Contraceptive Counseling Methods

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Questions and Answers

What is a benefit of using progestin-only methods in perimenopausal women?

Reduces vasomotor symptoms (correct)

Decreases the risk of ovarian cancer

Increases the risk of venous thromboembolism

Increases LDL cholesterol levels

What is a non-contraceptive benefit of Copper and LNG 52 IUDs?

Helps with menstrual cramps (correct)

Reduces the risk of dysmenorrhea

Reduces the risk of acne

Increases the risk of ectopic pregnancy

Which of the following is a risk factor for decreased efficacy of Ulipristal acetate (Ella)?

BMI < 25

Diabetes mellitus

Hypertension

BMI > 35 (correct)

What is an important patient education point when prescribing Ulipristal acetate (Ella)?

Pump and dump for 24 hours after taking Ulipristal acetate Signup and view all the answers

What is the recommended action if no menses occur within 3 weeks of starting hormonal contraception?

Perform a pregnancy test Signup and view all the answers

What is a management strategy for unscheduled bleeding in CHC users?

Take a hormone break or increase the dose of estrogen Signup and view all the answers

What is a benefit of progestin in contraceptive hormones?

Thicken cervical mucus and prevent ovulation Signup and view all the answers

What is a non-contraceptive benefit of hormonal IUDs?

Reduction of cervical cancer Signup and view all the answers

What is a risk or adverse effect of the implant contraceptive method?

Irregular bleeding Signup and view all the answers

What should a patient be educated about when using the implant contraceptive method?

Bleeding irregularities are common and will improve within 3-6 months Signup and view all the answers

What is a characteristic of the implant contraceptive method?

It is highly effective and long-term Signup and view all the answers

What is the action of estrogens in contraceptive hormones?

Decrease FSH and maintain endometrium Signup and view all the answers

What is a benefit of hormonal IUDs?

Helps with dysmenorrhea and endometriosis symptoms Signup and view all the answers

What is the purpose of the PATH questions in contraceptive counseling?

To determine the patient's attitudes towards parenting and pregnancy Signup and view all the answers

What is one of the primary non-contraceptive benefits of using combined oral contraceptives?

Reduces symptoms of endometriosis Signup and view all the answers

Which of the following describes patient education regarding the Copper IUD?

Use a backup method for 7 days after insertion Signup and view all the answers

What is a disadvantage of the Copper IUD?

Minor procedure requirement with increased risk for PID Signup and view all the answers

After the insertion of an IUD, what is recommended for managing cramping?

Continue taking NSAIDs as needed Signup and view all the answers

What effect does the Copper IUD have on sperm motility?

Decreases sperm motility Signup and view all the answers

Which contraceptive method has a risk associated with users having a BMI greater than 30?

The patch Signup and view all the answers

What is one common expectation for bleeding after the insertion of an IUD?

Bleeding may worsen for the first 3-6 months Signup and view all the answers

Which of the following methods is cited as being able to function as an emergency contraceptive?

Copper IUD Signup and view all the answers

A 25-year-old female presents for a routine pap smear. Her last pap smear was 1 year ago and was normal. Which of the following is the MOST appropriate screening recommendation for this patient?

Repeat pap smear in 1 year Signup and view all the answers

A 35-year-old female presents for a routine pap smear. Her last pap smear was 3 years ago and was normal. Which of the following is the MOST appropriate screening recommendation for this patient?

Repeat pap smear in 3 years Signup and view all the answers

A 22-year-old female presents with an abnormal pap smear. She is diagnosed with high-risk HPV. Which of the following is the MOST appropriate next step in management?

Colposcopy Signup and view all the answers

A 40-year-old female presents with an abnormal pap smear. She is diagnosed with high-risk HPV. Her reflex test for HPV 16/18 is positive. Which of the following is the MOST appropriate next step in management?

Colposcopy Signup and view all the answers

A 28-year-old female presents for a routine pap smear. She has had 3 consecutive normal pap smears in the past 3 years. Which of the following is the MOST appropriate screening recommendation for this patient?

Repeat pap smear in 3 years Signup and view all the answers

Which of the following is a TRUE statement regarding colposcopy?

Colposcopy is used to identify precancerous and cancerous lesions Signup and view all the answers

What percentage of cases of squamous cervical neoplasia are attributed to HPV 16?

60% Signup and view all the answers

Which of the following is a risk factor for persistence of HPV infection?

Cigarette smoking Signup and view all the answers

What is the recommended screening method for women aged 25-65 years according to the ACS guidelines?

Primary HPV test alone every 5 years Signup and view all the answers

What is the next step in management for a patient with an ASCUS pap result in the 21-24 year-old age group?

No further testing or evaluation needed Signup and view all the answers

How many FDA-approved primary HPV tests are available?

2 Signup and view all the answers

What is the purpose of reflex to 16, 18/45 in cotest Pap?

To test for genotypes if hrHPV is positive Signup and view all the answers

Which of the following is a risk factor for cervical cancer?

Coitarche < 25 years Signup and view all the answers

According to the USPSTF guidelines, what is the recommended screening method for women aged 30-65 years?

All of the above Signup and view all the answers

Which of the following is TRUE regarding the relationship between HPV and cervical cancer?

High-risk HPV infection is a necessary factor for the development of squamous cervical neoplasia. Signup and view all the answers

Which of the following HPV genotypes is responsible for the highest percentage of cervical cancer cases?

HPV 16 Signup and view all the answers

A patient presents with a history of HIV infection. This patient is considered to be at ______ risk for persistent HPV infection.

increased Signup and view all the answers

At what age can HIV-infected and immunocompromised individuals start with cytology alone?

Within 1 year of onset of sexual activity or within 1st year of HIV diagnosis, no later than 21 Signup and view all the answers

Which of the following age groups is most likely to effectively clear HPV infection within 8-24 months?

18-25 years old Signup and view all the answers

According to the ACS guidelines, what is the recommended screening frequency for women aged 25-65 years using the primary HPV test alone?

Every 5 years Signup and view all the answers

What is the goal of colposcopy?

To identify precancerous and cancerous lesions Signup and view all the answers

What is the significance of acetic acid in colposcopy?

It improves visualization of abnormal areas, which appear white Signup and view all the answers

A 23-year-old woman presents with an ASCUS pap result. Which of the following is the MOST appropriate next step in management?

No further action is required Signup and view all the answers

What is the recommended action for a patient under 29 with a high-risk HPV diagnosis?

Do not routinely check for HPV Signup and view all the answers

A 32-year-old woman presents for a routine Pap smear. Her last Pap smear was 3 years ago and was normal. Which of the following is the MOST appropriate screening recommendation for this patient?

All of the above are appropriate Signup and view all the answers

A 45-year-old woman presents with a positive primary HPV test result. She is unable to undergo reflex cytology from the same sample. What is the MOST appropriate next step in management?

Colposcopy plus cytology Signup and view all the answers

What is the recommended screening method for women aged 30-65 years?

Cytology and HPV cotesting Signup and view all the answers

Why do we re-check yearly for high-risk HPV?

Because it is transient Signup and view all the answers

Study Notes

Contraceptive Counseling

Most effective contraceptive method is one that the patient will consistently use.
Essential to take a thorough medical and family history before prescribing contraceptives.
Utilize U.S. Medical Eligibility Criteria for assessing suitability based on conditions such as heart disease, VTE, CVA, liver disease, gallbladder disease, migraines with aura, hypertension, clotting disorders, and cancer.

PATH Questions

PA: Parenting/Pregnancy Attitudes
T: Timing for wanting to have children.
H: Importance of preventing pregnancy until the desired time.

Hormonal Contraceptives

Progestins: Functions by thickening cervical mucus, preventing ovulation (inhibiting gonadotropin release), and suppressing endometrial activity.
Estrogens: Decrease FSH levels and help maintain the endometrium, reducing breakthrough bleeding.

Highly Effective Contraceptives

Implant:
- Contains 68 mg etonogestrel; offers high effectiveness and long-term use.
- Fertility resumes rapidly post-removal; can be used during breastfeeding.
- Alleviates symptoms of dysmenorrhea and endometriosis, reduces PID risk.
- Causes irregular bleeding, especially during the first year; requires a minor procedure.
Hormonal IUDs:
- Inhibit fertilization and prevent implantation; highly effective and long-term use.
- Benefits include rapid fertility return, and management of heavy menstrual bleeding, dysmenorrhea, and reducing risks for endometrial hyperplasia, PID, and cervical cancer.
- Change in menses and other side effects may occur; no protection against STDs.
- Urine pregnancy test needed if no menses in 3 weeks post-use.

Emergency Contraception

Ulipristal Acetate (Ella): Effective up to 120 hours post-intercourse but less effective for BMI over 35; side effects include HA, dysmenorrhea, and nausea.
Copper and LNg 52 IUDs: Best for obese individuals, effective if inserted within 5 days (120 hours).

Special Populations

Perimenopause: Combined hormonal contraceptives (CHC) can ease vasomotor symptoms if no other risks are present; progestin-only methods and copper IUDs are also acceptable.
Immigrants: Require tailored contraceptive counseling that considers cultural and individual factors.

Managing Adverse Effects

Unscheduled Bleeding:
- For CHC users, consider reassurance and hormone adjustments; smoking cessation recommended.
- Depo and implants may require reassurance as side effects normalize in 3-6 months; NSAIDs suggested.
Post-Procedure Care: Advisories include avoiding vaginal contact for 24 hours, managing cramping, and scheduling follow-up visits.
Copper IUD: Nearly 99% effective for 12 years, functions as emergency contraception; may initially cause heavier bleeding and dysmenorrhea.

Other Effective Contraceptives

Combined Oral Contraceptives (the Pill): Available in various formulations, effective and convenient.
Patch: Contraindicated for women with BMI over 30; effective for 7 days.
Ring: New ring inserted monthly, effective up to 35 days.
Shot (Depo-Provera): Administered every 12-14 weeks, effectively reduces heavy menstrual bleeding and endometriosis symptoms, with various additional health benefits.

HPV and Cervical Cancer

High-risk HPV is required for squamous cervical neoplasia development but is not solely sufficient.
HPV infection can be transient or persistent, impacting cancer risk.

HPV Types and Prevalence

HPV 16 and 18 are the most common types, causing about 75% of HPV-related cancers.
HPV 16 is associated with 60% of cases, while HPV 18 accounts for another 15%.
Twelve other HPV types contribute to the remaining cases.

Factors Leading to HPV Persistence

Cigarette smoking increases the risk of persistent HPV infection.
A compromised immune system, including HIV infection, raises the likelihood of HPV persistence.
Infection at an age greater than 30 years increases the risk; young individuals often clear the virus within 8-24 months.

Risk Factors for Cervical Cancer

Early coitarche before age 25 may elevate cancer risk.
Cytology testing does not include HPV testing unless ordered reflexively for atypical squamous cells of undetermined significance (ASCUS) in those over 25 years.

Cervical Cancer Screening Tests

Co-testing with Pap smear and hrHPV testing is conducted using liquid-based cytology.
Reflex HPV testing is performed only if the cytology is ASCUS in women over 25.
Two FDA-approved primary hrHPV tests exist, using the same collection method as a liquid Pap.

Cervical Cancer Screening Guidelines

ACS recommends starting screening at age 25, with options for primary HPV testing every 5 years or co-testing/cytology alone every 3 years for women aged 25-65.
USPSTF suggests starting at age 21, recommending cytology alone every 3 years for those aged 21-29, and various screening options for ages 30-65.

Management of ASCUS Results

For women aged 21-24 with ASCUS, no reflex HPV testing is required.

Special Populations Screening

HIV-infected individuals should start cytology testing within a year of sexual activity or HIV diagnosis, no later than age 21.
Those under 30 with normal Paps should repeat cytology in 1 year, transitioning to every 3 years after three consecutive normal results.
Individuals over 30 can use cytology or co-testing, with co-testing switching to every 3 years after one negative test.

Colposcopy Insights

Colposcopy uses an illuminated, magnified view to identify precancerous and cancerous lesions.
Acetic acid enhances visualization of abnormal areas, making them appear white for easier biopsy.

Important Reminders

High-risk HPV can be transient or chronic, necessitating annual re-checks.
Routine HPV testing is not conducted for individuals under 29.
Follow the appropriate algorithm based on the original abnormal Pap result; positive hrHPV findings should lead to genotype testing (16/18) and potentially a colposcopy.