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Chapter 58
Contraception
23
Medical
Graduate
08/21/2013

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Cards

Term
How do serum levels of FSH and LH change througout the menstrual cycle of a woman on combined medication?
Definition
There is no rise in either LH or FSH
Term
How do serum levels of FSH and LH change throughout the menstrual cycle of a woman on sequential medication?
Definition
LH rises irregularly during estrogen treatment, progesting causes another LH surge. FSH remains low throughout.
Term
How do serum levels of FSH and LH change throughout the menstrual cycle of a woman on progestin-only contraceptives?
Definition
FSH levels are unchanged throughout the cycle, several LH surges may occur.
Term
How does the risk of VTE change under oral contraceptive treatment?
Definition
Increased from 3 to 6 per 100,000 users annually
Term
How does the risk of MI increase in smoking women taking oral contraceptives?
Definition
There is a 20- to 30-fold increase in the risk of MI. However, this still amounts to 500-600 per million woman years.
Term
Name 6 contraindications to the use of oral contraceptives
Definition

1. Undiagnosed vaginal bleeding

2. Prior history of VTE, MI or stroke

3. Increased risk for cardiovascular events (e.g. active SLE, uncontrolled DM or HTN, sickle cell anemia)

4. Smokers > 35 years old

5. Current or prior breast cancer

6. Active liver disease

Term
How do oral contraceptive affect the risk of breast cancer?
Definition
Relative risk of 1.24, persists for 10 years after discontinuation of the drug
Term
How do oral contraceptives change the risk of cervical cancer?
Definition
Relative risk of 4 after 10 years' use
Term
What percentage of women will experience intermenstrual bleeding when taking oral contraceptives?
Definition
10-20% of women experience them in the first 6 months of use.
Term
How should the progestin-only pill be taken?
Definition
Every day at the same time. A delay of as little as 2-3 hours reduces effectiveness for 48 hours.
Term
What is the protocol for administration of levonorgestrel as emergency contraception?
Definition
Two doses given 12 hours apart, the first within 72 hours of intercourse (some studies suggest effectiveness up to 5 days post-coitus)
Term
What are the three regimens for emergency contraception?
Definition

1. Levonorgestrel + estrogen

2. Levonorgestrel only

3. Copper T 380A IUD

Term
How soon after unprotected sex should the T 380A IUD be inserted to be effective as emergency contraception?
Definition
7 days
Term
What are three health benefits seen in women using DMPA (long-term contraception)?
Definition

Decreased risk of endometrial cancer (by 80%)

 

Lower frequency of sickle cell crises (by 70%)

 

Some patients with endometriosis have improvement of symptoms

Term
How long after ceasing DMPA treatment does fertility return?
Definition
Up to 10 months
Term
What is the major risk of DMPA therapy? What are some other side effects?
Definition

Bone mineral loss

 

Other possible side effects include depression, mood swings, irregular bleeding in the first 6 months.

Term
What are the five side-effects/complications of the copper IUD?
Definition

1. PID - at insertion

2. Ectopic pregnancy - 5-8% of pregnancies with an IUD are ectopic, but risk still reduced compared to no contraception at all

3. Spontaneous abortion - ~50%

4. Uterine perforation - 1-2:1000 insertions

5. Expulsion - 5%, during the first few weeks

Term
Which adverse event associated with the copper IUD is not seen in the levonorgestrel-releasing IUD?
Definition
PID
Term
What is the risk of an ectopic pregnancy in levonorgestrel-releasing IUD?
Definition
50% of pregnancies are ectopic, however, risk still less than using no contraception at all
Term
How should a woman with an IUD with missing strings be managed?
Definition

If they cannot be seen even with gentle probing of the endocervix, order a pregnancy test and TVUS.

 

Intraperitoneal IUDs should be removed operatively.

Term
What are three common regimens of medical induced abotion?
Definition

Mifepristone plus misoprostol

 

Misoprostol only

 

Methotrexate plus misoprostol

Term
How soon after the first day of last menstrual period can medical abortion be induced?
Definition
<49 days
Term
How should a woman with a medically induced abortion be followed?
Definition
Follow-up with U/S after 24 hours. If abortion has not occured - repeat misoprostol dose and F/U after 4 weeks. If abortion has still not occured - proceed to suction curretage.
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