Contraception/Sterilization

Question 1

What general category is the most effective REVERSIBLE form of contraception?

Answer 1

Hormonal Contraceptives

Question 2

In what 2 forms can oral contraceptive pills be given?

Answer 2

1. Estrogen + Progesterone

2. Progestin ONLY

Question 3

What is the primary role of Estrogen with Oral Contraceptive Pills?

Answer 3

Regulate cycle

Question 4

What is the primary role(s) of Progesterone with Oral Contraceptive Pills?

Answer 4

(-) LH and ovulation

Thicken cervical mucus to prevent sperm migration and creates an unfavorable environment for fertilization

Question 5

With Oral Contraceptive Pills, what component is responsible for the major actions of (-) LH/ovulation, thickening cervical mucus to create an unfavorable environment?

Answer 5

Progesterone

Question 6

What form of Oral Contraceptive Pills are the best in breastfeeding women?

Answer 6

Progestin ONLY

Question 7

In women who are breastfeeding or have a contraindication for taking Estrogen, what type of Oral Contraceptive Pills can be given?

Answer 7

Progestin ONLY

Question 8

What are the most serious adverse effects of Oral Contraceptive Pills? (4)

Answer 8

DVT/PE
Gallbladder disease
MI
Hepatic tumors

Question 9

What are the most serious adverse effects of Oral Contraceptive Pills? (4)

Answer 9

• DVT/PE
• Gallbladder disease
• MI
• Hepatic tumors

Question 10

What are some common adverse effects with Oral Contraceptive Pills?

Answer 10

Breakthrough bleeding/Amenorrhea

Weight gain, breast tenderness, nausea, etc.

Question 11

What is the Transdermal Patch made of and how long is it worn?

Answer 11

Estrogen + Progesterone

= Worn for 3 weeks

Question 12

The Transdermal Hormonal Patch should be used with caution in what type of women and what does it have a greater risk of?

Answer 12

Caution: obese women

–> Greater risk of thrombosis

Question 13

The Vaginal Ring options are made of?

Answer 13

Estrogen + Progesterone

Question 14

What differentiates the basic Vaginal Ring from the Annovera Ring?

Answer 14

The Annovera Ring is re-used for 13 months

– BOTH in for 3 weeks and out for 1

Question 15

In what patients should you NOT use Hormonal Contraceptives in? (3)

Answer 15

• Smokers > 35 yo
• Liver disease
• History of Thrombosis

Question 16

In what patients should you NOT use Hormonal Contraceptives in? (3)

Answer 16

• Smokers > 35
• Liver disease
• History of Thrombosis

Question 17

What is Depo Provera?

Answer 17

INJECTABLE Progestin (hormonal contraceptive)

Question 18

How often is Depo Provera given?

Answer 18

IM injection every 11-13 weeks

Question 19

Depo Provera is a Progestin IM injection. What is a serious adverse effect that can be seen with greater than 2 years use?

Answer 19

Bone density alterations

Question 20

What are 3 adverse effects of the Depo Provera injection?

Answer 20

• Irregular bleeding
• WEIGHT GAIN
• Exacerbation of depression

Question 21

LARCs

Answer 21

Long Acting Reversible Contraceptives

Question 22

What are 2 forms of LARCs?

Answer 22

Nexplanon

IUDs

Question 23

What is Nexplanon?

Answer 23

Rod shaped implantable LARC

Question 24

How long can Nexplanon be used for? Is it safe for breastfeeding patients?

Answer 24

3 years

– YES

Question 25

What is one absolute contraindication for Nexplanon?

Answer 25

Breast cancer

Question 26

There are 5 types of IUDs. What are the 4 Levonorgestrel IUDs?

Answer 26

- Mirena - Kyleena - Liletta - Skyla

Question 27

There are 5 types of IUDs. What is the Copper T?

Answer 27

Paraguard

Question 28

How long can each of the 4 Levonorgestrel IUDs be used respectively?

Answer 28

Mirena - 7 years Kyleena - 5 years Liletta - 7 years Skyla - 3 years

Question 29

How long can the Paraguard IUD be used and what disease should not use it?

Answer 29

10 years | -- do not use with Wilson's disease patients due to copper

Question 30

Barrier Contraceptives have a ___ failure rate due to?

Answer 30

HIGH | -- Depend on proper use at time of sex

Question 31

What is the only Contraception method that protects against STIs?

Answer 31

CONDOMS

Question 32

What is a reason that female condoms, diaphragms, cervical caps and sponges are not well tolerated?

Answer 32

They have to be left in the vagina for at least 6 hours after sex

Question 33

Diaphragms are dome shaped devices that have to be fit to the individual. What do they have an increased risk of?

Answer 33

UTI

Question 34

What is Phexxi?

Answer 34

Gel that is inserted into the vagina before sex every time

Question 35

What is the MOA for Phexxi?

Answer 35

Hormone free! | -- Raises the pH of the vagina to decrease sperm motility

Question 36

What are some possible side effects of Phexxi?

Answer 36

Burning, itching and infections of both the female and male

Question 37

What are 3 natural methods of contraception?

Answer 37

- Calendar method - Basal body temp. method - Cervical mucus method

Question 38

How do you do the Basal Body Temperature method?

Answer 38

Check temperature daily before getting out of bed = 0.5 - 1 degree increase with ovulation --> avoid sex for a few days after that

Question 39

Emergency Contraception prevents ovulation and fertilization for those who had unprotected sex. What are 2 types?

Answer 39

Plan B | Ella

Question 40

Plan B vs. Ella

Answer 40

Plan B: 2 pills of progestin; must be used within 120 hours | Ella: must be used within 5 days

Question 41

Sterilization should be considered _____

Answer 41

Permanent

Question 42

What should you address with especially your young patients who want sterilization?

Answer 42

Other options, reasons, etc. due to REGRET

Question 43

What is the Vasectomy and when does complete azoospermia occur?

Answer 43

Occlusion of the vas deferens | -- 10 weeks

Question 44

What is the most common approach to female sterilization?

Answer 44

Mini-laparotomy

Question 45

Female Sterilization methods can occlude the tubes or even remove them. What are 2 types of clips and which has the higher failure rate?

Answer 45

Hulka = higher failure rate | Filshie

Question 46

Why is the Hysteroscopy method of female sterilization not used so much?

Answer 46

Steel coils placed which cause pain

Question 47

What are the 2 options of what you can do to the fallopian tubes with sterilization?

Answer 47

``` Occlude them Remove them (salpingectomy) ```

Question 48

What is the only method of protection against STIs?

Answer 48

CONDOMS