contraception

Question 1

what is mechanism of copper IUD vs LNG IUD?

Answer 1

• copper IUD: acts as pre and post fertilization; inhibition of sperm, altered tubal motility, destruction of ovum
• LNG IUD: same as copper IUD + endometrial thinning/altered cervical mucus

Question 2

what are the different types of LNG IUD– what are differences, how long do they last?

Answer 2

52 mg of LNG

• Mirena: LNG-20, delivers 20 mcg daily; 5 years
• Liletta: LNG-18, delivers 18.6 mcg daily; 4 years

19. 5 mg LNG
    - Kyleena: LNG 19.5, delivers 17.5 mcg dialy (5 years)
20. 5 mg LNG
    - Skyla- LNG-13.5, delivers 14 mcg daily, 3 years. smaller T frame

Question 3

back-up needed with LARCs?

Answer 3

• no backup contraception needed for copper IUD
• for LNG IUD, need 7 days of backup contraception unless:
  a) immediately s/p surgical AB
  b) within 21 days of childbirth
  c) transition from other reliable method
  d) within 7 days of menses
• for implant - all the above except within 5 days of menses for (d)

Question 4

risk of migration of implant?

Answer 4

• up to 40%
• best way to localize with newer generation is xray
• older version, high frequency US (52 hz and higher)

Question 5

contraindication to IUD

Answer 5

• active pelvic infection/STDs
• pregnancy
• malignancy
• undiagnosed vaginal bleeding
• uterine anomalies
• PID, PP endometritis, septic AB within the past 3 months

Question 6

what is definition of postpartum IUD inseriton?

Answer 6

• up to 10 minutes after delivery
• increased risk of expulsion (10-27%) vs interval or psot-AB
• contraindicated in pts with IAI/endometritis, PPH, sepsis

Question 7

actinomyces comes back on pap, with IUD in place. what do you do?

Answer 7

• do not need treatment if asymptomatic.

Question 8

when are the highest PID rates after IUD?

Answer 8

• first 3 weeks

Question 9

what are benefits of OCPs other than contraception?

Answer 9

• regular menses
• decreased dysmenorrhea
• RR endometrial ca/ovarian ca
• decreased fxnl ovarian cysts and benign disease
• treatment of endometriosis

Question 10

criteria for being reasonably certain someone is not pregnant

Answer 10

• menses in last 7 days
• no intercourse since last menses
• breast feeding (85%+ feeds), amenorrhoeic, < 6 mos of delivery
• within 4 weeks postpartum
• using contraception reliably

Question 11

starting OCPs- when do you need backup?

Answer 11

• no backup contraception needed if menses 5 or fewer days ago
• if more than 5 days, the abstinence until next cycle or backup contraception x 7 days

Question 12

when can you start OCPs postparutm?

Answer 12

• not within the first 21 days, risk of VTE too high
• between 21-30 days, risk of VTE goes down. but intereference with breast feeding occurs up to 30 days. so if breast feeding, can initiate OCPs at 30 days on. if not can initiate at 21 days
• any risk factor for VTE, should way 4-6 weeks after delivery to start OCPs. VTE risk does not return to baseline until 12 weeks PP

Question 13

contra-indications to OCPs

Answer 13

• breast cancer
• any estrogen sesnitie tumor
• thrombophilia
• smoke over 35 years
• CHD/CVA
• migraine with aura
• superficial DVT

Question 14

DM and OCPs?

Answer 14

• okay to use, would use alternative if 20+ years or microvascular

Question 15

specific meds that mess with metabolism?

Answer 15

• liver enzyme inducers:
• carbamazepine (tegretol), felbamate, phenobarbital, phenytoin, primidone.
• OCPs reduce lamotrigene (lamictal)
• st johns wart: hepatic enzyme inducer increases E&P metabolism

Question 16

what antibiotic reduces estrogen levels?

Answer 16

rifampin

Question 17

what antiretroviral reduces estrogen levels?

Answer 17

fosamprenavir

Question 18

essure/tubal occlusion follow-up?

Answer 18

• 3 months HSG, if tube(s) patent repeat in 3 months
• if still patent in 6 months, then consider procedure failure
• have to be on contraception during confirmation period

Question 19

obesity and ocps?

Answer 19

• increased risk of vte and failure
• however benefits outweigh risk, and vte risk in pregnancy is higher
• if hx of roux en y can decrease absoprtion

Question 20

SLE and OCPs?

Answer 20

if no evidence of vasculitis, nephritis, APAS, then okay!