20- contraception and sterilization Quiz

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Questions and Answers

What is one of the primary advantages of using condoms for contraception?

They provide effective contraception without hormonal side effects. (correct)

They can be used for an unlimited amount of time.

They require no medical prescription.

They are biodegradable and environmentally friendly.

What is a critical requirement for effective use of a diaphragm?

It must be inserted immediately before intercourse.

It can be used without any additional contraceptive methods.

A contraceptive jelly or cream must be applied before insertion. (correct)

It should only be used during the menstrual cycle.

What is the failure rate of spermicides when used alone for contraception?

10% per year

5% per year

20% per year

15% per year (correct)

What is essential for the effectiveness of the periodic abstinence method in preventing pregnancy?

Accurate prediction of ovulation. Signup and view all the answers

How long can a diaphragm be inserted before intercourse?

Up to 6 hours Signup and view all the answers

What are oral contraceptives primarily made of?

Estrogen and progestin Signup and view all the answers

Which of the following is NOT a form of spermicidal preparation?

Hormonal pills Signup and view all the answers

What happens to women's fertility during the menstrual cycle?

Women are typically fertile from ovulation to 2-3 days afterwards. Signup and view all the answers

What is the current range of ethinyl estradiol dosage in oral contraceptives?

15 to 35 μg Signup and view all the answers

Which of the following is NOT a known risk factor for enhancing VTE risk?

Varicose veins Signup and view all the answers

What is the relative risk of cervical cancer after 10 years of using oral contraceptives?

4 Signup and view all the answers

Which risk factor acts synergistically with age above 35 years for increased risk when using combination oral contraceptives?

Cigarette smoking Signup and view all the answers

What is a potentially rare condition that occurs among combination oral contraceptive users in the presence of specific risk factors?

Myocardial infarction Signup and view all the answers

What is the reported relative risk of breast cancer for current users of oral contraceptives compared to those who have never used them?

1.24 Signup and view all the answers

Which of the following should NOT be prescribed the combination oral contraceptive due to contraindications?

A 38-year-old woman with hypertension Signup and view all the answers

Which condition is a contraindication for using progestin-only contraceptives?

Active liver disease Signup and view all the answers

What is a common side effect associated with progestin-only contraceptives?

Irregular bleeding Signup and view all the answers

What risk factor is associated with an increased incidence of stroke among women in the reproductive age group?

Cigarette smoking Signup and view all the answers

What percentage of women using oral contraceptives may experience intermenstrual bleeding during the first few months?

10-20% Signup and view all the answers

What is a significant reason for the high failure rate of coitus interruptus as a contraceptive method?

Potential semen exposure before orgasm. Signup and view all the answers

Which of the following methods is considered ineffective and unreliable for contraception?

Postcoital douche. Signup and view all the answers

What hormone levels are reduced due to suckling in the lactational amenorrhea method?

Gonadotropin-releasing hormone, luteinizing hormone, and follicle-stimulating hormone. Signup and view all the answers

What is a common barrier to effective use of contraceptive methods?

Inadequate motivation and access. Signup and view all the answers

Which contraceptive method has the lowest cumulative pregnancy rates during the first six months of nursing?

Lactational amenorrhea. Signup and view all the answers

Which option is NOT considered a traditional method of contraception?

Diaphragm. Signup and view all the answers

What is the primary function of the male condom in contraception?

To cover the penis and block seminal fluid deposition. Signup and view all the answers

What is the primary active ingredient in combination oral contraceptives used for emergency contraception?

Levonorgestrel Signup and view all the answers

What is the average time frame within which the levonorgestrel-alone formulation should be administered to be effective?

5 days Signup and view all the answers

What is the most significant potential risk associated with the use of depot medroxyprogesterone acetate (DMPA)?

Reduction in bone mineral density Signup and view all the answers

Which of the following contraceptives releases etonogestrel and maintains its efficacy for up to 3 years?

Implants Signup and view all the answers

What is the perfect use failure rate for the copper T 380A IUD?

0.6 pregnancies per 100 woman-years Signup and view all the answers

Which progestin is classified as a first-generation progestin?

Norethindrone Signup and view all the answers

What is the primary reason the sequential oral contraceptive method has been abandoned?

Higher incidence of endometrial cancer Signup and view all the answers

Which regimen requires backup contraception for at least 7 days after initiation?

21-day use + 7 days placebo pills Signup and view all the answers

How does oral contraceptives primarily reduce the chance of pregnancy?

By changing cervical mucus consistency Signup and view all the answers

What is the approximate pregnancy rate attributable to method failure in women using oral contraceptives for 12 months?

15 per 1,134 women Signup and view all the answers

Which cancer risk is reduced by the use of oral contraceptives?

Endometrial cancer Signup and view all the answers

What effect do most current combination oral contraceptives have on the risk of venous thromboembolism (VTE)?

They roughly triple the risk Signup and view all the answers

Which of the following is not a benefit of using oral contraceptives?

Increased risk of ectopic pregnancy Signup and view all the answers

What commonly occurs in women during the first few cycles of extended use of oral contraceptives?

Irregular bleeding Signup and view all the answers

What is a significant adverse effect associated with desogestrel use in combination oral contraceptives?

Potential for higher venous thromboembolism risk Signup and view all the answers

Study Notes

Contraception and Sterilization

Unintended pregnancies have social and economic implications.
Approximately 40% of unintended pregnancies occur in women who do not want to get pregnant but do not use contraception.
Approximately 60% of unintended pregnancies occur in women using some form of birth control.

Learning Objectives

Contraceptive methods
Side effects and contraindications of contraceptive methods
Mechanism of action of oral contraceptives
Emergency contraceptive methods
Surgical sterilization

Problems

Inadequate motivation
Side effects
Access to contraceptive methods
Difficulty in using correctly

Methods of Contraception

Traditional methods: coitus interruptus, postcoital douche, lactational amenorrhea, periodic abstinence (rhythm or natural family planning)
Barrier methods: condoms (male and female), diaphragm, cervical cap, vaginal sponge, spermicides
Hormonal methods: oral contraceptives, injectable or implantable long-acting progestins. IUD and sterilization (tubal ligation or vasectomy) are also included

Coitus Interruptus

One of the oldest contraceptive methods
Involves withdrawal of the penis before ejaculation
Failure rate likely higher than most methods
Failure may result from semen escaping before orgasm or semen depositing on the external female genitalia near the vagina.

Postcoital Douche

Uses plain water, vinegar, or "feminine hygiene" products
The douche flushes semen out of the vagina. Additives to water may have spermicidal properties.
Sperm can be found in cervical mucus within 90 seconds of ejaculation.
Ineffective and unreliable method.

Lactational Amenorrhea

A highly efficient method for breastfeeding women.
Suckling reduces the release of gonadotropin-releasing hormone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH).
During the first 6 months of nursing, cumulative pregnancy rates are 0.9 to 1.2%.
At 12 months, pregnancy rates can be as high as 7.4%.

Male Condom

Serves as a cover for the penis during coitus to prevent semen deposition in the vagina.
Highly effective and inexpensive contraception
Provides protection against sexually transmitted infections (STIs).
Some condoms contain a spermicide.

Female Condom

Made of thin polyurethane material with two flexible rings at each end.
One ring fits inside the vagina and the other outside near the introitus.

Vaginal Diaphragm

A mechanical barrier between the vagina and cervical canal.
A contraceptive jelly or cream should be placed on the cervical side before insertion as the device is ineffective without it.
Can be inserted up to 6 hours before intercourse and should be left in place for at least 6-24 hours after intercourse.

Spermicidal Preparations

Vaginal jellies, creams, gels, suppositories, vaginal sponge, and foams.
Toxic effect on sperm.
Mechanical barrier to sperm entry into the cervical canal.
Can be used alone or with a diaphragm or condom.
Failure rate of approximately 15% per year when used alone.

Periodic Abstinence

Women are fertile for only a few days of the menstrual cycle.
The fertile period is from ovulation to 2-3 days thereafter.
Accurate prediction of ovulation is essential for the success of this method.
Studies report 1-year life-table pregnancy rates between 10 and 25 per 100 woman-years.

Oral Contraceptives

Provide an estrogen and a progestin.
Current ethinyl estradiol dose ranges between 15 and 35 µg.
Commonly used progestins include estranes (norethindrone and norethindrone acetate), gonanes (levonorgestrel), desogestrel and norgestimate, and spironolactone analogue (drospirenone).
Sequential method is no longer used due to higher endometrial cancer incidence.
Backup contraception recommended during the first week of the cycle to maximize efficacy.
Different regimens include 21-day use, 7-day interval; 21-day use + 7-day placebo pills; and 24-day use + 4-day placebo pills.
Backup contraception needed at least 7 days after initiation.
Extended use regimens (84-day, 126-day) are increasingly used.
Irregular bleeding is common, especially during the initial cycles.

Mechanisms of Oral Contraceptives

Change the consistency of cervical mucus, resulting in less sperm penetration.
Make the endometrial lining less receptive to implantation.
Alter tubal transport of both sperm and oocytes.

Advantages of Oral Contraceptives

Reduction of ovarian cancer risk (40-80%).
Reduction of endometrial cancer risk (50%).
Reduction of colorectal cancer risk.
Reduction of ectopic pregnancy risk (90%).
Reduction of pelvic inflammatory disease (PID) risk (50-80%).
Reduction of menstrual disorders.
Reduction of benign breast disease risk (30-50%).
Reduction of acne.
Reduction of bone mineral density loss.
Reduction in progression of rheumatoid arthritis.

Disadvantages and Side Effects of Oral Contraceptives

Use of most current combination oral contraceptives roughly triples a user's risk of venous thromboembolism (VTE) from approximately 3 to 9 events per 100,000 users annually.
Risk increased up to 7-fold with desogestrel.
Risk factors for VTE include recent leg trauma, pelvic surgery, stasis (but not varicose veins), and factor V Leiden mutation.
Myocardial infarction (MI) is rare but possible with oral contraceptives, especially in presence of risk factors such as hypertension, diabetes, severe dyslipidemia, and cigarette smoking.
Age above 35 years and smoking act synergistically to increase risk; thus, prescribing combination oral contraceptives to women over 35 who smoke is not recommended.
Stroke is rare during the reproductive years.
Risk factors include cigarette smoking, migraine, headaches, and hypertension; relative risk varies between 2-fold and 10-fold depending on the number of risk factors.
Cervical cancer risk increases with duration of use, with a relative risk of 4 after 10 years of use.
Breast cancer risk in current users compared with never users is 1.24.
Intermenstrual bleeding including breakthrough bleeding and spotting is seen in 10-20% of women.
Nausea may occur in up to 10% of users.
Significant headaches and weight gain are less frequent.

Contraindications

Pregnancy
Undiagnosed vaginal bleeding
Prior history of VTE, MI, or stroke
Active systemic lupus erythematosus
Uncontrolled diabetes
Hypertension
Cigarette smokers over age 35 years
Current or prior breast cancer
Active liver disease

Progestin-Only Pill

Ideal for women with estrogen contraindications.
Mechanism of action includes less permeable cervical mucus to sperm and altered endometrial activity.
Associated with side effects, particularly irregular bleeding.
Ideal candidates include older women who smoke; women with sickle cell anemia; women with mental retardation; women with migraine, headaches, hypertension, or systemic lupus erythematosus; or women who are breastfeeding.

Emergency Contraception

Postcoital/emergency contraception is used to prevent pregnancy after unprotected intercourse.
Methods include combination oral contraceptives containing progestin levonorgestrel, levonorgestrel tablets, and the copper T 380A IUD.
Many authorities recommend dosing within 72 hours, though effectiveness is possible up to 5 days.
The IUD may inhibit implantation or possibly interfere with sperm function.
The T 380A IUD is inserted within 7 days of unprotected intercourse.

Long-Acting Hormonal Contraceptives

Depot medroxyprogesterone acetate (DMPA) is used, with a 0.3 pregnancy per 100 woman-years failure rate within one year.
DMPA reduces endometrial cancer risk by 80% (in some women with endometriosis).
DMPA use does not increase arterial or venous disease risk but does reduce bone mineral density.
Long-term use can cause amenorrhea in up to 70% of users after 1 year. Return to baseline fertility after discontinuation can take up to 10 months.

Implants

Release etonogestrel, a desogestrel metabolite (which is effective for up to 3 years)
Vaginal Ring: Releases ethinyl estradiol and etonogestrel.
Transdermal Patch: Release norgestimate and ethinyl estradiol.

Intrauterine Devices (IUDs)

Two types available: copper T 380A and levonorgestrel-releasing IUD.
Mechanism of action is unknown, likely includes spermicidal activity, interference with normal development/fertilization of ova, and endometrium activity promoting phagocytosis of sperm or hindering sperm migration/capacitation.
Perfect use failure rate of the T 380A is 0.6 pregnancies per 100 woman-years.
Useful lifespan of T 380A IUD is 10 years.
Major risks include PID, ectopic pregnancy, spontaneous abortion, uterine perforation, and expulsion. The risk of PID is with insertion.
Risk of spontaneous abortion is 50% if an IUD user becomes pregnant with the device in place.
Expulsion is common in first few weeks of use (approximately 5%).

Sterilization

Sterilization is a permanent method of contraception.
The cumulative risk of regret over 14 years is 12.7%.
Postpartum sterilization can be performed during cesarean or vaginal delivery (2-3cm minilaparotomy in umbilical region).
Common techniques include Pomeroy and Parkland techniques.
Failure rates vary by procedure (7.5%-18.5%).

Hysteroscopic Microinsert Placement

Involves a fallopian tube implant with a delivery catheter.
The implant is a spring-like device (40mm in length and 0.8 mm in diameter).
Hysterosalpingogram should be performed 3 months after procedure to confirm fallopian tube closure.
Alternative contraception until tubal occlusion is documented is needed.
At 3 months after the procedure, 3.5% of patients didn't show tubal occlusion, but at 6 months, all women showed total occlusion.

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