LARCs

Question 1

IUD insertion

Answer 1

• Cat 2 (benefits outweighs risks)
• Can be inserted anytime in cycle as long as preg can be ruled out
• silent of hx of PID okay for insertion with single clinic visit
• if cervical cultures are positive, leave IUD in, and complete treatment
• complete treatment prior to insertion if ACTIVE infection
• first 4w increased risk PID, then done

Question 2

IUD & +preg test

Answer 2

• # 1 figure out if ectopic

- remove IUD if desired pregnancy (avoid chorio, abruption, previa, PTD, FGR)

Question 3

IUDs and ectopic pregnancy

Answer 3

• increased relative risk

- absolute risk very low

Question 4

IUD post aborion

Answer 4

• okay for immediate insertion all trimesters
• no back up needed
• CI if after septic abortion

Question 5

IUD and breast feeding

Answer 5

• Cat 2 (benefits outweighs risks)

- progesterone theoretically decreases milk supply, not supported in literature, still counsel pts

Question 6

Complications of IUDs

Answer 6

• expulsion
• perforation
• failure

Question 7

Copper IUD

Answer 7

• inhibits fertilization
• no abortifacient
• emergency contraception: 5d post intercourse
• NOT affected by obesity
• associated with increased menstrual bleeding
• no backup contraception needed

Question 8

Progesterone IUD

Answer 8

• varying dosing 13.5-20 ug prog daily
• inhibits fertilization: inhibits ovulation, thickens cervical mucous, alters endometrial lining
• not abortifacient
• SE: HA, nausea, ovarian cyst formation, breast tenderness
• decreased menstrual bleeding (treats AUB)
• backup contraception 7 days (unless immediate after abortion/child birth)

Question 9

Implants

Answer 9

• insert anytime during menstrual cycle if preg ruled out
• radio-opaque and visible on Xray
• surpasses ovulation, thickens cervical mucus and alters endometrial lining
• most effective method of reversible contraception (good for obese pts)
• menstrual irregularity (light & heavy), acne, weight gain
• !% chance insertion and removal complications
• lost implant found by XRAY, CT, or US
• return of fertility rapid after removal
• need backup contraception for 7d (unless immediate after abortion/child birth)