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15 Cards in this Set

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What is the potential risk of tubal ligation (beyond normal surgx risk)?
potential ectopic pregnancy
What is Essure?
- pro?
- con?
transcervical sterilization: polyester fibers (PET) places hysteroscopically induce local tissue growth and tubal blockage.
- outpatient w/o general anesthesia
- may req more than one procedure, tubal spasm, possible expulsion --> need verification of occlusion w/ hysterosalpinogram 3m afterwards.
How does the pill work?
inhibits the LH surge w/ progestin --> inhibits ovulation, thickens, cervical mucus, decreases tubal mobility, thins endometrium.
What are some additional pros of the pill?
decreased:
- anemia
- dysmenorrhea
- mittelschmerz
- benign breast dz
- ovarian cancer
- endometrial cancer (80% reduction!)
- decreased corpus luteum cysts
- decreased death from colorectal cancer
Given the following, give whether it is an absolute or relative contraindication of the pill:
- diabetes
- smoking and under <35y
- hepatoma
- pregnancy
- previous or active thromboembolic dz
- obesity
- migraines
- gallbladder dz
- HTN
- undx'ed genital bleeding
- estrogen dependent neoplasm
Absolute: preg, thrombolic, undx'd genital bleeding, smoking/age<35, E2 dependent neoplasm, hepatoma

Relative: HTN, diabetes, Gallbladder dz, obesity, migraines
What has the lowest E/Progestin dose of any combined hormonal method?
- cons?
Nuvaring
- 25% of cycles accompanied by additional spotting, possible expulsion.
Does Nuvaring get felt by sexual partners?
no, not scientifically speaking.
What are some downsides to the patch?
application site problems, increased nausea and breast tenderness compared to oral, lower efficacy in women >90kg.
What is the failure rate (relatively speaking) of an IUD?
- what hormone is in the IUD?
- can it cause amenorrhea?
- does it always stop ovulation?
- how long does it take to return to normal after removal?
- does the IUD prevent implantation?
0.1% This is LOWER than tubal ligation!!
- ONLY progestin
- yes; 20% of women after one year have no cycles.
- no; most women are still ovulating.
- ~3m, usually
- NO, just thickens the cervical mucus, alters tubal motility, and thins endometrium. Also inhibits, but doesn't stop, ovulation.
How does the copper IUD work?
- how long does it last
- disadvantages?
spermicidal effect of copper ions
- can last for up to 10 years
- w/o progestin, typically increased menstrual bleeding.
What is the failure risk of diaphragm? condoms?
6-16%
2-15%
What is the failure risk of natural family planning?
1-25%...
What are the 3 options for emergency contraception?
- what are the time periods of use for each?
- which is most effective?
Plan B (progestin only): ASAP, but can be up to 5 days
- less side effects b/c no estrogen

E + progestin: ASAP, but up to 3-4 days

Copper IUD: up to 8 days

Copper is most effective, the others are <1% if used in <12hrs.
Do Plan B and COC (progestin + E) disrupt an implanted pregnancy?
No. They only work if taken before ovulation --> blocking LH surge.
A 23 year old presents to your office for her annual exam. She tells you that she has concerns about taking the Pill because a friend of hers just had a blood clot in her leg while on the Pill. She would like another form of birth control. She is married; she has completed her childbearing. She was originally placed on the pill because she had heavy menstrual cycles. You suggest:

A different brand of oral contraceptive
The Mirena IUD
The copper IUD
A tubal ligation
Mirena!

Not copper, b/c she was orginally placed on pill b/c of heavy menses, which copper can make worse (mirena lessens).