Obgyn Contraception Text

Front 1

methods of preventing pregnancy

Back 1

1. inhibiting the development and release of the egg (oral OCP, long-acting progesterone injection, contraceptive patch or ring)
2. imposing a mechanical, chemical, or temporal barrier between sperm and egg (condom, diaphragm, spermicide, natural family planning, IUD)
3. alter ability of fertilized egg to implant and grow- IUD and postcoital oral contraception

Front 2

method failure rate vs typical failure rate

Back 2

method- if used perfectly
typical- if used in the typical fashion

Front 3

benefits of hormonal contraceptives for women

Back 3

1. dec risk of ovarian and uterine cancer
2. safer than pregnancy for most women
3. most effective, reversible pregnancy prevention
4. periods are shorter, more predictable and less painful.
5. dec risk of benign breast disease, ovarian disease and pelvic infection
6. overall dec risk of ectopic preg

Front 4

mechanism of action combination OCPs

Back 4

1. combo pills-- contain estrogen and progesterone. Progesterone agent provides the major contraceptive effect- suppresses secretion of LH and thus inhibits ovulation, also thickens cervical mucus and alters fallopian tube peristalsis, inhibiting sperm movement and fertilization if ovulation did occur. estrogen inhibits release of FSH and subsequent follicle developement. also potentiates action of progesterone
-- most pills have the same ratio of progesterone to estrogen in every pill but some are phasic allowing for decreased total doses, but inc breakthrough bleeding

Front 5

pill that extends cycle to having periods once every three months?

Back 5

ethinyl estradiol/levonorgestrel

Front 6

mechanism of action of progesterone only pills ("mini-pills")
- when are these pills especially useful?

Back 6

1. MOA- thickens cervical mucus making it relatively impermeable to sperm
2. lactating women and women over 40, also in women that have CI to estrogen containing pills
(40% of women will still ovulate with these pills)

Front 7

directions for taking minipill

Back 7

progesterone only pills must be taken at the same time each day
- if woman is more than 3 hours late in taking pill then backup contraception must be used for the next 48 hours

Front 8

effects of estrogen agent in OCPs

Back 8

affect lipid metabolis, potentiate sodium and water retention, increase renin, stimulate CYP 450 system, increase sex-hormone binding globulin, and can dec antithrombin III

Front 9

effects of progesterone in OCPs

Back 9

increase sebum, stimulate facial and body hair, induce smooth muscle relaxation, inc risk of cholestatic jaundice

Front 10

most common reason for discontinuing combined OCPs

Back 10

abnormal bleeding in the first 3 months of pill use-- spotting (occurs in10-30% of women)

Front 11

What can be given if spotting persists after 3 months of OCP use?

Back 11

7 day course of exogenous estrogen 1.25 mg conjugated

Front 12

tx of amenorrhea occuring during OCP use?

Back 12

obtain preg test, then can inc to pill with higher dose of estrogen

Front 13

complications of combined OCPs-- seek immediate attn, but need to d/c or can continue?

Back 13

1. retinal artery thrombosis- d/c
2. stroke- d/c
3. MI- d/c
4. pulmonary embolism- d/c
5. hepatic neoplasm/adenoma- d/c
6. thrombophlebitis - d/c
7. amenorrhea- continue
8. breast masses- may continue
9. cholecystitis/lithiasis- may continue
10. severe headache/migraine- may continue
11. glactorrhea-- pituitary adenoma- may continue

Front 14

Absolute contraindications to use of combined OCPs

Back 14

1. thrombophlebitis/thromboembolic dz
2. undiagnosed abn vaginal bleeding
3. cerebral vascular disease
4. known or suspected pregnancy
5. coronary artery disease
6. smokers > 35 yo
7. impaired liver function
8. congenital hyperlipidemia
9. known or suspected breast ca
10. hepatic neoplasm

Front 15

relative contraindications to use of combined OCPs

Back 15

1. severe vascular headache (classic migraine, cluster)
2. severe THN (if <35-40 and in good control, may elect to still take)
3. DM <35-40 yo
4. gallbladder disease-- may exacerbate sx
5. obstructive jaundice during pregnancy
6. epilepsy -- antiepileptic drugs may dec efficacy of OCP. does not make seizure disorder worse
7. morbid obesity- must monitor glucose and lipid profile regularly

Front 16

conditions that are no longer considered contraindications for combined OCPs

Back 16

1. uterine leiomyoma- low dose ok
2. sickle cell dz
3. before elective surgery

Front 17

postpill amenorrhea

Back 17

occurs in 3% of women, often young women who had irregular periods to begin with

Front 18

drugs that decrease the effectiveness of OCPs

Back 18

1. barbiturates
2. benzodiazepines
3. sulfa drugs
4. carbamezapine
5. phenytoin
6. rifampin

Front 19

drugs that have decreased biotransformation when taken with OCPs

Back 19

1. anticoagulants
2. methyldopa
3. phenothiazines
4. reserpine
5. TCAs

Front 20

what is the most important factor in patient selection for IUD placement?

Back 20

risk of STD infection

Front 21

when is the best time to insert an IUD?

Back 21

when the patient is menstruating-- because it confirms that she is not pregnant and the cervix is slightly open

Front 22

methods of natural family planning?

Back 22

calendar method, basal body temperature method, cervical mucus method, symptothermal method (combined temperature and cervical mucus methods)

Front 23

indications of ovulation?

Back 23

rise in basal body temperature of 0.5- 1.0 degrees F or presence of thin stretchy clear cervical mucus