Progestin-Only Contraceptives Quiz
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What is the primary mechanism of action of progestin-only contraceptives?

  • Inhibit ovulation (correct)
  • Increase cervical mucus production
  • Support fertilization
  • Enhance tubal motility

    • What is one of the noncontraceptive benefits of using Depo Provera?

  • Increased risk of ovarian cancer
  • Reduction of menstrual flow
  • Protection against endometrial cancer (correct)
  • Prevention of cervical cancer

    • How often must Depo Provera injections be administered?

  • Annually
  • Every 3 months (correct)
  • Every 6 months
  • Every month

    • Which of the following is a common side effect of Depo Provera?

    <p>Menstrual irregularities (C)</p> Signup and view all the answers

    What dosage of oral conjugated estrogen is typically administered for treatment?

    <p>1.25mg (B)</p> Signup and view all the answers

    What is a limitation of simply listing all contraceptive methods during counseling?

    <p>It does not consider the patient's reproductive health goals. (C)</p> Signup and view all the answers

    Which approach should be avoided when discussing contraceptive options with patients?

    <p>Assuming the patient's preferences are aligned with the provider’s. (B)</p> Signup and view all the answers

    What factor should be considered in patient-centered contraceptive counseling?

    <p>The patient's reproductive health goals and preferences. (C)</p> Signup and view all the answers

    What is an important aspect of creating a safe space in contraceptive counseling?

    <p>Listening actively to the patient. (D)</p> Signup and view all the answers

    Why is it essential to ask permission before providing information about contraceptive options?

    <p>To ensure the patient feels in control of their healthcare choices. (C)</p> Signup and view all the answers

    What is the average percentage of women who experience amenorrhea after one year of using certain contraceptive methods?

    <p>50-75% (A)</p> Signup and view all the answers

    What is the VTE risk associated with Twirla for women with a BMI greater than 30?

    <p>Lower effectiveness (C)</p> Signup and view all the answers

    Which contraception method is reusable and can be used for up to 13 months?

    <p>Annovera (A)</p> Signup and view all the answers

    If a contraceptive ring is expelled and reinserted more than 48 hours later, what should be done?

    <p>Use backup contraception for 7 days (A)</p> Signup and view all the answers

    What could occur if a woman exclusively breastfeeds for more than 6 months postpartum?

    <p>Unlikely to ovulate immediately (A)</p> Signup and view all the answers

    How long must women wait after delivery to start combined hormonal contraception to avoid VTE risk?

    <p>21 days (A)</p> Signup and view all the answers

    What is one of the mechanisms of action of progestin-only pills (POPs)?

    <p>Thin the endometrium (D)</p> Signup and view all the answers

    What is the expulsion rate for IUDs immediately postpartum?

    <p>10-40% (A)</p> Signup and view all the answers

    What is the primary mechanism of action for drosperinone in contraceptive use?

    <p>Ovulation suppression is the main mechanism of action. (C)</p> Signup and view all the answers

    What is the half-life of norethindrone?

    <p>7.7 hours (B)</p> Signup and view all the answers

    When should a dose of norethindrone be considered missed?

    <p>If it is taken more than 3 hours late. (A)</p> Signup and view all the answers

    Which of the following methods can be classified as true barrier contraceptives?

    <p>Condoms (D)</p> Signup and view all the answers

    What is the typical failure rate for condoms?

    <p>13% (C)</p> Signup and view all the answers

    How does Phexxi maintain lower vaginal pH?

    <p>By using lactic acid, citric acid, and potassium bitartrate. (C)</p> Signup and view all the answers

    Which fertility awareness method involves observing cervical secretions?

    <p>Billings/Creighton Methods (B)</p> Signup and view all the answers

    What is the Pearl index for Phexxi in terms of pregnancies per 100 users per year?

    <p>27.5 (B)</p> Signup and view all the answers

    Which of the following best describes the use of diaphragms and cervical caps?

    <p>They must be used with spermicide. (B)</p> Signup and view all the answers

    What should users do if they miss a dose of dorsperinone?

    <p>Take the missed pill as soon as possible and use backup contraception. (B)</p> Signup and view all the answers

    What does the symptothermal method involve tracking?

    <p>Basal body temperature and cervical mucus (A)</p> Signup and view all the answers

    Which of the following statements about the Natural Cycles app is true?

    <p>It is FDA cleared and calculates fertile days based on temperature. (C)</p> Signup and view all the answers

    What is a primary advantage of the fertility awareness method?

    <p>There are no side effects associated with it. (C)</p> Signup and view all the answers

    What is the typical use failure rate of the withdrawal method?

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

    What is a significant characteristic of the Copper or 52mg LNG IUD?

    <p>It can be used for immediate contraception after unprotected intercourse. (A)</p> Signup and view all the answers

    Which form of emergency contraception can be used up to 120 hours after unprotected intercourse?

    <p>UPA (C)</p> Signup and view all the answers

    Which hormone does UPA primarily target to delay or prevent ovulation?

    <p>Luteinizing Hormone (LH) (D)</p> Signup and view all the answers

    What should a user expect when utilizing the typical use of fertility awareness methods?

    <p>Variable effectiveness based on personal factors (A)</p> Signup and view all the answers

    What is the typical use failure rate of the Natural Cycles app?

    <p>6.5% (D)</p> Signup and view all the answers

    What does the symptothermal method recommend before engaging in intercourse?

    <p>Engage after three days of higher temperatures. (C)</p> Signup and view all the answers

    What is the primary mechanism of action for the Copper IUD?

    <p>Prevent sperm from fertilizing the egg through a foreign body effect (C)</p> Signup and view all the answers

    What potential side effect is common in the first 3-6 months of using the Copper IUD?

    <p>Heavier bleeding and cramping (D)</p> Signup and view all the answers

    Which of the following is a contraindication for using hormonal IUDs?

    <p>Distorted uterine cavity (D)</p> Signup and view all the answers

    What is the duration of effectiveness for the Skyla hormonal IUD?

    <p>3 years (B)</p> Signup and view all the answers

    What is the primary mechanism of action for Nexplanon?

    <p>Inhibit ovulation primarily and also inhibit fertilization (A)</p> Signup and view all the answers

    Which option describes a common bleeding pattern change associated with Nexplanon?

    <p>22% experience amenorrhea (A)</p> Signup and view all the answers

    What is the effectiveness rate of the hormonal IUD?

    <p>99% (B)</p> Signup and view all the answers

    Which screening is recommended before IUD placement?

    <p>Screening for gonorrhea and chlamydia (A)</p> Signup and view all the answers

    What distinguishes the hormonal IUD from the Copper IUD in terms of mechanism?

    <p>Hormonal IUD primarily thickens cervical mucus (C)</p> Signup and view all the answers

    Which is not a common side effect of the hormonal IUD?

    <p>Significant abdominal pain (A)</p> Signup and view all the answers

    What is the recommended backup method after IUD insertion if more than 7 days have passed since the last menstrual period?

    <p>Use condoms for 7 days (B)</p> Signup and view all the answers

    What effect does the hormonal IUD typically have on menstrual cycles after an initial period?

    <p>Decreases the severity of menstrual cramps (D)</p> Signup and view all the answers

    Which of the following factors is necessary for starting hormonal contraception?

    <p>Verification of non-pregnancy status (A)</p> Signup and view all the answers

    Study Notes

    Reversible Contraception

    • Jill Brown, MD MPH MHS FACOG, CAPT (R) USPHS, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University presented on reversible contraception.

    Objectives

    • Describe the mechanism of action of contraceptive methods
    • Discuss effectiveness, risks, and benefits of reversible contraceptive methods
    • Describe barriers to initiation and maintenance of different contraceptive methods
    • Familiarize with approach to non-directive counseling

    Mechanisms of Action

    • All contraceptives prevent fertilization
    • Incapacitates Sperm:
      • Copper IUD
    • Prevents Ovulation:
      • Hormonal Contraceptives (Combined)
        • Combined Oral Contraceptives (COCs)
        • Emergency Contraceptive Pills
        • Combined Hormonal Vaginal Rings
      • Hormonal Contraceptives (Progestin-only)*
        • Implants
        • Injectables
        • Progestin-only Pills (POPs)
        • Progestin-only Vaginal Rings
      • Lactation Amenorrhea Method (LAM)
      • Progestin-only hormonal methods have more than one mechanism of action.
    • Thickens Cervical Mucus:
      • Hormonal Contraceptives (Progestin-only)*
      • Hormonal IUDs
      • Implants
      • Injectables
      • Progestin-only Pills (POPs)
      • Progestin-only Vaginal Rings
    • Blocks Sperm
      • Male Condoms
      • Female Condoms

    Hormonal Contraception Mechanisms

    • The presentation discussed the hormonal cycles, specifically the follicular and luteal phases, FSH, LH release, and follicle development.
    • Estrogen and Progesterone play critical roles in the ovarian cycle and uterine cycle, leading to ovulation and preparation for implantation.
    • Progesterone inhibits mid-cycle LH release and ovulation.

    Comparing Contraceptive Methods

    • Effectiveness is tiered, with implants and vasectomy as the most effective, and condoms and withdrawal as less effective
    • Methods with higher effectiveness have lower pregnancy rates per 100 users in one year (Pearl Index).

    IUD Considerations

    • Screen for GC/CT before or at placement if screening is not current or risk factors are present.
    • Do not delay insertion for results; can treat if comes back positive.
    • Development of Pelvic Inflammatory Disease (PID)
    • Treat PID and leave IUD in place
    • Consider IUD removal if not improving
    • Pregnancy
    • Ectopic - IUD can generally be left in place
    • Intraueterine IUD should be removed.

    LARCS-Copper IUD

    • Non-hormonal
    • Primary mechanism prevents sperm from fertilizing the egg; foreign body effect of plastic frame and copper are toxic to sperm.
    • 99% effective
    • Lasts 10-12 years
    • Heavier bleeding and cramping common first 3-6 months, decreasing with use.

    LARCS - Hormonal IUDs (Levonorgestrel)

    • Progestin only; mainly local effect on uterus
    • Mechanism of action: primarily prevent fertilization; foreign body effect from plastic frame and hormonal effect -> thicken cervical mucus, suppress endometrium.
    • 99% effective
    • Lighter, shorter periods, or amenorrhea
    • Irregular spotting common first 3-6 months.

    Hormonal IUDs Types

    Numerous types of hormonal IUDs, differing in duration of use and total progestin, initial progestin/day release, length of progestin, device diameter, and amenorrhea rates after one year.

    Nexplanon (Etonogestrel Implant)

    • Progestin only
    • Mechanism of action: primary = inhibit ovulation, secondary = inhibit fertilization by causing changes in cervical mucus and tubal motility unfavorable to sperm.
    • 99% effective
    • FDA approved for 3 years; data showing effectiveness for up to 5 years; placed inner upper arm, no pelvic exam needed.

    Depo-Provera (Depot-Medroxyprogesterone Acetate)

    • Progestin only
    • Mechanism of action: primary = inhibit ovulation, secondary = inhibit fertilization by causing changes in cervical mucus and tubal motility unfavorable to sperm, given by injection
    • IM 150mg (upper arm or buttock)
    • SUBQ 104mg (anterior thigh or abdomen)
    • Discrete, safe, effective (99% perfect use, 94% typical use)
    • Requires office visit
    • Non-contraceptive benefits (protection from ovarian cancer, endometrial cancer, salpingitis, ectopic pregnancy, benign breast disease, acne, and iron deficiency)
    • Side effects: menstrual irregularities (irregular bleeding; ~8% discontinuation); weight gain; delay in return to fertility up to 18 months (median 10 months); bone mineral density decreased.

    Depo and Bone Mineral Density

    • Greatest loss in first 1-2 years of use, then plateaus.
    • DMPA does not reduce peak bone mass or increase osteoporotic fracture risk later in life.
    • Skeletal health concerns should not limit duration of use of DMPA.

    Combined Hormonal Contraceptives (CHCs)

    • Pill, patch, ring
    • Estrogen and progestin - many different formulations
    • 20 to 35 mcg of ethinyl estradiol most common
    • Individual progestin potencies, androgenicity, and side effects vary
    • Perfect use failure 0.3%, typical use 7%

    Progestin Classification

    • Various progestin types with differing potencies, androgenic effects, and generations.

    Progestin and VTE Risk

    • Various progestin types and their risk of venous thromboembolism (VTE).

    CHCs (cont.)

    • Degree of androgenic differences between different formulations is not clinically significant.
    • Multiphasic dosing is introduced to provide lower hormone dosage earlier in the month but doesn't provide a significant advantage over monophasic dosing.
    • Can use cyclically or continuously.
    • Mechanisms of action to inhibit ovulation, suppress FSH and LH, and affect cervical mucus

    Transdermal Patch

    • Xulane (ethinyl estradiol and norelgestromin - EE/N) or Twirla (ethinyl estradiol and levonorgestrel - EE/LNG)
    • Weekly application
    • Application site issues may occur; average EE concentrations are higher in patch users than in pill users.
    • Risk of VTE may be present in some formulations, and risk increases with BMI > 30.

    Vaginal Ring

    • Nuvaring (etonogestrel/ethinyl estradiol ring); and
    • Annovera
    • Reusable over time; Can stay in place during intercourse
    • Unplanned removal may require backup contraceptive method.

    Postpartum Contraception

    • Ability to ovulate as soon as four weeks following delivery; unlikely to ovulate for first six months if breastfeeding
    • Timing of initiation important, breastfeeding, birth spacing
    • Non-estrogen-containing contraceptive methods can be started promptly post delivery
    • Delay in CHC start varies by expert committee guidance (6 weeks, some later)
    • IUD expulsion rate higher immediately postpartum.

    Progestin-only Pills (POPs)

    • Norethindrone (0.35mg) and drosperinone (4mg)
    • Actions include thickening cervical mucus, suppressing ovulation, suppressing FSH and LH, and thinning endometrium.
    • Norethindrone POPs don't consistently suppress ovulation; drosperinone does
    • POPs have short half-life; it is critical to take them at the same time each day.
    • Missed doses require taking the missed pill immediately and using backup for 2 days until regular schedule resumes

    POPs (cont.)

    • Doses missed if more than 3 hours late should be addressed with immediate administration and backup to time.

    Pericoital Contraception (Condons, Diaphragm, Cervical Cap, Sponge, Phexxi)

    • Nonhormonal reversible methods used at the time of intercourse
    • Condoms, diaphragms, cervical caps, sponges, and Phexxi are considered barrier contraceptives.
    • Use with spermicide can further reduce risk of cervical and upper genital infection.
    • Failure rates are higher than for hormonal methods and IUDs.

    Phexxi

    • Vaginal pH regulator gel
    • Maintain lower vaginal pH to immobilize sperm
    • Single-use applicators
    • Pearl Index 27.5 pregnancies per 100 users per year.

    Fertility Awareness Methods

    • Avoid intercourse during the fertile period (5 days before ovulation to 24 hours after);
    • Standard Days, Cervical mucus, TwoDay method, Billings/Creighton
    • Symptothermal method: monitor cervical mucus and basal body temperature.

    Natural Cycles App

    • FDA-cleared app that calculates fertile days based on daily body temperature readings.

    Fertility Awareness (cont.)

    • Main advantage is lack of side effects.
    • Relative contraindications include irregular cycles, pregnancy interruption of cycle, inability to track physiological changes, and lacking support.

    Withdrawal

    • Commonly used, either as sole method or in combination.
    • No cost and no side effects.
    • Less effective than other methods.

    Emergency Contraception (EC)

    • IUD: Most effective, not impacted by BMI; can use either copper or LNG 52mg; visit required for insertion, Provides ongoing contraception; no backup needed
    • Medication: Less effective than IUD; Can use up to 120 hrs; Requires Rx; Must wait 5 days before starting hormonal BC; Can use up to 72 hrs; Available OTC in many places; Can start hormonal BC at same time.

    Emergency Contraception (cont.)

    • Copper or LNG-containing IUDs prevent implantation of the egg if fertilization has occurred.
    • UPA (progesterone receptor modulator) lowers LH levels to prevent ovulation.

    How do we talk about contraception?

    • Listing all methods; Promoting certain methods

    Limitations

    • Listing all methods may not elicit patients' goals and preferences
    • Promoting certain methods may be based on healthcare provider preferences or assumptions.

    Patient-Centered Contraceptive Counseling

    • Full range of options
    • Patient preferences
    • Maximize access

    Additional Notes

    • The slides presented various contraceptive methods with their pros and cons, mechanisms of action, and considerations.
    • Important factors like patient preferences, side effects, and effectiveness should be discussed and considered when counselling patients.

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    Contraception Lecture PDF

    Description

    This quiz tests your knowledge on progestin-only contraceptives, focusing on their mechanism of action, benefits, side effects, and dosages. Prepare to evaluate your understanding of Depo Provera and its clinical applications.

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