Week 3 pt 1 Flashcards
1) ~____% unintended pregnancies occur among couples who were using a contraceptive method in the month the woman became pregnant
2) What are the 2 reasons for this?
1) ~50%
2) Either the method did not work properly OR the couple did not use it consistently or correctly.
(The other 50% were sexually active but not using any birth control)
List factors affecting contraception choice
1) Efficacy
2) Safety
3) Availability
4) Cost
5) Personal acceptability to pt and partner
6) Side effects
7) Route of delivery: PO, transvaginal, intrauterine, SQ
What are some different frequencies of contraceptive delivery?
QD (daily), Q weekly, Q mo, Q 5 yr, Q 10 yr
True or false: Ability to provide STD protection and career/life choices are both factors influencing contraceptive choice
True
True or false: Responsibility of contraception for which partner and Past Medical History both influence contraceptive choice
True
Define the Pearl Index (PI)
The number of contraceptive failures per 100 women
-years of exposure and uses as the denominator the total months or cycles of exposure from the initiation of the product to the end of or the discontinuation of the product.
How do you calculate the pearl index?
(Number of pregnancies x 12) x 100 / (Number of women in the study x Duration of study in months)
*Lower score is better
Name a statistical estimation of pregnancy risk per year
Pearl Index (PI)
List hormonal contraceptives that inhibit the development and release of the egg
1) OCP
2) Long-acting progesterone injection/shot
3) Intradermal implant
4) Contraceptive patch
5) Contraceptive ring
6) IUD
Give examples of Imposing a mechanical, chemical, or temporal barrier between sperm and egg
Condom
Diaphragm
Sponge
Spermicide
Fertility awareness
Natural family planning
Intrauterine contraception (IUC or IUD)
Describe secondary mechanisms of contraceptives that are imposing a mechanical, chemical, or temporal barrier between sperm and egg
Alter the ability of the fertilized egg to implant and grow
Intrauterine device (IUD) may be used in emergency contraception
Give examples of hormonal contraceptives
-Implantable rod*
-IUD-intrauterine device*
-Copper=non-hormonal
-Injectables/shot*
-Pills
-Combination▫
-Progestin only
-Patches▫
-Rings▫
Why are LARCs a good contraceptive?
1) Reversible
2) Ideal for timing and spacing of pregnancies
3) Few contraindications/side effects
Describe the nexplanon implant
1) SubQ; Radiopaque
2) Placed 1st 5 days of menses
3) Steady low dose of progestin suppressing ovulation & changing cervical mucous
4) Patient must feel for it daily.
1) Are OCPs or IUDs more common?
2) When are IUDs inserted?
3) What are the risks of IUDs?
4) What can IUDs treat?
1) In the USA birth control pills are more common (despite efficacy)
2) Can be inserted anytime in the cycle (as long as not pregnant)
3) Risk of expulsion, perforation
4) Treats both metrorrhagia/menorrhagia
1) What do hormonal IUDs contain?
2) Which one can last up to 5 years? Who can use it?
2) Which one lasts up to 3 years? Who can use it?
3) Are there any others?
1) Levonorgestrel IUD: (0.2/0.2%) (progestin)
2) Mirena: up to 5 years, parous and nulliparous women
3) Kyleena: nulliparous, up to 3 years
4) There are others, with various years of efficacy
1) What do non-hormonal IUDs contain?
2) How long does the most common bran last?
3) Will the patient menstruate?
1) Copper IUD: (0.8/0.6%)
2) Paragard up to 10 years
3) Patient will still have cycle
What is the MOA of IUDs with progestin?
1) Thickens the mucus of the cervix, which makes it harder for sperm to get to the egg.
2) Thins the uterine lining – So, if fertilization occurs, no implantation
IUDs with Progestin:
1) What are the side effects?
2) What are the risks?
3) What are the benefits?
1) Irregular bleeding, cramping, amenorrhea, abdominal/pelvic pain
2) PID, infection, ectopic pregnancy, uterine perforation, expulsion, ovarian cysts, clots
3) Decrease menstrual blood loss (up to 50%) and severity of dysmenorrhea
IUD with progestin: Local progesterone effect is used to relieve pain related to what 2 things?
Endometriosis and adenomyosis
Copper IUD (Paragard):
1) Are there hormones?
2) How long does it last?
3) Can pts have CTs/MRIs?
1) No hormones; still ovulate
2) Effective for at least 10-12yrs
3) Can have CT/MRI
What are the risks/ benefits of the copper IUD?
Same as hormonal IUDs except:
Does not help with dysmenorrhea, menorrhagia and metrorrhagia and may make periods heavier and more painful
IUDs:
1) When is infection risk highest?
2) Which pts may benefit from STD screening before insertion? Can an IUD remain in place if there’s an STD?
3) How are IUDs removed?
1) First 20 days after insertion
2) High risk patients may benefit from STD screening prior to insertion
IUD may remain in place on long as no signs of spread to endometrium or fallopian tubes if +STD
3) Speculum and pull on string
Can become imbedded in uterine wall and require hysteroscopy for removal
List 4 absolute contraindications to IUD placement
1) Active pelvic infection
2) Cervical or uterine CA
3) Distortion or abnormality of the body of the uterus
4) Uterine cavity that is not of sufficient depth to support the device (6-9cm)
COCs/COCPs
1) What happens during a placebo week? Why is it important?
2) Is this required?
1) During placebo week, estrogen/progesterone levels fall, triggering a fake period
This bleed is reassuring to the woman that she is NOT pregnant
2) This bleed is NOT required for birth control; extended cycle pills
What are the benefits of COCs?
1) More predictable, shorter periods
2) Decrease painful periods (dysmenorrhea), acne, symptoms of PCOS
3) Protect bone health
4) Decreased androgenic symptoms
5) Reduce ovarian cysts
6) Reduce risk of ovarian cancer
COC/COCP types: Describe Monophasic and give examples
1) Contain a constant amount of estrogen and progestin in each active pill.
2) Examples: Yasmin, Sorintec, Estarylla, Previfem,Jolessa Portia
*Classic regimen is 21 days active pill and 7 days placebo
COC/COCP types: Describe Biphasic and give examples
1) Deliver the same amount of estrogen each day while progestin dose is increased halfway through cycle.
2) Examples: LoSeasonique, Camrese L, Daysee, Mircette
COC/COCP types: Describe Triphasic and give examples. What is one unique downside and one unique use?
1) 3 different doses of progestin and estrogen that change approximately every 7 days.
2) Examples: TriSprintec, Trivora, TriNessa, Cyclessa
3) *Associated with breakthrough bleeding
*Used for acne treatment
What 3 reasons are extended cycle pills best for? (i.e. No placebo week (week 4))
1) Menorrhagia
2) Dysmenorrhea
3) Endometriosis
Continuous regiments (extended cycle): What are they? Give an example
1) Formulation specifically extends the cycle to every 3 months
2) Seasonale, Seasonique
What is an alternative to a continuous regimen? Describe
1) Give patient 3 monthly packs and have them skip the placebo week and go immediately into the next pack
a) Shorter and less frequent menses
b) Higher rate of breakthrough bleeding that is worse in the first 12 weeks cycle
c) *Hepatic adenomas
List 5 positives of oral contraceptives
1) Predictable, shorter, and less painful periods
2) Reduce the risk of iron-deficiency anemia
3) Lower incidence of endometrial and ovarian cancers
4) Decrease risk of ectopic pregnancy
5) Reduced undesired pregnancy
What are the absolute contraindications to COCPs?
-Pregnancy
-Current breast cancer/ hormone-sensitive CA
-Migraine (w aura)
-B/P >160/90
-Ischemic heart disease/CHF/CVA
-Liver cirrhosis, active hepatitis, or hepatic tumors
-Postpartum and breastfeeding before 6 weeks
-Smoking after age 35
-Hx DVT
-AUB
List the pros of the pill
1) Regulate fertility/cycle
2) Lifestyle-career etc.
3) Predictability
4) Inexpensive
5) Noninvasive
6) Decrease risk of endometrial, ovarian, colorectal CA
List the cons of the pill
-CVA & MI
-DVT/PE
-Breast, cervical CA risk
-Can decrease libido (esp progestin)
-Breakthrough bleeding
-Amenorrhea
-HTN
-Gallstones/cholestasis
-HA/weight gain/breast tenderness*
*estrogen component
List and describe the 3 ways to start an OCP
1) First day start: Provides the maximum contraceptive effect in the first cycle
-No back up form needed
2) Sunday start: Start first Sunday after menses onset
-Use secondary form for first 7 days
3) Quick start: Started on the day it is prescribed, better compliance
-Confirm patient not pregnant
-Back-up form is needed for the first 7 days
Progestin Only Pill (POP) OCPs:
1) What is it also called?
2) Who is it the pill of choice for?
3) What is the main perk of this form?
1) Aka “mini-pill”
2) Pill of choice for nursing mothers
3) Less risk of adverse effects
Give 3 examples of women who can’t take pills with estrogen
Breastfeeding mothers, women with a hx of blood clots, women with SEs on combined pills
Emergency contraception:
1) What is unnecessary?
2) Do you need a pregnancy test?
1) Physical exam or laboratory tests unnecessary for the oral medication
2) No pregnancy test (unless suspect based on cycle history or symptoms)
Plan B
1) Is it Rx or OTC?
2) What may pts need?
3) Is it safe for all ppl?
1) OTC
2) May need an antiemetic
3) Believed to be safe even if woman has absolute contraindications to routine OCP use
Patches: Estrogen/Progestin combination (OrthoEvra)
1) Are the SEs, contraindications, effectiveness different from combo OCPs?
2) Are there any increased risks?
1) All the same
2) *Release more than 60% more estrogen than OCPs
higher risk of estrogen-related complications ie. DVT
1) When can you use Ella? Do you need an Rx?
2) Describe Paragard IUD as an emergency contraceptive
1) Up to 12ohrs (5d); need Rx
2) Within 5 days; <1% failure rate; needs Rx and appt.
Estrogen/Progestin combination (OrthoEvra) patch:
1) When do you start it? How long is it effective? When do you change patches?
2) Where do you place it?
3) What are 2 downsides?
1) Start: first 5d of period
-Effective x 1 week; replace weekly x 3 weeks
-4th week: patch-free
2) Clean, dry skin of buttocks, upper outer arm, lower abdomen
3) Skin irritant for some; no regular swimming
Depo-Provera:
1) What is the method of use? How often is it given?
2) What hormone(s) is/are in it?
3) Do you ovulate?
4) What is there a risk of?
1) “The shot”; IM injection q three months (arm or glutes)
2) Progestin only (Medroxyprogesterone acetate)
3) Depo-Provera typically suppresses ovulation, keeping your ovaries from releasing an egg
thickens cervical mucus to keep sperm from reaching the egg
4) *Risk of osteoporosis; limit to 2 years of use
List the efficacies of:
1) NuvaRing (combined estrogen/progestin)
2) Cervical cap
3) Diaphragm
4) Female condom
5) Male condom
1) 91%
2) 68%
3) 78%
4) 79%
5) 82%
Films, foams, Jellies – 72%
Nuvaring:
1) What does it release/ when?
2) When is it placed into the vagina?
1) Releases sustained amount of estrogen and progestin daily
2) At beginning of menses by the patient
Nuvaring:
1) How long do you leave it in?
2) What does it look like?
3) Are the effects only local?
1) Left in place for 3 weeks
*Can be take out for up to 3 hours, without altering efficacy
2) Colorless, odorless, 2-inch diameter
3) Metabolism still occurs in the liver
1) What is the oldest and most widely used contraception?
2) Does it protect against STIs? Explain.
3) What is a downside?
1) Condoms
2) STD protection; only latex condoms protect against HIV
3) Subject to higher failure rate due to inconsistent, incorrect use, or damage to the barrier material
