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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
new POP aporoved in 2019
Drosperinone 14d/4 placebo (Slynd) 24 hour missed pill window CI women at inc risk hyperkalemia, hepatic impairment and adrenel insufficiency
26
Progestin only injection (Depo Provera, Depo SQ) admin
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
27
POI Depo Provera | advantages and disadvantages
:) : 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
28
is depo provera rapidly reversible?
no | can dealy infertility for up to 18 monts (caution in women >35 who are interested in future conception)
29
Depo Provera AE
``` progestin related (acne, weight gain) severe depression (rare) BBW Bone Loss due to dec Estrogen production ```
30
Depo Provera clinical pearls
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
31
``` Progestin Only (LNG) IUD Mirena, Liletta, Kyleena, Skyla ``` admin
inserted into uterus by healthcare professional and usually stays in place for 3-6 yrs
32
PO IUDs and length of efficacy
Mirena 6 (maybe 7) Liletta 6 Kyleena 5 Skyla 3
33
PO IUDs advantages
amenorrhea, menorrhagia improves, endometriosis improves, adherence, ins spontaneity, dec endometrial cancer, effective, readily reversible
34
PO IUDs disadvantages
irregular menses for 3-6mo, expulsion (rare), inc risk PID 20 days after insertion
35
PO IUDs AE
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
PAINS acronym
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
Progestin Only (LNG) IUD clinical pearls
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
``` Copper IUD (Paragard) admin ```
inserted into uterus by health care professional and good for 10 years works primarily as spermicide
39
Copper IUD (Paragard) advantages
cycle remains regular, adherence, spontaneity, cost effective readily reversible, may be effective for 12 years
40
Copper IUD (Paragard) disadvantages
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
Copper IUD (Paragard) AE
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
Copper IUD (Paragard) Clinical Pearls
may be used for emergency contraception
43
Sponge
non latex non rx can insert 6 h prior, can remain in place for 24h must leave in for 6h post intercourse
44
Diaphragm
latex rx can insert 6h prior and remain in place 24h keep in for 6 hours post intercourse
45
Cervical Cap
non latex rx can insert 6h prior and remain in place 48h keep in for 6 hours post intercourse
46
female condom
non latex non rx insert up to 8 hours prior immediate removal
47
male condom
latex/non latex non rx immediately prior and immediately after
48
periodic abstinence
avoiding sex when ovulating high pregnancy rates NaturalCycles.com
49
Male sterilization advantages disadvantages
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
Female sterilization advantages disadvantages
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
Yuzpe
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
Levonorgestrel (po) (Plan B)
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
Ulipristal (Ella)
``` 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
Copper IUD emergency contraceptive
``` 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
LNG IUD emergency contraception
``` 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
which emergency contraception options are needed within 5 days or 3 days
Yuzpe and LNG (Plan B) are within 3 days Ulipristal/Ella, Copper IUD, and LNG IUD are within 5 days
57
which contraceptives dec endometrial cancer
CHCs (po, patch, ring), POCs, IUDs
58
which barrier contraceptives are latex
diaphragm and male condom
59
which contraceptives are rapidly reversible?
CHC patch, POI (progestin only implant) Nexplanon, IUDs
60
POI (progestin only implant) Nexplanon, Implanon | admin
rod inserted SQ in upper arm
61
POI nexplanon advantages and disadvantages
:) : 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
POI Nexplanon AE
``` progestin related (weight gain, acne) bleeding irregularities, inflammatoin, hematoma, pain, redness, difficulty removing rod, rod breaks, fibrosis ```
63
Which IUD contraceptives are good for 6 years
Mirena, Liletta
64
Which IUD contraceptive is good for 5 years
Kyleena
65
Which IUD contraceptive is good for 3 years
Skyla
66
which contraceptives are CHCs | which are POCs
CHCs are COCs, Patch, Ring POCs are Depo-Provera, Nexplanon, PO (LNG) IUDs
67
When to start a contraceptive?
all of them can be started any time as long as pateint is certainly not pregnant
68
how long is additional contraception needed for copper IUD
none
69
how long is additional contraception needed for LNG IUDs
BUM x7d if starting >7d post menses
70
how long is additional contraception needed for implant
BUM x7d if >5d post menses
71
how long is additional contraception needed for injectable
BUM x7d if starting >7d post menses
72
how long is additional contraception needed for CHC
BUM x7d if >5d post menses
73
how long is additional contraception needed for POP
BUM x2d if >5d post menses
74
what if pt misses dose of COC?
<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
What if patch application is delayed or detached?
<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
What if delayed insertion/reinsertion of ring?
<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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