Contraception

Question 1

Natural Methods

Answer 1

Avoid intercourse and/or ejaculation around time of ovulation to prevent conception from occuring
- requires female with regular, predictable cycles

Question 2

Ovulation Timing

Answer 2

ovulation occurs 14 days prior to 1st day of menses

• avoid intercourse 5 days prior and 3 days after ovulation
• need to determine cycle variability
• can use body temps –> if pregnant, body temp will stay elevated
• cervical mucous -> most abundant, watery, and egg-whitey at time of ovulation

Question 3

Barrier Method

Answer 3

prevent sperm from fertilizing egg by use of physical or pharmacologic barrier

Question 4

Condoms

Answer 4

BEST STI PROTECTION

• male is more effective and more common
• most effective when used with spermicide

Question 5

Diaphragm

Answer 5

requires fitting by trained physician

- decreases STIs, must take out within 24 hours to avoid bad infection

Question 6

Cervical Cap

Answer 6

silicone rubber cap, needs to be fitted, take out within 24 hours to avoid infection
- increased risk of toxic shock

Question 7

Sponge

Answer 7

circular disc that you moisten with tap water and insert into vagina, leave in place for 24 hrs
- increased rate of yeast infections, UTIs, and Toxic Shock Syndrome

Question 8

Spermicides

Answer 8

foams, creams, jellies

- damages cell membranes of sperm cells and bacteria

Question 9

Combined Estrogen/Progesterone

Answer 9

Pill, Ring, Patch
- estrogen/progesterone induced inhibition of midcycle surge of gonadotropin secretion –> ovulation does not occur
Absolute Contraindications = thromboembolic stroke, CAD, estrogen dependent tumor, liver disease, pregs, uterine bleeding, smoker, migrains

Question 10

Combined Non-contraceptive benefits

Answer 10

Reduction in dysmenorrea
Reduction in menorrhagia
Reduction of ovarian, endometrial, colorectal cancers
Improves osteopenia and osteoporosis

Question 11

Oral Combined “The Pill”

Answer 11

Estrogen -> ethinyl estrdiol
Progestin -> 1st and 2nd generation -> more androgenic, the newer ones are less androgenic (S.E. include increased LDL and decreased HDL)
General S.E. = breast tenderness, nausea, headaches, moody, irregular bleeding, weight change

Question 12

Drospirenone

Answer 12

spironolactone analog -> improves weight stability/water retention
- may increase serum K

Question 13

Phases of Combined Pill

Answer 13

Monophasic -> 3 weeks, then week off
Biphasic and Triphasic -> varying doses for 3 weeks, then week off
- use week off to avoid endometrial metaplasia/hyperplasia

Question 14

Common side effects of combined pill

Answer 14

Breakthrough bleeding

• first 10 day -> estrogen
• after 10 days -> progestin

Question 15

Combined Vaginal Ring

Answer 15

worn intravaginally for 3 weeks, then out for 1

• can put back in if it falls out
• comparable efficacy to oral
• lower dose of hormone
• rapid return to ovulation

Question 16

Combined Patch

Answer 16

change once a week for 3 weeks, then one week patch free

• similar efficacy, greater failure rate in heavier women
• more breakthrough bleeding and breast discomfort

Question 17

Progesterone Only Method

Answer 17

inhibition of ovulation -> progestin effect also causes changes to endometrium and cervical mucous –> decreased sperm transport and implantation

Question 18

Progesterone Oral

Answer 18

patients who want effective contraception but want/need to avoid estrogen
- nursing moms
Issues to consider -> irregular bleeding, other SE, duration of effect and return to fertility, chance of breakthrough ovulation if pill missed

Question 19

Progesterone non-contraceptive benefits

Answer 19

eventual reduction of menstrual flow

• no increased risk of stroke, MI, or thromboembolic event
• reduced risk of endometrial cancer and PID

Question 20

Progesterone Only Pill

Answer 20

Start: first day of menses, or sunday, or immediate

• take it daily at same time!
• timing is critical - within 3 hours or back up needed

Question 21

Progesterone Only Injection

Answer 21

Medroxyprogesterone acetate (Depo)

• return to fertility is longer!!!
• concern with bone health

Question 22

Progesterone Only Implants

Answer 22

Rods implanted subcutaneously under skin

- remove once no longer effective

Question 23

Male Hormonal Contraception

Answer 23

in development -> stay tuned

Question 24

Emergency Contraception

Answer 24

Prevention of pregnancy within 72-120 hrs of unprotected intercourse of failed contraception method
Mechanism - inhibit ovulation of prevent fertilization

Question 25

Emergency Contraception Formulas

Answer 25

Plan B - progestin only Ella - Ulipristal Acetate Combo pack - estrogen and progestin *Reduces pregnancy 75-95%, politcally controversial, state/pharmacy variability

Question 26

IUDs

Answer 26

Copper - pre-fertilization effect -> induces reaction of endometrium resulting in inflammatory response preventing viable sperm from reaching tubes Mirean - slow release progesterone -> inhibits ovulation and inhibits sperm survival and implantation Skyla - lower dose -> same as mirena

Question 27

Screening for IUD use

Answer 27

Copper - want regular periods, no hormones, no hx dysmenorrhea, no hx menorrhagia Mirena - OK w/ irregular periods, OK w/ amenorrhea, hx dysmenorrhea, hx of menorrhagia

Question 28

Myths about IUDs

Answer 28

``` Not abortifacients Don't cause ectopic pregnancies Don't cause pelvic infection Don't increase risk of fertility Aren't big Can be used in nulliparous women ```

Question 29

Contraindications for IUD

Answer 29

- pregnancy, congenital or acquired uterine cavity malformation - acute STD, cervicitis, vaginitis - known or suspected cervical neoplasia - liver disease - immunodeficienct

Question 30

Sterilization

Answer 30

should be considered permanent -> appropriate counseling and selection, reversible procedures do exist but come with limited success Tubal or Vasectomy

Question 31

Surgical Tubal Occlusion

Answer 31

laproscopic procedure - ligation, section removal, clips, rings, coils, plugs, cautery Nonsurgical -> microinserts placed into proximal fallopian tubes, or radiofrequency delivered to fallopian tubes

Question 32

Vasectomy

Answer 32

procedure that results in ligation of vas deferens - under local anesthesia - safe, effective - need 20 ejaculations or 3 months following of sperm analysis