSH, and LH.

Question 21

A 23-year old woman who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?

Answer 21

Rifampin causes induction of CYP450, causing an increase metabolism of birth control pills.

Question 22

What hormone cause the thickening of the cervical mucous?

Answer 22

Progesterone.