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Women's Health Exam 2 and Final > Reproductive Physiology, Contraception > Flashcards

Reproductive Physiology, Contraception Flashcards

1
Q

follicular phase

A

day 0 to day 14
FSH released from P to recruit follicles to grow and develop, one follicle dominates and releases estrogen, estrogen rises until day 14
inc estrogen will increase progesterone to dec FSH and GnRH and cause death of non-dominant follicles, and dec meses flow

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2
Q

day 14

A

final day of follicualr phase

estrogen reaches threshold to cause LH surge, oocyte release and ovulation

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3
Q

luteal phase

A

day 14-28 ish
corpus luteum is formed from follicles that didnt make it
if conception has occurred, the corpus luteum releases Progesterone to stop menses in preparation for preggo
if conception didnt occur, the corpus luteum dies off and doesnt release progesterone (sheds) and menstruation occurs again

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4
Q

what is the reset like to connect day 28 to day 1

A

as E and P decrease, dec - fb to FSH so FSH increases, increases E, LH spikes, progesterone preps but then menses again if not preggo

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5
Q

contraception MOA progestin and estrogen

A

progestin blocks LH surge to prevent ovulation needed for conception; MOST OF CONTRACEPTIVE EFFECTS; thickens cervical mucus, endometrial atrophy (prevent implantation)

estrogen prevents FSH release to prevent follicular development and maturation; CYCLE CONTROL AND REGULATE ENDOMETRIAL LINING,

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6
Q

how long does a pt have to try a contraceptive before an AE can indicate a medication change

A

3 months

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7
Q

when are women the most fertile?

A

24 - 48 hours post-ovulation (LH surge)

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8
Q

physical assessment with contraception

A

BP before initiating CHC
1pregnancy test when needed
weight measurement for monitoring
omit PELVIC EXAM unless IUD

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9
Q

Which meds are CHCs

A

pills, patch, ring

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10
Q

CHC tablets
advantages
disadvantages

A

:) : regulates blood loss, good for anemia, endometriosis, fibrosis, dec cramps , increased spontaneity, dec ovarian, endometrial colorectal cancer, dec benign breast mass (NOT CANCER)

:( : spotting, post pill amenorrhea, mood changes, adherence, expensive, dec libido, cervial and breast cancer, no STD protection,

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11
Q

CHCs AE
common
serious

A

common: nausea, bloating, breakthrough bleeding (improve after 2-3 mo)

serious: 
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
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12
Q

ACHES pneumonic

A 
for CHCs
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
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13
Q

CHC ring
Nuvaring, Annovera
how to use

A

insert into vagina and leave for 3 weeks, then 4th week is ring free
**Annovera is insert same ring every four weeks for up to a yr

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14
Q

CHC ring advantages and disadvantages

A

:) : less spotting than CHC, dec ovarian, colorectal and endometrial cancers like COCs, dec benign breast mass (not cancer), good for adherence, non latex, Nuvaring grace period 35 d, can remove for intercourse for up to 3 hours, can use with tamponor yeast infection

:( : spotting, amenorrhea, insert and removal, discomfort during intercourse, nuvaring requires refrigeration

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15
Q

CHC ring AE

A 
ACHES
Abdominal pain
Chest pain
Headaches
Eye problems
Severe leg pain
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16
Q

Are CHC rings systemic or local

A

systemic

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17
Q

CHC patch (Xulane, Twirla) how to use

A

place patch on dry, harless area of upper arm, shoulder, abdomen or buttox
do NOT place near breast
rotate site qwk
1 patch a week x3 wks then 4th week patch free (like ring but change qwk)

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18
Q

CHC patch advantages and disadvantages

A

:) : less spotting than COC, good for adherence, dec endometrial, colorectal and ovarian cancers, dec benign breast mass (not cancer), grace period up to 9 days (ok if forgot to change patch week 2 and left it on for an extra 7 days), can swim and bathe with it

:( : spotting possible, amenorrhea, inc risk breast cancer, clot risk, skin irritation, rotating site, patch can detach

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19
Q

CHC patch AE unique

A

higher risk blood clots, irritation at patch site,

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20
Q

Xulane clinical pearl

A

less effective in women >198lb/90kg

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21
Q

Twirla patch clinical pearl

A

CI BMI >30

lower estrogen exposure than Xulane which cn decrease clot risk

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22
Q

Progestin only Contraceptives (POCs)
(norethindrone)
how to use

A

po qd, no placebo week, continuous

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23
Q

POCs advantages and disadvantages

A

dec blood loss, dec cramps, inc libido, spontaneity, easy to use, dec endometrial cancer, preferred over CHC bc of CI, reversible and efficacious

:( : irregular menses (E provides cycle control), adherence hard, anxiety, irritability, fewer contraceptive bennies, P- related SE (acne, weight gain)

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24
Q

POCs missed dose management

A

POP dose needs to be taken at the same time every day
if dose is missed, pt has 3 HOURS to take it
if missed dose occurs, BAM x48h

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25
Q

new POP aporoved in 2019

A

Drosperinone 14d/4 placebo (Slynd)
24 hour missed pill window
CI women at inc risk hyperkalemia, hepatic impairment and adrenel insufficiency

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26
Q

Progestin only injection (Depo Provera, Depo SQ)

admin

A

1 mL crystalline susp of Depot medroxyprogesterone acetate (DMPA) in deltoid or buttox
150 mg IM q 11-13 wks
104mg SQ q 11-13 wks

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27
Q

POI Depo Provera

advantages and disadvantages

A

:) : dec cramping, amenorrhea, dec blood loss, dec endometriosis, inc compliance, dec endometrial cancer, effective

:( : irregular menses, risk of depression, dec BMD, weight gain, slow return to fertility, provider visit needed every time

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28
Q

is depo provera rapidly reversible?

A

no

can dealy infertility for up to 18 monts (caution in women >35 who are interested in future conception)

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29
Q

Depo Provera AE

A 
progestin related (acne, weight gain) 
severe depression (rare) 
BBW Bone Loss due to dec Estrogen production
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30
Q

Depo Provera clinical pearls

A

do not massage area for a few hrs, irregular spotting in beginning
Take Calcium! 1000-1200mg/d
can be given no longer than 15 wks apart

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31
Q 
Progestin Only (LNG) IUD
Mirena, Liletta, Kyleena, Skyla

admin

A

inserted into uterus by healthcare professional and usually stays in place for 3-6 yrs

32
Q

PO IUDs and length of efficacy

A

Mirena 6 (maybe 7)
Liletta 6
Kyleena 5
Skyla 3

33
Q

PO IUDs advantages

A

amenorrhea, menorrhagia improves, endometriosis improves, adherence, ins spontaneity, dec endometrial cancer, effective, readily reversible

34
Q

PO IUDs disadvantages

A

irregular menses for 3-6mo, expulsion (rare), inc risk PID 20 days after insertion

35
Q

PO IUDs AE

A

PAINS
Period late, abnormal spotting, inc/dec bleeding
Abdominal pain, pain with intercourse
Infection (STI), abnormal vaginal discharge
Not feeling well, fever, chills
String missing, shorter or longer

36
Q

PAINS acronym

A

For IUDs!
Period late, abnormal spotting, inc/dec bleeding
Abdominal pain, pain with intercourse
Infection (STI), abnormal vaginal discharge
Not feeling well, fever, chills
String missing, shorter or longer

37
Q

Progestin Only (LNG) IUD clinical pearls

A

LNG causes cervical mucus thickening
string of IUD stays outside cervix
Skyla has metal ring that may interfere with MRI
placement easier with lidocaine spray

38
Q 
Copper IUD (Paragard)
admin
A

inserted into uterus by health care professional and good for 10 years
works primarily as spermicide

39
Q

Copper IUD (Paragard) advantages

A

cycle remains regular, adherence, spontaneity, cost effective readily reversible, may be effective for 12 years

40
Q

Copper IUD (Paragard) disadvantages

A

dysmenorrhea, spotting, cramping, monthly blood loss inc 50% (use NSAIDs), discomfort during sex, expulsion, PID inc risk for 20 days post-insertion, foreign body

41
Q

Copper IUD (Paragard) AE

A

PAINS
Period late, abnormal spotting, inc/dec bleeding
Abdominal pain, pain with sex
Infection (STI), abnormal vaginal discharge
Not feeling well, fever, chills
String missing, shorter or longer

42
Q

Copper IUD (Paragard) Clinical Pearls

A

may be used for emergency contraception

43
Q

Sponge

A

non latex
non rx
can insert 6 h prior, can remain in place for 24h
must leave in for 6h post intercourse

44
Q

Diaphragm

A

latex
rx
can insert 6h prior and remain in place 24h
keep in for 6 hours post intercourse

45
Q

Cervical Cap

A

non latex
rx
can insert 6h prior and remain in place 48h
keep in for 6 hours post intercourse

46
Q

female condom

A

non latex
non rx
insert up to 8 hours prior
immediate removal

47
Q

male condom

A

latex/non latex
non rx
immediately prior and immediately after

48
Q

periodic abstinence

A

avoiding sex when ovulating
high pregnancy rates
NaturalCycles.com

49
Q

Male sterilization
advantages
disadvantages

A

vasectomy
sterility ~3 mo post op
inc sexual enjoyment, simpler, safer than female sterilization, no further visits once sperm count = 0

:( : fear of op preventing sexual function, regret, short term discomfort, no STI protection

50
Q

Female sterilization
advantages
disadvantages

A

Laparoscopic (transabdominal)
- Bipolar cautery (high risk fistulation and ectopic preggo)
- Silastic Band (highest failure rate)
Filshie clip (may apply postpartum)

Postpartum or internal mini-laparotomy
- ligation or excision

:) : no preggo worry, dec ovarian cancer, permanent, v effective
:( : regret, outpt surgery, ectopic preggo, not readily rev, does not prevent HIV/STI

51
Q

Yuzpe

A

emergency contraception
WITHIN 3 DAYS
2 doses, N/V, cost high, breast tnederness, HA
Can take w food or meclizine50mg 30-60 min before each dose

52
Q

Levonorgestrel (po) (Plan B)

A

1.5mg tav po x1 WITHIN 3 DAYS
v accessible, cost high, N/V, menstrual changes

ongoing need for contraception, check for STI, need medical F/U, BUM x7d, can use multiple times per cyc;e

53
Q

Ulipristal (Ella)

A 
emergency contraceptive
30mg po x1 
WITHIN 5 DAYS
more effective than po LNG (Plan B)
Rx :/, CYP3A4 substrate, N/V, HA, abdominal pain, menses changes, dysmenorrhea

only ONCE per cycle
BUM x14d or until end of cycle

54
Q

Copper IUD emergency contraceptive

A 
place WITHIN 5 DAYS
PAINS
Period late, abnormal spotting, inc/dec bleeding
Abdominal pain
Infection (STI), vaginal discharge
Not feeling well, fever, chills
String missing, shorter or longer

most effective, need office visit

55
Q

LNG IUD emergency contraception

A 
WITHIN 5 DAYS
PAINS
Period late, abnormal spotting, inc/dec bleeding
Abdominal pain
Infection (STI), vaginal discharge
Not feeling well, fever, chills
String missing, shorter or longer

off-label, need office visit

56
Q

which emergency contraception options are needed within 5 days or 3 days

A

Yuzpe and LNG (Plan B) are within 3 days

Ulipristal/Ella, Copper IUD, and LNG IUD are within 5 days

57
Q

which contraceptives dec endometrial cancer

A

CHCs (po, patch, ring), POCs, IUDs

58
Q

which barrier contraceptives are latex

A

diaphragm and male condom

59
Q

which contraceptives are rapidly reversible?

A

CHC patch, POI (progestin only implant) Nexplanon, IUDs

60
Q

POI (progestin only implant) Nexplanon, Implanon

admin

A

rod inserted SQ in upper arm

61
Q

POI nexplanon advantages and disadvantages

A

:) : amenorrhea, menorrhagia improve; adherence, readily reversible, effective for 3 years, MRI safe, varying BMIs ok

:( : irregular meses first 6 mo, expulsion, inc risk infection first 20d, progestin-related AE

62
Q

POI Nexplanon AE

A 
progestin related (weight gain, acne)
bleeding irregularities, inflammatoin, hematoma, pain, redness, difficulty removing rod, rod breaks, fibrosis
63
Q

Which IUD contraceptives are good for 6 years

A

Mirena, Liletta

64
Q

Which IUD contraceptive is good for 5 years

A

Kyleena

65
Q

Which IUD contraceptive is good for 3 years

A

Skyla

66
Q

which contraceptives are CHCs

which are POCs

A

CHCs are COCs, Patch, Ring

POCs are Depo-Provera, Nexplanon, PO (LNG) IUDs

67
Q

When to start a contraceptive?

A

all of them can be started any time as long as pateint is certainly not pregnant

68
Q

how long is additional contraception needed for copper IUD

A

none

69
Q

how long is additional contraception needed for LNG IUDs

A

BUM x7d if starting >7d post menses

70
Q

how long is additional contraception needed for implant

A

BUM x7d if >5d post menses

71
Q

how long is additional contraception needed for injectable

A

BUM x7d if starting >7d post menses

72
Q

how long is additional contraception needed for CHC

A

BUM x7d if >5d post menses

73
Q

how long is additional contraception needed for POP

A

BUM x2d if >5d post menses

74
Q

what if pt misses dose of COC?

A

<24h (late) or 24-48h (missed 1 dose): take dose ASAP, continue taking at usual time, no contraception needed

if >48h (2+ pills missed): take most recent ASAP, discard missed, BAM x7d

  • if doses were missed in week 3, finish the hormone pills in current pack even if it omits week 4, start new pack immediately after
  • consider EC if missed in week 1 and had intercourse <5d prior
75
Q

What if patch application is delayed or detached?

A

<48h: apply new one ASAP, keep same patch change day, EC not needed

> 48h: apply new patch ASAP, use BAM x7d, if occurred in third patch week, omit week 4 by finishing third week and starting new patch immediately
*EC considered if delay was in week 1 and unprotected intercourse occurred within the last 5d

76
Q

What if delayed insertion/reinsertion of ring?

A

<48h: insert ring ASAP, keep in until scheduled ring day, no BUM needed, EC not needed

> 48h: insert ASAP, keep in until scheduled ring removal day, use BUM until its been in for 7d, omit week 4 by finishing up week 3 and inserting new ring right after
*EC considered if delay was in week 1 and unprotected intercourse occurred within the last 5d

Women's Health Exam 2 and Final (5 decks)

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