29 Questions
Which class of progestins do norethindrone and norethindrone acetate belong to?
Estranes
Which progestin in the estranes category is mentioned to have more estrogenic activity compared to other progestins in the same class?
Ethynodiol diacetate
What is the class of progestins that include norgestrel and levonorgestrel?
Gonanes
Drospirenone is related to which other compound mentioned above?
Spironolactone
Which compound derived from drospirenone is mentioned as having antiandrogenic activity?
Cyproterone acetate
In monophasic COCs, drospirenone is estimated to have an antiandrogenic activity equivalent to how much spironolactone?
25 mg
Which type of cancer is NOT associated with reduced risk with COC use?
Cervical cancer
What is the likely risk factor for chlamydia infections in women using COCs?
Sexual exposure
Which of the following STIs is NOT associated with COC use?
Human immunodeficiency virus
What is the impact of COC use on pelvic inflammatory disease (PID)?
No correlation
Which of the following is a potential benefit of COC use?
Reduced risk of ovarian cancer
What is the correlation between COC use and bacterial vaginosis?
Variable results
Which generation of progestins used in combined oral contraceptive pills includes Norethindrone acetate?
First generation
Which progestin, listed in the text, has a distinct classification from others?
Cyproterone acetate
Which one of these progestins is NOT classified under the second generation?
Norgestimate
Which progestin belongs to the first generation but NOT to the second generation?
Norethynodrel
According to the information, which generation of progestins includes Gestodene?
Third generation
Under what circumstances can a provider be reasonably certain that a patient is not pregnant?
If the patient has no symptoms or signs of pregnancy and meets any of the specified criteria
What is the typical timeframe for a patient to return for the contraceptive implant after receiving a single injection of DMPA?
Within 5 days of the first day of her next menstrual period
What is the primary reason for offering a single injection of DMPA before the contraceptive implant?
To avoid the need for implant removal if the repeat urine pregnancy test is positive
According to the Quick Start Algorithm for Hormonal Contraception, what is an indication that a patient is not pregnant?
The patient is within 7 days from the first day of menstrual bleeding
What is a reliable method of contraception, according to the text?
Correctly and consistently using a reliable method of contraception
What is the purpose of the checklist used to assess the possibility of pregnancy?
To rule out pregnancy in a patient
What additional contraception is required if two or more consecutive hormonal pills are missed?
Backup contraception, such as male or female condoms is needed
What happens to the risk of ovulation if two or more pills are missed?
The risk of ovulation is increased
When should emergency contraception be used if pills were missed in the first week of the cycle?
If unprotected intercourse occurred during this week
What happens if pills were missed in the last week of hormone pills?
The patient should finish that last week of hormone pills, then skip week 4, and immediately move on to a new pill pack the next day
Which of the following statements is true regarding the use of progestin-containing contraceptives at the same time as ulipristal acetate?
It decreases the efficacy of ulipristal acetate
What happens if one pill is missed?
No additional contraception is required
Study Notes
Quick Start Algorithm for Hormonal Contraception
- Providers may offer a single injection of DMPA and ask the patient to return for the implant within 5 days of the first day of her next menstrual period to avoid the need for implant removal if the repeat urine pregnancy test is positive.
Pregnancy Assessment
- A provider can be reasonably certain that a patient is not pregnant if she has no symptoms or signs of pregnancy and meets any of the following criteria:
- Has not had intercourse since last normal menses.
- Has been correctly and consistently using a reliable method of contraception.
- Is within 7 days from the first day of menstrual bleeding.
Contraceptives and Cancer
- COC use is associated with a slightly increased risk of developing cervical cancer.
- COC use is associated with a reduced risk of developing ovarian and endometrial cancers.
Contraceptives and STI Acquisition
- COC use positively correlates with chlamydia infections but not with gonorrhea, herpes simplex virus-2, trichomoniasis, syphilis, and human papillomavirus.
- COCs may be associated with increased rates of chlamydia, but not with pelvic inflammatory disease (PID).
Missed Pills
- If one pill is missed, the patient can take the missed pill as soon as possible and continue with the usual regimen.
- If two or more pills are missed, the remaining pills should be taken at the usual time, and backup contraception is generally needed.
- If two or more pills are missed in the first week of the cycle and unprotected intercourse occurs, use of emergency contraception may be necessary.
Progestins
- There are different classes of progestins, including estranes (e.g. norethindrone, norethindrone acetate), gonanes (e.g. norgestrel, levonorgestrel), and antiandrogenic progestins (e.g. drospirenone, dienogest, cyproterone acetate).
- Antiandrogenic progestins have some antiandrogenic activity and are sometimes referred to as fourth-generation progestins.
- Drospirenone is a weak antiandrogen that has progestogenic, antiandrogenic, and anti-mineralocorticoid activity.
Explore the varying risks of breast, cervical, ovarian, and endometrial cancers associated with the use of Combined Oral Contraceptives (COCs). Delve into the detailed presentation of these issues and their impact on cancer development.
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