Secrets 50K

Front 1

What are subsequent fertility rates following treatment for ectopic?

Back 1

Pt w/ previous term pregnancy: 80%
Nulliparous: 40%
Ruptured: 65%
Unruptured: 82%

Front 2

What contraceptions methods are available in the U.S.? (7)

Back 2

1) Abstinence, withdrawal, rhythm
2) Permanent sterilizatiojn
3) Hormonal
4) IUD
5) Barrier
6) Spermicide
7) Emergency contraception

Front 3

What are the various hormonal methods of contraception available in the U.S.? (5)

Back 3

1) OCPs: combos and progestin-only
2) Injectibles: Depot medroxyprogestesterone acetate & Lunelle (E2 cypionate + medroxyprogesterone)
3) Implant: Norplant (6 levonorgestrel rings)
4) Vaginal ring: Nuvaring (ethinyl E2 + etonorgestrel
5) Transdermal patch: Evra (ethinyl E2 + norgestimate)

Front 4

What are the options for barrier methods in the U.S.? (3)

Back 4

1) Diaphragm
2) Cervical cap
3) Condoms (female and male)

Front 5

What are the options for IUD in the U.S.? (2)

Back 5

1) Mirena: levonorgestrel
2) Paraguard: copper

Front 6

With no contraception, what % of women will get pregnant in 1 yr?

Back 6

85%

Front 7

With spermicide only, what % of women will get unintended pregnancy in 1 yr?

Back 7

26%

Front 8

With "rhythm" method, what % of women will get unintended pregnancy in 1 yr?

Back 8

25%

Front 9

With female condoms, what % of women will get unintended pregnancy in 1 yr?

Back 9

21%

Front 10

With diaphragm/cervical cap, what % of women will get unintended pregnancy in 1 yr?

Back 10

20%

Front 11

With withdrawal method, what % of women will get unintended pregnancy in 1 yr?

Back 11

17%

Front 12

With male condoms, what % of women will get unintended pregnancy in 1 yr?

Back 12

14%

Front 13

With progestin-only OCPs, what % of women will get unintended pregnancy in 1 yr?

Back 13

7%

Front 14

With combo OCPs, what % of women will get unintended pregnancy in 1 yr?

Back 14

5%

Front 15

With vaginal ring, what % of women will get unintended pregnancy in 1 yr?

Back 15

1.2%

Front 16

With IUD, what % of women will get unintended pregnancy in 1 yr?

Back 16

0.8

Front 17

With transdermal patch, what % of women will get unintended pregnancy in 1 yr?

Back 17

0.7

Front 18

With tubal ligation, what % of women will get unintended pregnancy in 1 yr?

Back 18

0.55

Front 19

With depo-provera, what % of women will get unintended pregnancy in 1 yr?

Back 19

0.3

Front 20

With vasectomy, what % of women will get unintended pregnancy in 1 yr?

Back 20

0.15

Front 21

With norplant, what % of women will get unintended pregnancy in 1 yr?

Back 21

0.05

Front 22

What are the estrogenic effects of OCPs? (1)

Back 22

suppress FSH and LH -> inhibit ovulation

Front 23

What are the progesterone effects of OCPs? (5)

Back 23

1) Suppress LH
2) Thicken cervical mucous
3) May inhibit sperm capacitation
4) Produce decidualized endometrium with exhausted & atrophic glands
5) Alter uterus & fallopian tube motility

Front 24

Association btw OCPs and MI?
OCPs and stroke?

Back 24

1) Weak association (RR=0.9-2.5) is current use, NONE for past use. Smoking is independent RF for MI & OCPs + smoking can increase risk of MI
2) Historical link btw high-dose OCPs; but no consistent, strong link btw them with modern dosages.
*Women with other independent RFs (smoking, DM) may have slightly increased stroke risk while on OCPs

Front 25

Association btw OCPs and DVTs?

Back 25

Slightly increased risk for 2nd and 3rd generation (~3fold vs ctrl), but this is less than risk of DVTs with pregnancy
*Factor V Leiden mutation in 3-5% of caucasians seems to be responsible for most of the DVTs...

Front 26

What is role of combo OCPs in treatment of hyperandrogenism?

Back 26

Suppresses ovarian, adrenal, & peripheral androgen metabolism.
Estrogen part increases SHBP and blocks 5α-reductase -> less DHT

Front 27

What is role of OCPs in treatment of menstrual disorders? (3)

Back 27

1) Can treat primary dysmenorrhea (use if NSAIDs are ineffective)
2) Can treat heavy or inter-menstrual bleeding (restore endometrial synchrony)
3) Acute menorrhagia: high doses for 3-4d then taper

Front 28

What is role of OCPs in treatment of endometriosis?

Back 28

Reduce pelvic pain
Long-term suppression after initial medical or surgical therapy

Front 29

What is role of OCPs in treatment of hypoestrogenic states? (3)

Back 29

1) Use as HRT for pts with hypothalamic amenorrhea
2) Or for peri-menopausal pts (treats symptoms and makes things regular)
3) Post-rads, -chemo, or -BSO HRT

Front 30

What is role of OCPs in treatment of ovarian cysts?

Back 30

Induce cyst regression, in theory (not much evidence to support)

Front 31

What is role of OCPs in treatment of other menstrual-related disorders?

Back 31

1) Treat premenstrual dysphoric disorder
2) Menstrual migraines (minimize hormone fluctuation)

Front 32

What is association btw OCPs and ovarian cancer?

Back 32

Users are LESS likely to develop ovarian cancer than never-users
Decreases by up to 40% with even 3-6mos of OCP use
Protective effect persists up to 15 years after d/cing OCPs
May help decrease hereditary ovarian cancer risk too

Front 33

What is association btw OCPs and endometrial cancer?

Back 33

50% risk reduction vs never-users
20% reduction w/ 1yr. 40% w/ 2 yrs, 60% w/ 4+yrs
Reduction persists for up to 15yrs after d/c

Front 34

What is association btw OCPs and breast cancer?

Back 34

Slight increase in relative risk associated with current or recent use vs never use
FHx of breast cancer doesn't influence this association
Duration, dose, formulation don't influence
This increase does NOT persist beyond 4 yrs post-d/cing OCPs

Front 35

What are non-contraceptive benefits of OCP use? (8)

Back 35

1) Reduce cancer risk for: ovarian, endometrial, possibly colorectal cancer
2) Reduce risk for benign breast disease (fibroadenomas, fibrocystic changes)
3) Less symptomatic PID
4) Less risk of ectopic
5) Increase bone mineral density
6) Decrease hirsutism & acne
7) May improve RA symptoms
8) Decrease menstrual flow, anemia, dysmenorrhea

Front 36

What are contraindications to OCP use?

Back 36

1) H/o DVT or PE
2) H/o CVA, CAD, ischemic heart dz
3) DM with microvascular complications or >20yrs of DM
4) H/o estrogen-dep't cancer or breast cancer
5) Current pregnancy
6) Migraines w/ focal neuro symptoms
7) HTN (>160/100) or vascular dz
8) Active liver dz (viral, growth, cirrhosis)
9) Major surgery w/ prolonged leg immobilzation
10) H/o or FHx of hypercoagulable disorder

Front 37

What are potential side effects of long-acting hormonal contraception?

Back 37

1) Menstrual (esp w/ progestin-only) - irregular bleeding, spotting, amenorrhea
2) headaches
3) decrease bone mineral density (w/ depo-provera)

Front 38

What emergency contraception methods are available?

Back 38

1) Yupze (200mcg E2 + 1mg levonprgestrel q12h x2)
2) Preven: another combo method
3) Plan B: progestin-only
4) Copper IUD - can insert up to 7d after ovulation (failure rate 0.1%)

Front 39

When to use emergency contraception?

Back 39

best w/in 72h of unprotected intercourse
IUD: up to 7d after ovulation

Front 40

What is IUD mechanism of action? (3)

Back 40

1) Causes foreign-body reaction -> alter sperm motility and integrity
2) Alters tubal fluids -> alters ova & sperm transport
3) Alters uterine lining -> unfavorable for implantation

Front 41

What are contraindications for pregnancy? (6)

Back 41

1) Confirmed or suspected pregnancy
2) Known or suspected pelvic malignancy
3) Undiagnosed vaginal bleeding
4) Acute or chronic pelvic infection
5) High risk behavior for STDs
6) Hyperbilirubinemia 2/2 Wilson's dz (for copper IUDs only)

Front 42

What are major risks associated w/ IUDs? (4)

Back 42

1) Displaced string
2) Uterine perforation
3) difficult removal
4) Pelvic infection (w/ copper IUD) if STD exposure

Front 43

When to insert IUD?

Back 43

Mirena: 7d after menses onset or immediately after early pregnancy loss
Paraguard: insert at any point as long as pt is not pregnant
Can insert immediately postpartum, pastabortion, or w/in 6wks postpartum

Front 44

What are advantages of barrier method contraception? (4)

Back 44

Protect vs STDs
Don't need much prior planning
Easy access
No systemic side effects

Front 45

What are disadvantages of barrier method contraception?

Back 45

Need high motivation to use
Discomfort
Latex allergies
Diaphragm: Increased UTI risk

Front 46

What is role of permanent sterilization in contraception?

Back 46

One of most widely used methods worldwide
Most common method in U.S. female >30y/o
<1% pts will get pregnant after procedure in 1st yr
Risk of failure does persist, and varies by method & age.

Front 47

What are normal physiological changes seen in sexual response?

Back 47

Vasoconstriction & increased tone in genitals, breasts, skin
Elevation in pulse, BP, respiration

Front 48

What are phases of sexual response cycle? (4)

Back 48

1) Excitement
2) Plateau
3) Orgasm
4) Resolution

Front 49

Who describes the phases of the sexual response cycle?
What year?

Back 49

1) Masters & Johnson
2) 1966

Front 50

What are Kaplan's phases of sexual response? (3)

Back 50

Desire
Arousal
Orgasm