contraception

Question 1

hormone replacement therapy - contraindications

Answer 1

1. estrogen-depended carcinoma (breast or endometrial)

2. history of pulmonary embolism or DVT

Question 2

contraception - types

Answer 2

1. female condoms
2. vaginal diaphragm
3. OCPs
4. vaginal ring
5. trandermal Patch
6. Intramuscular injetion
7. intrauterine device
8. sterilization

Question 3

female condom - structure

Answer 3

2 rings and a thin material in between. 1 ring is placed deep into the vagina while the other is left at the introitus (opening that leads to the vaginal canal)
larger and bulkier than male condoms

Question 4

female condom - properties

Answer 4

offer some protection against HIV and STDs and are under female control

Question 5

Vaginal diaphragm - structure / placement

Answer 5

• circular ring with contraceptive jelly that covers the cervical canal (without the jelly is ineffective). The jelly is also used as a lubricant while placing the diaphragm
• should be placed 6 h before intercourse and left fot at least 6 h after

Question 6

Vaginal diaphragm - disadvantages

Answer 6

1. need to be fiitted properly
2. proper use requires advance preparation
3. improper placement or dislodging reduced efficay

Question 7

OCP - structure / way of using

Answer 7

combination pill of both estrogen + prgesterone. The pill is taken for 21 days and a placebo is taken for 7 days. During the 7 days of the placebo pills, the patient will experience menstruation. Women should start again on the Sunday after menst.

Question 8

OCP - properties

Answer 8

reduce risk of ovarian ca, endometrial ca, ectopic pregnancy
but increase the risk of thromboembolsim

Question 9

vaginal ring - structure and properties

Answer 9

vaginal ring that releases both estr and prog is inserted into the vagina for 3 wks. Hormone are released on a constant basis. When the ring is removed, withdrawal bleeding will occur. similar side effect and efficacy to OCPs

Question 10

Transdermal Patch - everything

Answer 10

a patch with a combination of estrogen and progest is placed on the skin for 7 days. Each wk the previous patch is removed and a new patch is placed. 3 wks of patches are follow by a free week (withdrawal bleeding).
NOT PLACED ONTHE BREAST
Similar side effect and efficacy to OCPs

Question 11

intramuscular injection - everything

Answer 11

depot medroxyprogesterone acetate is an intramuscular injection that is effective contraception for 3 months

Question 12

intrauterine device - location / properties

Answer 12

placed into the uterus and provides contraception for 10 years

Question 13

intrauterine device - types

Answer 13

1. copper device

2. levonogestrel device

Question 14

intrauterine device - side effects

Answer 14

PID (genital culture before placement)

Question 15

Sterilization?

Answer 15

surgical sterilization can done on both men + women/ Sterilization via tubal ligation and vasectomy is permanent of these devices

Question 16

sterilization - types

Answer 16

1. tubal ligation

2. vasectomy

Question 17

sterilization - tubal ligation

Answer 17

• surgical procedure that women may choose to undergoo for permanent contraception
• very low risk of pregnancy (but it occurs)
• increase incidence of ectopic pregnancy

Question 18

sterilization - vasectomy

Answer 18

surgical procedure in which ligation of the vas deferens is preformed

Question 19

medroxyprogesterone - SE

Answer 19

similar to pregnancy: weight gain, fatigue, breast tenderness

Question 20

emergency contraception options - methods and mechanism

Answer 20

1. copper IUD –> inf reaction
2. Ulipristal pill –> antiprogestin –> delays ovaluation
3. Levonorgestrel –> progenstin –> delays ovaluation
4. OCPs –> progenstin –> delays ovaluation

Question 21

emergency contraception options - methods and time after intercourse (hours)

Answer 21

1. copper IUD –> 0-120
2. Ulipristal pill –> 0-120
3. Levonorgestrel –> 0-72
4. OCPs –> 0-72

Question 22

emergency contraception options - methods and efficacy

Answer 22

1. copper IUD –> 99%
2. Ulipristal pill –> 85 or more
3. Levonorgestrel –> 85%
4. OCPs –> 75%

Question 23

absolute ontraindications to combined hormonal contraceptives

Answer 23

1. migraines with aura
2. 15 or more cigarettes daily plus 35 or older years old
3. hypertension more than 160/100
4. heart disease
5. DM with end organ
6. history of thromboembolic
7. antiphospholipid syndrome
8. history of stroke
   9 breast cancer
9. cirrhosis + liver cancer
10. major surgery with prolonged immobilization
    12 use less than 3 wks postpartum

Question 24

Estrogen-progestin contracepties - benefits

Answer 24

1. pregnancy prevention
2. endometrial + ovarian cancer risk reduction
3. menstrual regulation
4. hyperandrogenism treatment

Question 25

Estrogen-progestin contracepties - risks

Answer 25

``` DVT hypertension hepatic adenoma stroke or MI (both rare) cervical cancer ```