Contraception Methods Side Effects
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What is the primary mechanism of action of Levonorgestrel (Plan B)?

  • Inducing abortion
  • Thinning the lining of the uterus
  • Preventing ovulation (correct)
  • Blocking sperm fertilization

    • What is the main difference between Ulipristal (Ella) and Levonorgestrel (Plan B)?

  • Availability by prescription only
  • Mechanism of action as a progestin blocker
  • Time frame for use after unprotected intercourse (correct)
  • All of the above

    • What type of IUD does not release hormones?

  • Ella
  • Skyla
  • Mirena
  • Paragard (correct)

    • What is a common side effect of Mirena and Skyla IUDs?

    <p>Amenorrhea</p> Signup and view all the answers

    What is the primary advantage of IUDs?

    <p>All of the above</p> Signup and view all the answers

    Why may some women not have access to IUDs?

    <p>Lack of licensed providers</p> Signup and view all the answers

    What is a potential complication of IUD placement?

    <p>Expulsion of the device</p> Signup and view all the answers

    What is a characteristic of the Paragard IUD?

    <p>Causes heavier bleeding</p> Signup and view all the answers

    Why is screening for STIs performed during IUD placement?

    <p>To rule out underlying infections</p> Signup and view all the answers

    What is the similarity in the incidence of pelvic inflammatory disease between women with IUCs and women without them?

    <p>The incidence is the same</p> Signup and view all the answers

    What is the contraindication for latex-based condoms?

    <p>Latex allergy</p> Signup and view all the answers

    What is the primary function of the barrier methods of birth control?

    <p>To provide a barrier that prevents semen from entering the female reproductive tract</p> Signup and view all the answers

    What is the disadvantage of the female condom compared to the male condom?

    <p>It is more expensive</p> Signup and view all the answers

    What is the recommended replacement interval for diaphragms?

    <p>Every 2 years</p> Signup and view all the answers

    What is the failure rate of the diaphragm within a year?

    <p>12% failure rate</p> Signup and view all the answers

    What is the advantage of using male condoms?

    <p>They are available over the counter and are inexpensive or free</p> Signup and view all the answers

    What should be checked after a woman gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds?

    <p>The diaphragm fit</p> Signup and view all the answers

    What can weaken the integrity of latex-based condoms?

    <p>Petroleum-based products</p> Signup and view all the answers

    What is a common side effect of using hormonal contraceptives containing progestin?

    <p>Irregular bleeding</p> Signup and view all the answers

    Who should not use combined oral contraceptive pills?

    <p>All of the above</p> Signup and view all the answers

    What is a potential health risk associated with using hormonal contraceptives?

    <p>Blood clots</p> Signup and view all the answers

    What is a benefit of using combined oral contraceptive pills?

    <p>Helping with PCOS and acne</p> Signup and view all the answers

    What should you do if you miss a dose of combined oral contraceptive pills?

    <p>Take a pill as soon as you remember and then take the next dose at the regular time</p> Signup and view all the answers

    What is a characteristic of extended cycling combined oral contraceptive pills?

    <p>84 active pills, 7 days placebo</p> Signup and view all the answers

    Why are combined oral contraceptive pills not suitable for people who forget to take their pills every day?

    <p>Because they require a high level of adherence</p> Signup and view all the answers

    What is a contraindication for combined oral contraceptive pills?

    <p>All of the above</p> Signup and view all the answers

    What is not a benefit of using combined oral contraceptive pills?

    <p>Reducing the risk of STIs</p> Signup and view all the answers

    What percentage of infertility cases involve combined male and female factors?

    <p>20%</p> Signup and view all the answers

    What is the duration of well-timed intercourse required to define infertility in women over 35 years old?

    <p>6 months</p> Signup and view all the answers

    What is the risk of multiple gestation with clomiphene citrate compared to spontaneous pregnancies?

    <p>7% increase</p> Signup and view all the answers

    What percentage of infertility cases have unknown causes?

    <p>10%</p> Signup and view all the answers

    What is the common first-line medication to induce ovulation?

    <p>Clomiphene citrate</p> Signup and view all the answers

    When is clomiphene citrate usually started?

    <p>5 days after the start of menses</p> Signup and view all the answers

    What lifestyle factor impairs fertility in both sexes?

    <p>Smoking</p> Signup and view all the answers

    What is the percentage of infertility cases related to male factors?

    <p>35%</p> Signup and view all the answers

    What is the risk of miscarriage or ectopic pregnancy with clomiphene citrate compared to spontaneous pregnancies?

    <p>Same</p> Signup and view all the answers

    What is the primary mechanism of action of Human menopausal gonadotropin (Pergonal)?

    <p>It directly stimulates ovaries</p> Signup and view all the answers

    What is a possible risk associated with Human menopausal gonadotropin (Pergonal) treatment?

    <p>Ovarian hyperstimulation</p> Signup and view all the answers

    What is the primary purpose of Intrauterine insemination (IUI)?

    <p>To introduce washed sperm into the upper uterine cavity</p> Signup and view all the answers

    What is a possible outcome of In Vitro Fertilization (IVF)?

    <p>Multiple gestation</p> Signup and view all the answers

    What is the primary mechanism of action of Gamete intrafallopian transfer (GIFT)?

    <p>Sperm and eggs are combined and then placed in the fallopian tube for fertilization</p> Signup and view all the answers

    What is a common procedure used in Intracytoplasmic sperm injection (ICSI)?

    <p>Retrieving sperm from the epididymis using a needle through the skin</p> Signup and view all the answers

    What is a possible option for treatment of infertility due to male factors?

    <p>In Vitro Fertilization (IVF) with donor sperm</p> Signup and view all the answers

    What is a possible option for treatment of infertility due to ovarian factors?

    <p>Donor oocytes: Eggs are obtained from donors and combined with sperm in IVF.</p> Signup and view all the answers

    What is a possible option for treatment of infertility when the woman is unable to carry a pregnancy?

    <p>Surrogacy (gestational carrier): can use couple’s or donor egg/sperm.</p> Signup and view all the answers

    What is a disadvantage of using the female condom compared to the male condom?

    <p>It is more cumbersome</p> Signup and view all the answers

    What is a characteristic of the diaphragm?

    <p>It has a 12% failure rate within a year</p> Signup and view all the answers

    What is a potential problem with using latex-based condoms?

    <p>They are weakened by petroleum-based products</p> Signup and view all the answers

    What is an advantage of using male condoms?

    <p>They are less expensive than female condoms</p> Signup and view all the answers

    How often should diaphragms be replaced?

    <p>Every 2 years</p> Signup and view all the answers

    When should the fit of a diaphragm be checked?

    <p>After a woman gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds</p> Signup and view all the answers

    What is a characteristic of male condoms?

    <p>Most are latex-based</p> Signup and view all the answers

    What is the primary benefit of using condoms for contraception?

    <p>They are the only method that prevents infection while preventing pregnancy</p> Signup and view all the answers

    Which of the following is a consideration for patients who don't want their partners to know they're using contraception?

    <p>Barrier methods</p> Signup and view all the answers

    What is the advantage of hormonal methods of contraception?

    <p>They relieve PMS and have no impact on spontaneity</p> Signup and view all the answers

    Which of the following is a disadvantage of hormonal methods of contraception?

    <p>They can cause daily 3-8% failure rate</p> Signup and view all the answers

    What is the importance of access to contraception?

    <p>It increases educational and economic opportunity, reduces maternal mortality/morbidity, and decreases infant mortality/morbidity</p> Signup and view all the answers

    What is a common side effect of using hormonal contraceptives containing progestin?

    <p>All of the above</p> Signup and view all the answers

    What is the best method of contraception for a patient?

    <p>The one the patient has access to, can afford, will tolerate, and can use consistently</p> Signup and view all the answers

    What is a contraindication for combined oral contraceptive pills?

    <p>All of the above</p> Signup and view all the answers

    Why is it beneficial to have two years between pregnancies?

    <p>It is better for the health of the mother and the baby</p> Signup and view all the answers

    What should you do if you miss more than one dose of combined oral contraceptive pills?

    <p>Take the next dose, but use other birth control for 7 days</p> Signup and view all the answers

    What is a benefit of using combined oral contraceptive pills?

    <p>Both A and B</p> Signup and view all the answers

    What is a characteristic of extended cycling combined oral contraceptive pills?

    <p>84 active pills followed by 7 days of placebo</p> Signup and view all the answers

    Why are combined oral contraceptive pills not suitable for people who forget to take their pills every day?

    <p>Because they require consistent daily use</p> Signup and view all the answers

    What is the recommended time frame for placing a contraceptive sponge in the vagina?

    <p>Up to 24 hours before sexual intercourse</p> Signup and view all the answers

    What is the failure rate of the contraceptive sponge in women who have given birth?

    <p>24% over 1 year</p> Signup and view all the answers

    What is a potential health risk associated with using hormonal contraceptives?

    <p>All of the above</p> Signup and view all the answers

    What is a common complication associated with tubal ligation?

    <p>All of the above</p> Signup and view all the answers

    What is the primary advantage of vasectomy compared to bilateral tubal ligation?

    <p>It is safer and cheaper</p> Signup and view all the answers

    What is the primary mechanism of action of vasectomy?

    <p>Preventing sperm from exiting the male body</p> Signup and view all the answers

    What is the recommended follow-up care after a vasectomy?

    <p>Follow-up with sperm count and use alternate birth control until cleared by a physician</p> Signup and view all the answers

    What is the primary advantage of surgical methods of birth control compared to barrier methods?

    <p>They are more effective</p> Signup and view all the answers

    What is the primary action of Progestin-only pills on the cervix?

    <p>Thickening of cervical mucus</p> Signup and view all the answers

    What is a side effect of Progestin-only pills?

    <p>Irregular periods and more spotting</p> Signup and view all the answers

    How often must Progestin-only pills be taken to be effective?

    <p>Within a 3 hour window every day</p> Signup and view all the answers

    What is a risk associated with pregnancy while using Progestin-only pills?

    <p>Ectopic pregnancy</p> Signup and view all the answers

    How is the Contraceptive Ring used?

    <p>Inserted into the vagina for 3 weeks and removed for 1 week</p> Signup and view all the answers

    What is the primary advantage of the contraceptive patch?

    <p>It is a non-invasive method that does not require frequent administration</p> Signup and view all the answers

    What is the primary benefit of using the contraceptive implant?

    <p>It is a long-acting method that does not require frequent administration</p> Signup and view all the answers

    What is the primary limitation of using the contraceptive injection?

    <p>It is associated with weight gain and may diminish milk production</p> Signup and view all the answers

    What is the primary indication for using emergency contraception?

    <p>For women who have had unprotected sex or contraceptive failure</p> Signup and view all the answers

    What is the primary difference between the contraceptive patch and the contraceptive injection?

    <p>The patch is a short-acting method, while the injection is a long-acting method</p> Signup and view all the answers

    What is the primary advantage of using the contraceptive implant compared to the contraceptive injection?

    <p>The implant is a reversible method that can be removed at any time, while the injection is a long-acting method that requires waiting for its effects to wear off</p> Signup and view all the answers

    What is the primary limitation of using the contraceptive patch?

    <p>It is a barrier method that does not provide protection against STIs</p> Signup and view all the answers

    Study Notes

    Contraception

    • Hormonal methods: need a prescription, not effective against STIs, and may have side effects like nausea, breast tenderness, and mood swings.
    • Progestin methods: may cause irregular bleeding, and have adverse reactions like blood clots.
    • Contraindications: migraine with aura, hypertension, history of DVT, PE, stroke, and smokers over 35.
    • Not suitable for breastfeeding mothers.

    Combined Oral Contraceptive Pills

    • Contain 21 hormone-containing pills followed by 7 placebo pills.
    • Extended cycling: 84 active pills, 7 days placebo.
    • Can help with PCOS, acne, menstrual cramping, and heavy bleeding.
    • Missed dose: take a pill as soon as you remember, then take the next dose at the regular time.
    • If you miss more than one, take the next dose, but use other birth control for 7 days.
    • More effective in women who weigh over 165 pounds.

    Emergency Contraception

    • Levonorgestrel (PlanB): available over the counter or by prescription, more effective when taken within 72 hours of unprotected intercourse.
    • Works by preventing ovulation, does not affect an established pregnancy.
    • Must be used within 72 hours of unprotected sex.
    • Ulipristal (Ella): available by prescription only, works as a progestin blocker, and may affect an existing pregnancy.
    • May be used within 120 hours of unprotected intercourse.

    Intrauterine Devices (IUDs)

    • Types: copper (Paragard) and progestin-releasing (Mirena and Skyla).
    • T-shaped device inserted into the uterus, works by thinning the lining of the uterus and creating an environment not good for sperm.
    • Hormone-releasing IUDs also prevent ovulation.
    • Does not interrupt a pregnancy or cause abortion.
    • Advantages: no chance of user error, completely reversible, and long-acting.
    • Disadvantages: initially expensive, may not be accessible to some women, and may cause heavier bleeding and cramping.

    Barrier Methods of Birth Control

    • Male Condoms:
    • Consist of a sheath that goes over the penis, provide a barrier that prevents semen from entering the female reproductive tract.
    • Advantages: widely available, inexpensive, protect against STIs, allow male partner to be active in family planning.
    • Disadvantages: adherence is poor, breakage or slippage may occur, latex allergy is a contraindication, and can degrade over time.
    • Female Condom:
    • Contains two semi-rigid rings attached to the opening of a nitrile tube.
    • Placement is similar to a tampon, new female condom should be used with each episode of rectal or vaginal sex.
    • Expensive and more cumbersome than a male condom.
    • Diaphragm:
    • Flexible saucer that is placed into the vagina to cover the cervix.
    • Does not protect against STIs, has a 12% failure rate within a year.
    • Fit should be checked if the woman gives birth, has a miscarriage or abortion, or gains or loses more than 10 pounds.

    Fertility and Infertility

    • Infertility: lack of pregnancy after 12 months of well-timed intercourse (6 months if the woman is over 35 years old).
    • May involve recurrent spontaneous abortion (miscarriage).
    • Infertility may be related to male factors (35%), female factors (35%), and combined male and female factors (20%).
    • In about 10% of infertility cases, the cause is unknown.
    • Overweight or underweight women may be counseled to lose or gain weight to induce ovulation.

    Fertility Treatment

    • Clomiphene:
    • Selective estrogen receptor modulator, common first-line medication to induce ovulation.
    • Started 5 days after the start of menses, the risk of miscarriage or ectopic pregnancy is the same as with spontaneous pregnancies.
    • The risk of multiple gestation is increased 7% with clomiphene citrate compared to spontaneous pregnancies.
    • Human Menopausal Gonadotropin (Pergonal):
    • Self-administered IM injection given daily until ultrasound reveals a mature ovarian follicle.
    • Directly stimulates ovaries, recommend intercourse every other day for 1 week starting day 5 of beginning medication.
    • Patient required to come in for multiple office visits per cycle for labs and ultrasound.
    • Risk of ovarian hyperstimulation, serious cases require hospitalization.
    • The risk of multiple gestation is 10-20% (majority are twin gestation).

    Artificial Reproductive Technology (ART)

    • Multiple modalities exist, and may sometimes be combined to increase odds:
    • Intrauterine Insemination (IUI):
    • Sperm is washed and then introduced into the upper uterine cavity.
    • In Vitro Fertilization (IVF):
    • Used to treat infertility due to tubal factors, severe male factors, uterine, or ovarian factors.
    • Ovaries are stimulated and eggs retrieved by ultrasound-guided follicle aspiration and then mixed with cleaned sperm.
    • Successful fertilization can be identified after 17 hours and transplanted into the uterus or frozen.
    • Gamete Intrafallopian Transfer (GIFT):
    • Sperm and eggs are combined and then placed in the fallopian tube for fertilization via laparoscopy.
    • Requires general anesthesia and surgical intervention.
    • Intracytoplasmic Sperm Injection (ICSI):
    • Sperm is retrieved from the epididymis using a needle through the skin, and a single sperm cell is isolated and injected into an egg.
    • Donor Sperm:
    • Sperm is obtained from a donor, washed and used for fertilization either with IUI or IVF procedures.
    • Donor Oocytes:
    • Eggs are obtained from donors and combined with sperm (male partner's or donors) in IVF.
    • Surrogacy (Gestational Carrier):
    • Can use couple's or donor egg/sperm.

    Intrauterine Contraception (IUC)

    • IUCs have a small risk of perforating the uterus during insertion.
    • The incidence of pelvic inflammatory disease is the same for women with IUCs as for women without them.

    Barrier Methods of Birth Control

    • Male Condoms
      • Consist of a sheath that goes over the penis
      • Provide a barrier that prevents semen from entering the female reproductive tract
      • Most are latex-based; non-latex are made from animal intestine
      • Advantages: widely available, inexpensive, protect against STIs, allow male partner to be active in family planning
      • Disadvantages: poor adherence, breakage or slippage, latex allergy, degrade over time
    • Female Condom
      • Contains two semi-rigid rings attached to a nitrile tube
      • Placement is similar to a tampon
      • A new female condom should be used with each episode of rectal or vaginal sex
      • Expensive and more cumbersome than a male condom
    • Diaphragm
      • A flexible saucer that is placed into the vagina to cover the cervix
      • Does not protect against STIs
      • 12% failure rate within a year
      • Fit should be checked after childbirth, miscarriage, or abortion, or if weight changes by more than 10 pounds
      • Should be replaced every 2 years
    • Contraceptive Sponge
      • A spermicide-infused, foam disk that fits over the cervix
      • Available over the counter
      • 12% failure rate in women who have never given birth, 24% failure rate in women who have given birth
      • Should be placed up to 24 hours before sexual intercourse and stay in no more than 30 hours

    Contraception

    • Access to Contraception
      • Increases educational and economic opportunities for men and women
      • Reduces maternal mortality/morbidity
      • Decreases infant mortality/morbidity
      • Reduces stress on families
      • Prevents unsafe abortions
    • Contraception Considerations
      • The best method is the one that is accessible, affordable, and can be used consistently
      • Methods that don't invite user error have lower failure rates
      • Only condoms prevent infection while preventing pregnancy

    Hormonal Methods

    • How they Work
      • Suppress ovulation, thicken cervical mucus, and thin the uterine lining
    • Effectiveness
      • In a perfect world, failure rate is 0.3%
      • In reality, failure rate is 3-8% depending on the method
    • Advantages
      • No effect on future fertility, relieves PMS, lighter periods, no impact on spontaneity, can be used to treat PCOS, reduces acne
    • Disadvantages
      • Need a prescription, not effective against STIs, side effects, adverse reactions, contraindications

    Surgical Methods

    • Tubal Ligation
      • Most common method around the world and 2nd most common in the US
      • Can be performed outpatient or during a C-section
      • Surgical procedure with associated risks
      • Failure rate is 0.5%
    • Vasectomy
      • Safer and cheaper than bilateral tubal ligation, but fewer men have the procedure
      • Cutting the vas deferens prevents sperm from exiting the male body
      • Performed in an office under local anesthesia
      • Permanent procedure, but reversal is possible

    Contraceptive Patch

    • How it Works
      • A patch containing estrogen and progestin applied weekly for 3 weeks
      • Followed by a patch-free week, which causes a withdrawal bleed
    • Failure Rate
      • 9% with normal BMI, higher with obesity
    • Not for
      • Breastfeeding mothers

    Contraceptive Injection (Depo-Provera)

    • How it Works
      • A progestin-only injection given every 13 weeks until pregnancy is desired
    • Failure Rate
      • 6%
    • Concerns
      • Weight gain, used with breastfeeding mothers may diminish milk production

    Contraceptive Implant (LARC)

    • How it Works
      • A 4-cm rod of non-estrogen etonogestrel is inserted under the skin of the inner upper arm
      • Approved for use for 3 years
    • Failure Rate
      • Less than 0.05%
    • Concerns
      • Unscheduled bleeding, removal can be difficult, leaves scars

    Emergency Contraception

    • Options
      • Medication or a copper intrauterine contraception (IUC)
    • Progestin-only Pills (POPs)
      • Contain only progestin
      • Safe for breastfeeding mothers
      • Failure rate is 9%

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    Description

    This quiz covers the side effects and contraindications of various contraception methods, including those containing progestin. Learn about the risks and precautions to take.

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