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Questions and Answers
What is the significance of the Pearl Index in contraceptive methods?
What is the significance of the Pearl Index in contraceptive methods?
Which of the following characteristics is NOT considered when prescribing contraception?
Which of the following characteristics is NOT considered when prescribing contraception?
Which tier of contraceptive efficacy includes methods with a Pearl Index of 6-12?
Which tier of contraceptive efficacy includes methods with a Pearl Index of 6-12?
What is a major health risk associated with pregnancy that outweighs the risks of any contraceptive method?
What is a major health risk associated with pregnancy that outweighs the risks of any contraceptive method?
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What is the main challenge in using barrier methods effectively?
What is the main challenge in using barrier methods effectively?
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Which of the following methods is classified as a Long-Acting Reversible Contraceptive (LARC)?
Which of the following methods is classified as a Long-Acting Reversible Contraceptive (LARC)?
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What is a common side effect associated with the use of barrier methods?
What is a common side effect associated with the use of barrier methods?
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Which group of contraceptives is generally considered least effective?
Which group of contraceptives is generally considered least effective?
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What happens immediately after ejaculation when using a penile condom?
What happens immediately after ejaculation when using a penile condom?
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Which of the following statements about oral contraceptives is true?
Which of the following statements about oral contraceptives is true?
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Which contraception method has a failure rate of 12%?
Which contraception method has a failure rate of 12%?
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What is the maximum amount of time a diaphragm can be used before needing replacement?
What is the maximum amount of time a diaphragm can be used before needing replacement?
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What is a notable risk for women over age 35 who smoke regarding hormonal contraception?
What is a notable risk for women over age 35 who smoke regarding hormonal contraception?
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Which method can be inserted prior to erection and left after ejaculation?
Which method can be inserted prior to erection and left after ejaculation?
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Which of these is a benefit of estrogen-progestin contraceptives?
Which of these is a benefit of estrogen-progestin contraceptives?
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What should be used alongside a cervical cap for effectiveness?
What should be used alongside a cervical cap for effectiveness?
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What is the primary mode of action of Nexplanon?
What is the primary mode of action of Nexplanon?
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What is the recommended follow-up for a woman who has had a baby concerning the diaphragm's size?
What is the recommended follow-up for a woman who has had a baby concerning the diaphragm's size?
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Which factor is most crucial to consider when assessing the suitability of a contraceptive method for a patient?
Which factor is most crucial to consider when assessing the suitability of a contraceptive method for a patient?
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What is a significant reason for the higher rate of unintended pregnancy among women below the poverty level?
What is a significant reason for the higher rate of unintended pregnancy among women below the poverty level?
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What is the primary characteristic of methods classified under the most effective tier of contraceptive efficacy?
What is the primary characteristic of methods classified under the most effective tier of contraceptive efficacy?
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What is a common misconception about barrier methods of contraception?
What is a common misconception about barrier methods of contraception?
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The Pearl Index indicates that a lower index signifies what in terms of contraceptive methods?
The Pearl Index indicates that a lower index signifies what in terms of contraceptive methods?
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Which of the following options is a key aspect of the basic rules of contraceptive choice?
Which of the following options is a key aspect of the basic rules of contraceptive choice?
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Which statement about the failure rates of barrier methods is accurate?
Which statement about the failure rates of barrier methods is accurate?
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What is an important non-contraceptive benefit of using condoms?
What is an important non-contraceptive benefit of using condoms?
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What is a crucial step when using a penile condom correctly?
What is a crucial step when using a penile condom correctly?
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What is a limitation of using a vaginal condom like FC2?
What is a limitation of using a vaginal condom like FC2?
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What is one requirement for using a diaphragm?
What is one requirement for using a diaphragm?
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What role does spermicide play in the use of a cervical cap?
What role does spermicide play in the use of a cervical cap?
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Which hormonal contraceptive method mimics typical cyclical hormone levels?
Which hormonal contraceptive method mimics typical cyclical hormone levels?
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What is an adverse effect associated with lowering estrogen levels in oral contraceptives?
What is an adverse effect associated with lowering estrogen levels in oral contraceptives?
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What is the primary action of the Nexplanon contraceptive implant?
What is the primary action of the Nexplanon contraceptive implant?
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What is a common reason women discontinue the use of oral contraceptives?
What is a common reason women discontinue the use of oral contraceptives?
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What can result from using a diaphragm incorrectly?
What can result from using a diaphragm incorrectly?
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What is a significant benefit of estrogen-progestin contraceptives aside from pregnancy prevention?
What is a significant benefit of estrogen-progestin contraceptives aside from pregnancy prevention?
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What is a significant risk associated with surgical management of elective operative termination in the first trimester?
What is a significant risk associated with surgical management of elective operative termination in the first trimester?
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What is the mechanism of action for mifepristone in medical termination of pregnancy?
What is the mechanism of action for mifepristone in medical termination of pregnancy?
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Which of the following is a common side effect experienced by women after taking misoprostol?
Which of the following is a common side effect experienced by women after taking misoprostol?
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What is a disadvantage of surgical management concerning the procedure's scheduling?
What is a disadvantage of surgical management concerning the procedure's scheduling?
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After a medical termination with mifepristone and misoprostol, what is essential for the patient to do?
After a medical termination with mifepristone and misoprostol, what is essential for the patient to do?
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Study Notes
Economic Disparities
- Unintended pregnancy rate is five times higher in women below the poverty level.
- Long-Acting Reversible Contraceptives (LARCs) tend to have high initial costs.
Considerations for Contraceptive Prescription
- Evaluate efficacy, convenience, cost, accessibility, non-contraceptive benefits, side effects, medical contraindications, and reversibility.
Basic Rules of Contraceptive Choice
- Understand patient's medical status and reproductive desires.
- Acknowledge factors contributing to a high quality of life.
- Pregnancy poses greater health risks than any contraceptive method.
Pearl Index
- Measures contraceptive efficacy as a percentage.
- Represents the pregnancy rate among 100 women using a contraceptive method over one year; lower Pearl Index indicates higher effectiveness.
- Focuses on "typical use" statistics.
Successful Contraceptives
- Effectiveness shows similar rates for both perfect and typical usage.
- Efficacy increases as reliance on human action decreases.
Three Tiers of Contraceptive Efficacy
- Most Effective (Pearl Index 1 or less): Includes progesterone-delivery IUDs (Mirena, Kyleena, Liletta, Skyla), ParaGard, Nexplanon, and sterilization.
- Effective (Pearl Index 6-12): Includes Depo-Provera and hormonal contraceptive methods.
- Least Effective (Pearl Index 18 or more): Includes diaphragm, cervical cap, condoms, spermicide, withdrawal, and periodic abstinence.
Barrier Contraception
- Considered the least effective methods.
- Includes diaphragm, cervical cap, female condom, male condom, and contraceptive sponge.
- Designed for use with spermicide for enhanced effectiveness.
Penile Condom
- Constitutes 97% of the U.S. condom market, predominantly latex.
- Provides pregnancy and STI protection; non-latex options have higher failure rates.
- Incompatible with oil-based lubricants and unsuitable for latex-allergic individuals.
Proper Use of Penile Condom
- Must be placed on an erect penis before any genital contact.
- Leave space at the tip for semen; ensure to unroll to the base.
- Withdraw while holding the condom rim to prevent spillage, and use a new condom for each intercourse.
Vaginal Condom
- FC2 is the most widely available product, with non-latex options.
- Efficacy data is limited but assumed to be similar to male condoms.
- Can be inserted prior to erection and left post-ejaculation.
Diaphragm
- Requires fitting by a healthcare provider and a prescription.
- Covers the cervix and must be used with spermicide.
- Stays effective for 12% pregnancy rate over usage and lasts up to two years before replacement.
Cervical Cap
- Functions like a mini diaphragm, requires RX and fitting.
- Comes in three sizes based on parity and is used with spermicide.
- Can remain inserted for up to 48 hours, with cost around 60−60-60−75.
Non-Implanted Hormonal Contraception
- Encompasses oral contraceptive pills (OCPs), contraceptive rings, and patches.
- Most are combined estrogen-progestin formulations, allowing for cyclical use with withdrawal bleeds.
Non-Contraceptive Benefits of Estrogen-Progestin Contraceptives
- Reduces menstrual bleeding and dysmenorrhea.
- Alleviates PMS symptoms and improves acne.
- Lowers the incidence of ovarian cysts and benign breast disease; suppresses endometriosis.
Cycle Management
- Preference for cycle length must consider individual symptoms and treatment needs.
- Fewer cycles may result in fewer menstrual-related symptoms but can increase breakthrough bleeding.
Age Considerations with OCs
- Women over 35 who smoke should avoid combination OCs.
- Non-hypertensive women who do not smoke can use combination OCs safely until menopause.
LARCs and Sterilization
- Represent the highest tier of effectiveness in contraceptive methods.
- Nexplanon (progestin-only) acts by thickening cervical mucus, reducing tubal motility, and inhibiting ovulation along with endometrial thinning.
Economic Disparities
- Unintended pregnancy rate is five times higher in women below the poverty level.
- Long-Acting Reversible Contraceptives (LARCs) tend to have high initial costs.
Considerations for Contraceptive Prescription
- Evaluate efficacy, convenience, cost, accessibility, non-contraceptive benefits, side effects, medical contraindications, and reversibility.
Basic Rules of Contraceptive Choice
- Understand patient's medical status and reproductive desires.
- Acknowledge factors contributing to a high quality of life.
- Pregnancy poses greater health risks than any contraceptive method.
Pearl Index
- Measures contraceptive efficacy as a percentage.
- Represents the pregnancy rate among 100 women using a contraceptive method over one year; lower Pearl Index indicates higher effectiveness.
- Focuses on "typical use" statistics.
Successful Contraceptives
- Effectiveness shows similar rates for both perfect and typical usage.
- Efficacy increases as reliance on human action decreases.
Three Tiers of Contraceptive Efficacy
- Most Effective (Pearl Index 1 or less): Includes progesterone-delivery IUDs (Mirena, Kyleena, Liletta, Skyla), ParaGard, Nexplanon, and sterilization.
- Effective (Pearl Index 6-12): Includes Depo-Provera and hormonal contraceptive methods.
- Least Effective (Pearl Index 18 or more): Includes diaphragm, cervical cap, condoms, spermicide, withdrawal, and periodic abstinence.
Barrier Contraception
- Considered the least effective methods.
- Includes diaphragm, cervical cap, female condom, male condom, and contraceptive sponge.
- Designed for use with spermicide for enhanced effectiveness.
Penile Condom
- Constitutes 97% of the U.S. condom market, predominantly latex.
- Provides pregnancy and STI protection; non-latex options have higher failure rates.
- Incompatible with oil-based lubricants and unsuitable for latex-allergic individuals.
Proper Use of Penile Condom
- Must be placed on an erect penis before any genital contact.
- Leave space at the tip for semen; ensure to unroll to the base.
- Withdraw while holding the condom rim to prevent spillage, and use a new condom for each intercourse.
Vaginal Condom
- FC2 is the most widely available product, with non-latex options.
- Efficacy data is limited but assumed to be similar to male condoms.
- Can be inserted prior to erection and left post-ejaculation.
Diaphragm
- Requires fitting by a healthcare provider and a prescription.
- Covers the cervix and must be used with spermicide.
- Stays effective for 12% pregnancy rate over usage and lasts up to two years before replacement.
Cervical Cap
- Functions like a mini diaphragm, requires RX and fitting.
- Comes in three sizes based on parity and is used with spermicide.
- Can remain inserted for up to 48 hours, with cost around 60−60-60−75.
Non-Implanted Hormonal Contraception
- Encompasses oral contraceptive pills (OCPs), contraceptive rings, and patches.
- Most are combined estrogen-progestin formulations, allowing for cyclical use with withdrawal bleeds.
Non-Contraceptive Benefits of Estrogen-Progestin Contraceptives
- Reduces menstrual bleeding and dysmenorrhea.
- Alleviates PMS symptoms and improves acne.
- Lowers the incidence of ovarian cysts and benign breast disease; suppresses endometriosis.
Cycle Management
- Preference for cycle length must consider individual symptoms and treatment needs.
- Fewer cycles may result in fewer menstrual-related symptoms but can increase breakthrough bleeding.
Age Considerations with OCs
- Women over 35 who smoke should avoid combination OCs.
- Non-hypertensive women who do not smoke can use combination OCs safely until menopause.
LARCs and Sterilization
- Represent the highest tier of effectiveness in contraceptive methods.
- Nexplanon (progestin-only) acts by thickening cervical mucus, reducing tubal motility, and inhibiting ovulation along with endometrial thinning.
Elective Operative Termination in the First Trimester
- Most common method is cervical dilation and suction curettage.
- Dilation and manual curettage is an alternative option.
Advantages of Surgical Management
- Ensures complete evacuation of products of conception (POC).
- Allows for pathology evaluation if necessary.
- Minimal anesthesia required compared to other procedures.
- Short and specific procedure timeline.
- Can often be performed in an office setting, depending on practitioner and state regulations.
- Women generally report high satisfaction with this method.
Disadvantages of Surgical Management
- Requires anesthesia administration.
- Necessitates the use of an operating or procedure room.
- Scheduling may be required, which could be delayed.
- Generally costs more compared to medical management methods.
- Potential risks include uterine perforation, cervical damage, and infection.
- Typically a personal preference issue for patients.
Medical Management of Termination: Mifepristone
- Mifepristone can be used alone or in combination with misoprostol to terminate early pregnancies.
- Effective up to 70 days post the first day of the last menstrual period.
- It works by blocking progesterone, preventing the maintenance of the uterine lining.
- Leads to the breakdown of the endometrial lining, ultimately terminating the pregnancy.
- Has a 97% effectiveness rate for abortion.
- Misoprostol is administered up to 2 days later to promote cervical softening and uterine contractions.
- Most women experience abortion within 4 to 5 hours after taking misoprostol.
- Common side effects include cramps, heavy bleeding, dizziness, nausea/vomiting, diarrhea, and abdominal pain.
- Patients can take NSAIDs or acetaminophen for pain relief.
- A follow-up appointment is necessary within two weeks to confirm the completion of the abortion due to the risk of incomplete abortion.
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Description
This quiz covers key considerations in choosing contraceptives, focusing on the impact of economic disparities. It explores factors such as efficacy, convenience, cost, and accessibility, particularly in relation to women below the poverty level. By examining these considerations, participants will gain a better understanding of the complexities in contraceptive decision-making.
