Pocket Primary Care > Contraception > Flashcards

Contraception Flashcards

(60 cards)

Study These Flashcards
1
Q

Background

A

Almost half of all US pregnancies are unintended (pregnancy not desired at time of conception); 33% of women using contraception inconsistently, incorrectly, or not at all -> 95% of these pregnancies

Half of all Us women at risk of unintended pregnancy (sexually active, fertile, not currently pregnant); appropriate to discuss contraception with /all pts of reproductive age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors

A

Increase rates of unintended pregnancy in women 18-24 y, women living n provert, nonwhite ethnicity, and decrease education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Condition assoc w/increase in health risk from unintended pregnancy

A

Estrogen-sensitive cancer, cyanotic CHD, recent bariatric surgery or transplant, epilepsy, HTN, SLE, APS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Choosing a method

A

counsel pts to choose most effective method she and her partner are able to use successfully

Women with medical issues: refer to CDC Us medical eligibility criteria for contraceptive use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

First-year contraceptive failure rates

Implant

A

Perfect use: <1

Typical use:`<1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First-year contraceptive failure rates

Sterilization (tubal or vasectomy)

A

Perfect use: <1

Typical use: <1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

First-year contraceptive failure rates

IUD (copper or mirena)

A

Perfect use: <1

Typical use: <1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

First-year contraceptive failure rates

Depo Provera

A

Perfect use: <1

Typical use: 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

First-year contraceptive failure rates

Pill (combined or progestin only

A

Perfect use: <1

Typical use: 9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

First-year contraceptive failure rates

Patch/Ring

A

Perfect use: <1

Typical use: 9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

First-year contraceptive failure rates

Male condom

A

Perfect use: 2

Typical use: 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

First-year contraceptive failure rates

Diaphragm

A

Perfect use: 6

Typical use: 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

First-year contraceptive failure rates

withdrawal

A

Perfect use: 4

Typical use: 22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

First-year contraceptive failure rates

Periodic abstinence

A

Perfect use: -

Typical use: 24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

First-year contraceptive failure rates

Calendar

A

Perfect use: 5

Typical use: -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

First-year contraceptive failure rates

Ovulation method

A

Perfect use: 4

Typical use: -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

First-year contraceptive failure rates

Symptotheral

A

Perfect use: <1

Typical use:-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

First-year contraceptive failure rates

No method

A

Perfect use: 85

Typical use: 85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Combined Hormonal Methods

overview

A

Combo of synthetic estrogen (usually ethinyl estradiol (EE)) and progestin (multiple types)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Combined Hormonal Methods

Estrogen

A

Suppresses gonadotropin surge -> prevents ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Combined Hormonal Methods

Progestin

A

Affects cervical mucus, tubal peristalsis, and endometrial lining -> decrease sperm motility, prevents egg fertilization and implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Combined Hormonal Methods

benefits

A

improvement in menorrhagia, dysmenorrhea, anemia, PMS, acne, hirsutism; decrease risk of ovarian/endometrial CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Combined Hormonal Methods

risks

A

HTN, VTE ( up to 3-4X increase risk if no underlying RFs; up to 1.8X further w/3rd and 4th gen progestins; absolute risk still low and much < VTE risk w/pregnancy), MI, stroke; risk increase w/older preparations (estrogen >50ug)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Combined Hormonal Methods

Absolute contraindications

A

Hx of DVt/PE or stroke, AMI, known thrombogenic mutations, migraine w/aura or seuro s/sx, smokers older than 35 or 35, active liver disease, known/suspected estrogen-dependent tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Combined Hormonal Methods Vaginal ring
Nuvaring (15ug EE, 150ug etonogestrel); flexible plastic ring inserted by pt, intravaginal X3 weeks, removed X1 week; high pt satisfaction rates
26
Combined Hormonal Methods Transdermal patch
Ortho Evra (20ug EE, 150ug norelgestromin); apply q1wk; decrease efficacy in pts >90kg FDA warning: increased systemic estrogen exposure w/patch tan from OCP (w/35 ug EE), may cause increase risk VTE
27
Combination oral contraceptive pills (OCPs) General Approach
After review of medical hx and CI 1. Select estrogen and progesterone formulations 2, Set initiation plan (quick vs 1st day vs sunday start) 3. Decide on planned patter of use (cyclic vs extended vs continuous) 4. Discuss indications for backup methods 5. counsel (side effects)
28
Combination oral contraceptive pills (OCPs) Estrogen formulations
Low-dose (10-20ug) to high dose (50ug) formuations; standard 20-35 ug; breakthrough bleeding may increase w/ less than or equal to 20ug dose
29
Combination oral contraceptive pills (OCPs) Progestin formulations
Vary in androgenic activity 2nd gen: lveoneorgestrel (increase androgenic), norethindrone ( decrease androgenic) 3rd gen: norgestimate, desogestrol (least androgenic) 4th gen: drosperinone, (antiandrogenic + antimineralocorticoid activity)
30
Combination oral contraceptive pills (OCPs) Initiation
Can be safely provided after careful medical hx and BP Quick start: (preferred) take 1st pill as soon as prescription is filled; increase compliance w/o increase side effects; need backup contraception for 7 days 1st day start: take 1st pill on 1st day of period; backup contraception not needed Sunday start: Take 1st pill on sunday after period begins; backup needed X 7 days
31
Combination oral contraceptive pills (OCPs) Pattern of use
Can be given cyclically (21 active pills -> 7 hormone free pills), on extended cycle regimen (84 active pills -> 7 hormone free pills), or continuously. extended/continuous options may be preferred in women with premenstrual sx or for lifestyle; efficacy and safety equivalent to cyclic use
32
Combination oral contraceptive pills (OCPs) backup method indications
Missed pill: use backup contraception x 7 days after 2 or more missed pills medication interactions: efficacy decreased by meds that increase liver microsomal enzyme activity ( anticonvulsants, griseofulvin, rifampin, St johns wort); no clinical evidence on other antibiotics although some case reports w/PCN and tetracyclines
33
Combination oral contraceptive pills (OCPs) Side effects
Counsel pts in advance of side effects, these typically resolve in 2-3 months; also discuss risk/benefits of combined hormonal tx
34
Combination oral contraceptive pills (OCPs) Follow-up
Consider f/u 3 mos to check BP, evaluate for tolerance and side effects; can switch pill to adjust amount of EE or type of progestin per s/e
35
Combination oral contraceptive pills (OCPs) pregnancy
if pregnancy occurs while on OCPs. d/c upon dx, but reassure pts no adverse outcome a/w using OCPs at time of conception
36
OCP side effects estrogen excess
HA, nausea, mastalgia Try dosing QHS vs low estrogen pill (increase risk breackthrough bleeding)
37
OCP side effects Progestin and/or androgen excess
Hirsutism, acne, wt gain change to 3rd generation progestin
38
OCP side effects Progestin excess
Mood changes, decrease libido change 3rd generation progestin
39
OCP side effects Pregnancy; nonpathologic suppression of endometrial shedding
amenorrhea Pregnancy test; if + d/c OCP; if - reassurance; if pt desired menses -> increase EE or choose progestin w/increase endometrial activity (eg 1mg norethindrone -> 5mg) triphasic pill may be effective.
40
Progestin-only Methods progestin only mini pills
Option for pts w/ contraindicationto estrogen (including lactation); increase risk breakthrough bleeding; must take at the same time every day
41
Progestin-only Methods Injectable
Depot medroxyprogesterone acetate (DMPA); IM/SC injection q 3months benefits: no need for daily pt adherence, amenorrhea w/ongoing use, decrease endometrial cancer s/e: irregular bleeding, increase weight, HA FDA black box warning: can decrease BMD (esp in adolescents)
42
Progestin-only Methods Subdermal contraceptive implant
implanon very effective up to 3 years; fertility returns soon after removal; risk of irregular bleeding (primary reason for d/c)
43
Condoms
Consistent, correct use protects from STI acquisition/transmission; latex condoms decrease HIV risk by 80-95% Latex allergy in 1-6% of US population; synthetic and natural membrane condoms exist but decrease efficacy Female condomes: polyurethane sheath; option if cannot use male condome Spermicides: do not protect against STI's, irritation may increase risk of infection
44
Diaphragm, cervical cap
Require fitting by trained clinician; only effective when used with spermicide; do not prevent transmission of STI's
45
Intrauterine Contraception Benefits
Very effective, no maintenance; good option for women who desire to avoid pregnancy for >3 years, avoids estrogen exposure
46
Intrauterine Contraception Risk of ectopic pregnancy
Decrease overall risk c/w pts who do not use contraceptives but increase risk if pregnancy occurs
47
Intrauterine Contraception contraindications
Uterine distortion, active pelvic infection (wait 3 mos before insertion), women w/increase risk for STI's, pregnancy, unexplained uterine bleeding, active cervical/endometrial CA Not contraindicated in adolescents/young adults or nulliparous women
48
Intrauterine Contraception Levonorgestrel IUD (mirena/Skyla)
Inhibits sperm transport and ova fertilization; partially inhibits ovulation; decrease blood loss, decrease dysmenorrhea; effective for 5 y (mirena) or 3 y (Skyla)
49
Intrauterine Contraception Copper IUD
Releases copper continuously into uterine cavity; interferes with sperm transport, prevents fertilization; effective for at least 10 years
50
Tubal ligation
Prevents pregnancy by occluding or disrupting tubal patency; laprascopic (general anesthesia) vs hysteroscopic (often local anesthesia)
51
Vasectomy
interruption or occlusion of vas deferens; can br performed in outpt setting w/ local anesthesia; safest, least costly method of surgical sterilization
52
Emergency contraception Indications
Pts who have had unprotected intercourse, indluding failure of another method w/in previous 120 hours; improved access does not increase sexual risk taking or STI acquisition
53
Emergency contraception Access:
plan b one step available w/o prescription regardless of age; other options available to women aged 17 and over w/o Rx; and to younger women w/RX Contraindication to daily OCPs (VTE, liver disease) do not apply to EC
54
Emergency contraception Efficacy
Decreases pregnancy risk up to 88% (levonorgestrel EX); does not interrupt established pregnancy
55
Emergency contraception Options
Levonorgestrel EC Yuzpe regimen Ulipristal acetate Copper IUD
56
Emergency contraception Levonorgestrel EC
1 (1.5mg) dose (plan b 1 step) or 2 X0.75 mg taken 12 h apart; single dose as effective ; safer and more effective than yuzpe regimen w/ decrease rates of N/V, however, minimally effective for women >154 lb (70kg)
57
Emergency contraception Yuzpe regimen
(EE+progestin): 2 X (100ug EE + 0.5 mg levonorgestrel). Many OCPS can be sued; less effective than progestin-only, increase N/V
58
Emergency contraception Ulipristal acetate
Ella: Rx only; most effective oral option; pregnancy rate = 1.3% vs 2.2% for levonorgestrel (use 0-120 hrs after intercourse)
59
Emergency contraception Copper IUD
Most effective form of EC (10X efficacy of pills); insert w/in 5 days of intercourse; provides continuous contraception; avoid w/active gonorrhea/chlamydia infection
60
Emergency contraception counseling
Emphasize regular contraception use (can start OCPs the day after EC) consider screening for STIs: check pregnancy test if no menses in 3-4 weeks.
Pocket Primary Care
flashcards
Decks in class (18)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions