Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
23 Cards in this Set
- Front
- Back
|
If women want continuous use of ocp should we support it?
|
Yes - continuous or extended COC are okay
care should be given to patient preferences |
|
|
Are continuous and combined regimens just as effective for contraception?
|
YES
|
|
|
what are some non-contraceptive / Medical uses for combined oral contraceptives?
|
endometriosis - using it continuously for 6 months with no bleed has been shown to be very effective
(decreases dysmenorrhea, deep dyspareunia, and non-menstrual pelvic pain Abnormal uterine bleeding Bleeding diathesis women with severe pre-menstrual symptoms (good for PMDD - makes it better) women in peri-menopause - with abnormal bleeding- may benefit from hormone free interval to suppress vasomotor symptoms |
|
|
Is there any long-term safety on continued usage?
|
No long term data, but short term data is equivalent
|
|
|
What is the difference between mestranol and ethinyl estradiol?
|
mestranol is the pre-cursor to ethinyl estradiol - mestranol is broken down into ethynyl estradiol
|
|
|
What is
E1 E2 E3? |
E1 -Estrone
E2 - estradiol (or 17 beta-estradiol) E3 - estriol |
|
|
what is the relative potency (or estrogenic effect of these estrogens?)
|
Estradiol is 10x as potent as estrone
Estradiol is 80x as potent as estriol |
|
|
Where does northindrone come from?
|
It is actually derived from testosterone - they took off the 19 carbon from ethisterone and it turned an adrogen effect into a progesterone effect
|
|
|
what is the defn of low-dose oral contraceptives?
|
OCP with less than 50 mcg of EE
|
|
|
Please describe 1st, 2nd, 3rd, and 4th generation oral contraceptives
|
1st - high dose pills - >50 mcg of EE
2nd - low dose pills - use levonorgestrel, norgestimate, or other members of the northindrone family and either 20, 30, or 35 mcg of EE 3rd - desogestrel or gestodene + low dose EE 4th - drospirenone, dienogest, or nomegestrol acetate |
|
|
what is the main reason that people will discontinue the continuous COC
|
irregular bleeding or spotting
|
|
|
What should be included in the first work-up for breakthrough bleeding on the continuous/extended pill?
|
exclude
Pregnancy Polyp Cancer Cervical infection smoking malabsorption of hormone other drugs that may interfere with absorption Also inquire about compliance |
|
|
What do you do if a woman starts the combined COC on the C/E regime and has spotting
|
it's common in the first 3 months, but then will decrease, you can take a 3 day break (have a period) and then resume the pill and there should be no issues
|
|
|
So in comparing the C/E with the 28 day regime
|
bleeding/spotting is the same - but overall bleeding days less
efficacy is the same Less headache with C/E There was benefit with less bloating, less dysmenorrhea, less swelling and breast tenderness with the C/E regime genital itch, bloating, and menstrual pain less with C/E BASically - C/E regime is NOT worse the cyclic regimes and may actually even be better |
|
|
What will improve the continuation of the pill if there
|
If you counsel women on the symptoms of breakthrough bleeding beforehand
|
|
|
is there a risk for VTE with C/E regime?
|
Not any higher than the 28-day
seems that when people start the pill, they are most at risk, but long-term users are less at risk |
|
|
Is there an increased risk of MI?
|
No higher risk of Mi with C/E COC
BUT you did have a higher risk of you were a heavy smoker Have to remember that these risks are less than if you were pregnant, so you can compare these options |
|
|
What impact do CoCs have on cancer? particularly the C/E regime?
|
Endo Ca - better with COC
Ovarian Ca - better because less ovulation Cervical Ca - the evidence is minimal, Breast Ca - no association with CoC |
|
|
If you are having breakthrough spotting or bleeding, should you double up on your pills?
|
No - it will likely make the problem worse
take a 3 day pill free interval |
|
|
What is the overall trend in birth rate?
What is the trend in adolescents? What is the abortion rate in the adolescent group? |
Overall birth rate is falling
The rate in adolescents is the same There is a rise in the proportion of adolescents obtaining abortions- meaning we are NOT meeting the contraceptive needs of teens |
|
|
What is the frequency of contraceptive use (or proportion of use?)
|
32% - OCP
21% - Condom 15% - male sterilization 8% - female sterilization 6% - withdrawal 2% - DMPA 1% - IUD 2% - Rhythm |
|
|
What is the best way for a clinician to help patients make the best contraceptive choice?
|
Share information
Enhance motivation Help to develop Behavioural skills |
|
|
What is the concept of 'dual protection'?
|
Using both condoms for STI prevention and OCP for birth control
|
