Term
| How do serum levels of FSH and LH change througout the menstrual cycle of a woman on combined medication? |
|
Definition
| There is no rise in either LH or FSH |
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Term
| How do serum levels of FSH and LH change throughout the menstrual cycle of a woman on sequential medication? |
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Definition
| LH rises irregularly during estrogen treatment, progesting causes another LH surge. FSH remains low throughout. |
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Term
| How do serum levels of FSH and LH change throughout the menstrual cycle of a woman on progestin-only contraceptives? |
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Definition
| FSH levels are unchanged throughout the cycle, several LH surges may occur. |
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Term
| How does the risk of VTE change under oral contraceptive treatment? |
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Definition
| Increased from 3 to 6 per 100,000 users annually |
|
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Term
| How does the risk of MI increase in smoking women taking oral contraceptives? |
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Definition
| There is a 20- to 30-fold increase in the risk of MI. However, this still amounts to 500-600 per million woman years. |
|
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Term
| Name 6 contraindications to the use of oral contraceptives |
|
Definition
1. Undiagnosed vaginal bleeding
2. Prior history of VTE, MI or stroke
3. Increased risk for cardiovascular events (e.g. active SLE, uncontrolled DM or HTN, sickle cell anemia)
4. Smokers > 35 years old
5. Current or prior breast cancer
6. Active liver disease |
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Term
| How do oral contraceptive affect the risk of breast cancer? |
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Definition
| Relative risk of 1.24, persists for 10 years after discontinuation of the drug |
|
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Term
| How do oral contraceptives change the risk of cervical cancer? |
|
Definition
| Relative risk of 4 after 10 years' use |
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Term
| What percentage of women will experience intermenstrual bleeding when taking oral contraceptives? |
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Definition
| 10-20% of women experience them in the first 6 months of use. |
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Term
| How should the progestin-only pill be taken? |
|
Definition
| Every day at the same time. A delay of as little as 2-3 hours reduces effectiveness for 48 hours. |
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Term
| What is the protocol for administration of levonorgestrel as emergency contraception? |
|
Definition
| Two doses given 12 hours apart, the first within 72 hours of intercourse (some studies suggest effectiveness up to 5 days post-coitus) |
|
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Term
| What are the three regimens for emergency contraception? |
|
Definition
1. Levonorgestrel + estrogen
2. Levonorgestrel only
3. Copper T 380A IUD |
|
|
Term
| How soon after unprotected sex should the T 380A IUD be inserted to be effective as emergency contraception? |
|
Definition
|
|
Term
| What are three health benefits seen in women using DMPA (long-term contraception)? |
|
Definition
Decreased risk of endometrial cancer (by 80%)
Lower frequency of sickle cell crises (by 70%)
Some patients with endometriosis have improvement of symptoms |
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|
Term
| How long after ceasing DMPA treatment does fertility return? |
|
Definition
|
|
Term
| What is the major risk of DMPA therapy? What are some other side effects? |
|
Definition
Bone mineral loss
Other possible side effects include depression, mood swings, irregular bleeding in the first 6 months. |
|
|
Term
| What are the five side-effects/complications of the copper IUD? |
|
Definition
1. PID - at insertion
2. Ectopic pregnancy - 5-8% of pregnancies with an IUD are ectopic, but risk still reduced compared to no contraception at all
3. Spontaneous abortion - ~50%
4. Uterine perforation - 1-2:1000 insertions
5. Expulsion - 5%, during the first few weeks |
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|
Term
| Which adverse event associated with the copper IUD is not seen in the levonorgestrel-releasing IUD? |
|
Definition
|
|
Term
| What is the risk of an ectopic pregnancy in levonorgestrel-releasing IUD? |
|
Definition
| 50% of pregnancies are ectopic, however, risk still less than using no contraception at all |
|
|
Term
| How should a woman with an IUD with missing strings be managed? |
|
Definition
If they cannot be seen even with gentle probing of the endocervix, order a pregnancy test and TVUS.
Intraperitoneal IUDs should be removed operatively. |
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|
Term
| What are three common regimens of medical induced abotion? |
|
Definition
Mifepristone plus misoprostol
Misoprostol only
Methotrexate plus misoprostol |
|
|
Term
| How soon after the first day of last menstrual period can medical abortion be induced? |
|
Definition
|
|
Term
| How should a woman with a medically induced abortion be followed? |
|
Definition
| Follow-up with U/S after 24 hours. If abortion has not occured - repeat misoprostol dose and F/U after 4 weeks. If abortion has still not occured - proceed to suction curretage. |
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