# Role of Progestin in Contraception Prevent ___ surge inhibit ___ Thicken cervical ___ atrophy of ___ lessen ___

LH ovulation mucus endometrium bleeding inhibits sperm's swimming ability and implantation

# Levonorgestrel IUD more than ___ effective left in place for ___ years (based on each IUD) use back up method for ___ days after insertion Benefits: ___or lighter periods, safe to ___, lower risk of ___ cancer Return of fertility: ___

99% 3-7 years 7 amenorrhea, breastfeed, uterine immediate

# Copper IUD (Paragard) More than ___ effective left in place for ___ years no backup method needed, effective ___ Benefits: lower risk of __ cancer, safe to ___

99% 10+ immediately uterine, breastfeed

# Depo Shot ___% effective ___ mg IM or ___ mg SC every __ months Quick Start: start today and use backup for __ days Next Period: start within ___ days of period Benefits: lower risk of ___ cancer, safe to ___, lighter and less ___ periods Late dose: > 15 weeks + unprotected sex, use ___

94% 150 mg; 104 mg 7 days 7 days uterine, breastfeed, painful Emergency contraception

# Mini-Pill (POP-Norethindrone) ___% effective must be taken with ___ hours of the same time every day no ___ in the pack same starting methods as COC Benefits: Safe to ___, lack of ___ related SE Return of Fertility: ___

91% 3 hours placebo breastfeed estrogen immediate

# POP-Drospirenone 4mg (Slynd) ___% effective ___ placebos in the pack same starting info as COC same late dosing info as COC Benefits: safe to ___, lack of __ related side effects return of fertility: ___

91% 4 breastfeed, estrogen immediate

Contraception Flashcards by Reagan Smith

Role of Estrogen in Contraception

Suppress ___ production
prevent ___ follicle
increase sex hormone ___ globulin (SHBG)
increase binding of free ___

FSH
dominant
binding
androgens

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Role of Progestin in Contraception

Prevent ___ surge
inhibit ___
Thicken cervical ___
atrophy of ___
lessen ___

LH
ovulation
mucus
endometrium
bleeding

inhibits sperm’s swimming ability and implantation

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Not enough estrogen

Breakthrough bleeding ___ in the cycle
___ menses
vaginal ___
spotting
no ___ bleeding

early
light
dryness
withdrawal

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not enough progestin

breakthrough bleeding ___ in cycle
no ___bleeding
___ menses

late
withdrawal
heavy

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Levonorgestrel has high progestational activity and high ___ activity

androgenic

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Implant - Etonogestrel (Nexplanon)

more than ___ effective
left in place for up to ___ years
if inserted > 5 days after start of period, use backup method for ___ days
Return of fertility: may be delayed or rapid return within ___ weeks

99%
3 years
7 days
6 weeks

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Implant - Etonogestrel (Nexplanon)

Serious SE:
* ___ changes
* headaches
* acne

Common SE:
irregular bleeding for ___ months

mood
6-12

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Levonorgestrel IUD

more than ___ effective
left in place for ___ years (based on each IUD)
use back up method for ___ days after insertion
Benefits: ___or lighter periods, safe to ___, lower risk of ___ cancer
Return of fertility: ___

99%
3-7 years
7
amenorrhea, breastfeed, uterine
immediate

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Levonorgestrel IUD

Serious SE: (all about insertion)
* uterine ___
* expulsion
* infection

Common SE:
* spotting for first ___ months
* periods may become ___ or less ___
* cramping with insertion

perforation
3-6
lighter or less frequent

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Copper IUD (Paragard)

More than ___ effective
left in place for ___ years
no backup method needed, effective ___
Benefits: lower risk of __ cancer, safe to ___

99%
10+
immediately
uterine, breastfeed

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Copper IUD (Paragard)

Serious SE:
* uterine ___
* expulsion
* infection

Common SE:
* cramping with insertion
* spotting for the first ___ months
* periods may become ___

perforation
3-6 months
heavier

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Levonorgestrel Brands/Strengths/Duration

Mirena; ___ mg; ___ years
Skyla; ___ mg; ___ years
Liletta; ___ mg; ___ years
Kyleena; ___ mg; ___ years

52 mg, 7 years
13.5 mg, 3 years
52 mg, 6 years
19.5 mg, 5 years

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Depo Shot

___% effective
___ mg IM or ___ mg SC
every __ months
Quick Start: start today and use backup for __ days
Next Period: start within ___ days of period
Benefits: lower risk of ___ cancer, safe to ___, lighter and less ___ periods
Late dose:
> 15 weeks + unprotected sex, use ___

94%
150 mg; 104 mg
7 days
7 days
uterine, breastfeed, painful
Emergency contraception

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Depo Shot

Serious SE:
* ___ bone density
* ___ bleeding

Common SE:
* ___ gain
* changes in ___, mood, or headaches
* spotting or ___

Return of fertility: possible ___ of return

lower
heavier
weight
acne
amenorrhea
delay

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COC

___% effective
E + P
Quick Start: start today, if 5 days after ___ use backup for 7 days
Next period: start within ___ days of period
wait 5 days to start is ___ is used
Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods

Late dose:
* 1 pill: take ASAP and take next pill at usual time
* 2 or more pills: take 1 ASAP, take next pill ay usual time, use backup for ___ days

91%
period
5 days
Ella
acne, ovarian/uterine, regular
7 days

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COC

Serious SE:
* Blood ___
* stroke

Common SE:
* nausea
* spotting
* ___ discomfort
* Change in __
* headaches

Return of fertility: ____

clots
breast
mood
immediate

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Very low dose EE range

20-25 mcg

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Low dose EE range

30-35 mcg

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High dose EE range

50 mcg

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Mini-Pill (POP-Norethindrone)

___% effective
must be taken with ___ hours of the same time every day
no ___ in the pack
same starting methods as COC
Benefits: Safe to ___, lack of ___ related SE
Return of Fertility: ___

91%
3 hours
placebo
breastfeed
estrogen
immediate

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Mini-Pill (POP-Norethindrone)

Late Dose
* if more than 3 hours late: take pill ASAP and use backup for ___ days
* miss 1 or more pills, take 1 ASAP, take next pill at usual time, and use backup for ___ days

2 days

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Mini-Pill (POP-Norethindrone)

Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy

Common SE:
* spotting and menstrual changes more common than ___

headaches
heavy
ectopic

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POP-Drospirenone 4mg (Slynd)

___% effective
___ placebos in the pack
same starting info as COC
same late dosing info as COC
Benefits: safe to ___, lack of __ related side effects
return of fertility: ___

Study These Flashcards

91%
4
breastfeed, estrogen
immediate

POP-Drospirenone 4mg (Slynd)

Serious SE:
* Severe ___
* ___ bleeding
* ___ pregnancy
* ___kalemia

Common SE:
* spotting and menstrual changes more common than ___

Study These Flashcards

headaches
heavy
ectopic
hyperkalemia
COC

# Ring - EE and Etonogestrel (Nuvaring, Eluryng) * ___% effective * E + P (releases ___ mcg of ___ per day) * left in place for 3 weeks and removed for ___ week * new ring inserted after ___ days * Quick Start: Start today, if more than ___ day after period, use backup for 7 days * Next Period: start ___ day of period * wait ___ days if Ella is used * Benefits: improved ___, lower risk for ___ cancer, more ___, light, less painful periods * return of fertility: ____

* 91% * 15 mcg, EE * 1 week * 7 days * 1 day * first * 5 days * acne, ovarian/uterine, regular * immediate

# Ring - EE and Etonogestrel (Nuvaring, Eluryng) Serious SE: * Blood ___ * stroke Common SE: * nausea * spotting * ___ discomfort * chanhes in ___ * headaches

* clots * breast * mood

# Ring - EE and Etonogestrel (Nuvaring, Eluryng) Late Dose: * out for over 3 hours; reinsert and use backup for ___ days * in for over ___ weeks; remove ring, put in new ring and use back up for 7 days

* 7 days * 4 weeks

# Reusable Ring - Segestrone and EE (Annovera) * ___% effective * E + P (releases ___ mcg of ___ per day) * left in place for ___ weeks, removed for 1 week * wash with mild ___ and warm water * Quick Start: start today, if more than 5 days after period, used backup for 7 days * Next period: start on days ___ of period * Wait 5 days if ___ is used * Benefits: Improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods, can use one device up to ___ times * Return of fertility: ___

* 97% * 13 mcg, EE * soap * 2-5 * Ella * acne, ovarian/uterine, regular, 13x * immediate

# Reusable Ring - Segestrone and EE (Annovera) Late Dose: * out for more than 2 hours: reinsert and use backup for ___ days

7 days

# Reusable Ring - Segestrone and EE (Annovera) Serious SE: * blood ___ * stroke Common SE: * headache/___ * infection/___ * N/V

* clots * migraine * candidiasis

# Patch - Norelgestromin and EE (Xulane, Zafemy) * ___% effective * may be less effective if over ___ lbs * caution with BMI over ___ (still used clinically) * E +P (releases ___ mcg of ___ per day) * patches can be applied to arm, ___ , back , or ___ * new patch every __ weeks, patch free for ___ days * same starting info as COC * Benefit: improved ___, lower risk of ___ cancer, more ___, lighter, less painful periods * Return of fertility: ___

* 91% * 198 lbs * 30 * 35 mcg, EE * butt, abdomen * 3 weeks, 7 days * acne, ovarian/uterine, regular * immediate

# Patch - Norelgestromin and EE (Xulane, Zafemy) Late Dose: * off over ___hours: apply new patch, backup for 7 days * On over ___ days: apply new patch; backup for 7 days

* 24 hours * 9 days

# Patch - Norelgestromin and EE (Xulane, Zafemy) Serious SE: * blood ___ (more estrogen than most COC) Common SE: * nausea * spotting * ___ discomfot * ___ irritation * change in ___ * headaches

* clots * breast * skin * mood

# Patch - Levonorgestrel and EE (Twirla) * ___% effective * less effective as ___ increases * E + P (releases ___ mcg of ___ daily) * same administartion location as other patches * new patch every __ weeks, patch free for ___ days * Next Period: start on ___ day of period, use back up for the first 7 days of first cycle * wait ___ days is Ella is used * Benefits: improved ___, lower risk of ___ cancer, more ___, lighter, and less painful periods, ___ risk of blood clots * Return of Fertility: ___

* 91-96% * BMI * 30 mcg, EE * first * 5 days * acne, ovarian/uterine, regular, lower * immediate

# Patch - Levonorgestrel and EE (Twirla) Late Dose: * off less than __ hours: apply new patch, no backup needed * off greater than ___ hours: apply new patch and start and use backup for 7 days

24 hours

# Patch - Levonorgestrel and EE (Twirla) Serious SE: * Blood ___ Common SE: * nausea * spotting * increased ___ * ___ irritation * changes in ___ * headaches

* clots * weight * skin * mood

# Some Contraindications of COC * < ___ days postpartum * Venous ___ * ___ and vascular disease * migraine ___ aura * ___ cancer * BP > ___ * smoking over ___ cigs over the age of ___ * stroke

* 21 days * thromboembolism * diabetes * with * breast * 160/100 mmHg * 15 cigs, 35 years old

T or F: antibiotics and COC is controversial, and backup should be recommended

Truw

T or F: Amethyst is the only pack with no placebo pills that is FDA approved

True | skipping the placebo pills of other COCs is off label

# POP contraindication current ___ cancer

breast

T or F: For transgender men, testosterone treatment alone is enough to prevent pregnancy

FALSE; Testosterone use may decrease fertility but, can still lead to pregnancy | use contraceptives and estradiol to stop menses altogether

T or F: CHC is controversial for use in transgender men due to the presence of estrogen

True; progestin only would be a better option

T or F: Ella can only be used once per cycle

True

emergency contraception types (3)

* PlanB * Ella * Copper IUD

# Emergency Contraception Copper IUD * interferes with ___ viability and function * Most effective EC across all ___

* sperm * BMIs/weight

# Emergency Contraception Ulipristal Acetate * inhibits ___ and leads to follicular ___ * effective up to ___ days; better efficacy than LNG up to ___ lbs * effective after ___ surge has begun * interaction with ___ contraception * ___ only

* ovulation, rupture * 5 days, 194 lbs * LH * hormonal * rx

# Emergency Contraception Levonorgestrel * inhibits ___ * available ___ (not interaction with other methods) * may be less effective over ___ lbs (BMI of ___) * labled for ___ hours

* ovulation * OTC * 165 lbs, 25 * 72 hours

# Mifepristone (Mifeprex) * Selective ___ receptor modulator (SPRM) * Anti___ * decidual ___ * cervical __ * increased uterine ___ * prostaglandin ___

* progesterone * progesterone * necrosis * softening * contractility * sensitivity

# Misoprostol (Cytotec) * Prostaglandin ___ analogue * cervical ___ * uterine ___

* E1 * softening * contractions

# Medication abortion dosing Mifepristone: ___ mg po for 1 dose Misoprostol: ___ mcg buccally 24-48 hours later. (2x ___ mcg tablets in each cheek for 30 mins)

* 200 mg * 800 mcg, 200 mcg

# Medicaltion abortion counseling points bleeding and cramping is to be expected but contact your doctor if: * more than ___ pads/ hour for 2 consecutive hours * blood clots larger than a ___ * chills and fever greater than ___ or ___ for over 4 hours * most severe pain is ___ after misoprostol

* 2 pads * lemon * 101 degrees, 100.4 degrees * 2.5-4 hours

# Irregular Bleeding - Pills 1. take pill at the same time each day 2. ibuprofen ___ mg po ___ for 5 days 3. ___ acid 500 mg po TID for 5 days 4. change pill formulation

* 800 mg, TID * Mefenamic

# Irregular Bleeding - Implant/IUD 1. ibuprofen ___ mg po ___ for 5 days 2. ___ acid 500 mg po TID for 5 days 3. Combined pill with ___ for 1 cycle 4. EE ___ mcg daily for ___ days

* 800 mg, TID * Mefenamic * levonorgestrel * 50 mcg, 21 days

# Heavy/Prolonged Bleeding 1. ibuprofen ___ mg po ___ for 5 days when bleeding starts 2. EE ___ mcg daily for ___ days (or ___ pills) 3. ___ acid 1500 mg po TID for 3 days, then ___. mg po daily for 2 days when bleeding starts

* 800 mg, TID * 50 mcg, 21, combined * Tranexamic, 1000 mg

# Headaches and Nausea Headaches * pain relievers * if during hormone free week, consider __ use * if headaches get worse or are more often, seek evaluation Nausea * take pill at ___ or with ___ * if beginning of cycle, consider ___ use or ___ cycle

* extended * bedtime, food *continuous, extended

# breast tenderness and acne Breast Tenderness * wear supportive bra * hot/col compress * pain relievers * consider product with lower dose of ___ acne * topical * try different formulation of pills * switch from implant/IUD to ___

* estrogen * COC

# Mood changes * ___ cycle if changes during hormone free week * refer if major ___

* continuous * depression

Contraception Flashcards

(57 cards)