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50 Cards in this Set
- Front
- Back
What are subsequent fertility rates following treatment for ectopic?
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Pt w/ previous term pregnancy: 80%
Nulliparous: 40% Ruptured: 65% Unruptured: 82% |
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What contraceptions methods are available in the U.S.? (7)
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1) Abstinence, withdrawal, rhythm
2) Permanent sterilizatiojn 3) Hormonal 4) IUD 5) Barrier 6) Spermicide 7) Emergency contraception |
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What are the various hormonal methods of contraception available in the U.S.? (5)
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1) OCPs: combos and progestin-only
2) Injectibles: Depot medroxyprogestesterone acetate & Lunelle (E2 cypionate + medroxyprogesterone) 3) Implant: Norplant (6 levonorgestrel rings) 4) Vaginal ring: Nuvaring (ethinyl E2 + etonorgestrel 5) Transdermal patch: Evra (ethinyl E2 + norgestimate) |
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What are the options for barrier methods in the U.S.? (3)
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1) Diaphragm
2) Cervical cap 3) Condoms (female and male) |
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What are the options for IUD in the U.S.? (2)
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1) Mirena: levonorgestrel
2) Paraguard: copper |
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With no contraception, what % of women will get pregnant in 1 yr?
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85%
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With spermicide only, what % of women will get unintended pregnancy in 1 yr?
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26%
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With "rhythm" method, what % of women will get unintended pregnancy in 1 yr?
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25%
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With female condoms, what % of women will get unintended pregnancy in 1 yr?
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21%
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With diaphragm/cervical cap, what % of women will get unintended pregnancy in 1 yr?
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20%
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With withdrawal method, what % of women will get unintended pregnancy in 1 yr?
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17%
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With male condoms, what % of women will get unintended pregnancy in 1 yr?
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14%
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With progestin-only OCPs, what % of women will get unintended pregnancy in 1 yr?
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7%
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With combo OCPs, what % of women will get unintended pregnancy in 1 yr?
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5%
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With vaginal ring, what % of women will get unintended pregnancy in 1 yr?
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1.2%
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With IUD, what % of women will get unintended pregnancy in 1 yr?
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0.8
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With transdermal patch, what % of women will get unintended pregnancy in 1 yr?
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0.7
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With tubal ligation, what % of women will get unintended pregnancy in 1 yr?
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0.55
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With depo-provera, what % of women will get unintended pregnancy in 1 yr?
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0.3
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With vasectomy, what % of women will get unintended pregnancy in 1 yr?
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0.15
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With norplant, what % of women will get unintended pregnancy in 1 yr?
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0.05
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What are the estrogenic effects of OCPs? (1)
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suppress FSH and LH -> inhibit ovulation
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What are the progesterone effects of OCPs? (5)
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1) Suppress LH
2) Thicken cervical mucous 3) May inhibit sperm capacitation 4) Produce decidualized endometrium with exhausted & atrophic glands 5) Alter uterus & fallopian tube motility |
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Association btw OCPs and MI?
OCPs and stroke? |
1) Weak association (RR=0.9-2.5) is current use, NONE for past use. Smoking is independent RF for MI & OCPs + smoking can increase risk of MI
2) Historical link btw high-dose OCPs; but no consistent, strong link btw them with modern dosages. *Women with other independent RFs (smoking, DM) may have slightly increased stroke risk while on OCPs |
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Association btw OCPs and DVTs?
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Slightly increased risk for 2nd and 3rd generation (~3fold vs ctrl), but this is less than risk of DVTs with pregnancy
*Factor V Leiden mutation in 3-5% of caucasians seems to be responsible for most of the DVTs... |
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What is role of combo OCPs in treatment of hyperandrogenism?
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Suppresses ovarian, adrenal, & peripheral androgen metabolism.
Estrogen part increases SHBP and blocks 5α-reductase -> less DHT |
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What is role of OCPs in treatment of menstrual disorders? (3)
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1) Can treat primary dysmenorrhea (use if NSAIDs are ineffective)
2) Can treat heavy or inter-menstrual bleeding (restore endometrial synchrony) 3) Acute menorrhagia: high doses for 3-4d then taper |
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What is role of OCPs in treatment of endometriosis?
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Reduce pelvic pain
Long-term suppression after initial medical or surgical therapy |
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What is role of OCPs in treatment of hypoestrogenic states? (3)
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1) Use as HRT for pts with hypothalamic amenorrhea
2) Or for peri-menopausal pts (treats symptoms and makes things regular) 3) Post-rads, -chemo, or -BSO HRT |
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What is role of OCPs in treatment of ovarian cysts?
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Induce cyst regression, in theory (not much evidence to support)
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What is role of OCPs in treatment of other menstrual-related disorders?
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1) Treat premenstrual dysphoric disorder
2) Menstrual migraines (minimize hormone fluctuation) |
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What is association btw OCPs and ovarian cancer?
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Users are LESS likely to develop ovarian cancer than never-users
Decreases by up to 40% with even 3-6mos of OCP use Protective effect persists up to 15 years after d/cing OCPs May help decrease hereditary ovarian cancer risk too |
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What is association btw OCPs and endometrial cancer?
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50% risk reduction vs never-users
20% reduction w/ 1yr. 40% w/ 2 yrs, 60% w/ 4+yrs Reduction persists for up to 15yrs after d/c |
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What is association btw OCPs and breast cancer?
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Slight increase in relative risk associated with current or recent use vs never use
FHx of breast cancer doesn't influence this association Duration, dose, formulation don't influence This increase does NOT persist beyond 4 yrs post-d/cing OCPs |
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What are non-contraceptive benefits of OCP use? (8)
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1) Reduce cancer risk for: ovarian, endometrial, possibly colorectal cancer
2) Reduce risk for benign breast disease (fibroadenomas, fibrocystic changes) 3) Less symptomatic PID 4) Less risk of ectopic 5) Increase bone mineral density 6) Decrease hirsutism & acne 7) May improve RA symptoms 8) Decrease menstrual flow, anemia, dysmenorrhea |
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What are contraindications to OCP use?
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1) H/o DVT or PE
2) H/o CVA, CAD, ischemic heart dz 3) DM with microvascular complications or >20yrs of DM 4) H/o estrogen-dep't cancer or breast cancer 5) Current pregnancy 6) Migraines w/ focal neuro symptoms 7) HTN (>160/100) or vascular dz 8) Active liver dz (viral, growth, cirrhosis) 9) Major surgery w/ prolonged leg immobilzation 10) H/o or FHx of hypercoagulable disorder |
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What are potential side effects of long-acting hormonal contraception?
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1) Menstrual (esp w/ progestin-only) - irregular bleeding, spotting, amenorrhea
2) headaches 3) decrease bone mineral density (w/ depo-provera) |
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What emergency contraception methods are available?
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1) Yupze (200mcg E2 + 1mg levonprgestrel q12h x2)
2) Preven: another combo method 3) Plan B: progestin-only 4) Copper IUD - can insert up to 7d after ovulation (failure rate 0.1%) |
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When to use emergency contraception?
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best w/in 72h of unprotected intercourse
IUD: up to 7d after ovulation |
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What is IUD mechanism of action? (3)
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1) Causes foreign-body reaction -> alter sperm motility and integrity
2) Alters tubal fluids -> alters ova & sperm transport 3) Alters uterine lining -> unfavorable for implantation |
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What are contraindications for pregnancy? (6)
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1) Confirmed or suspected pregnancy
2) Known or suspected pelvic malignancy 3) Undiagnosed vaginal bleeding 4) Acute or chronic pelvic infection 5) High risk behavior for STDs 6) Hyperbilirubinemia 2/2 Wilson's dz (for copper IUDs only) |
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What are major risks associated w/ IUDs? (4)
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1) Displaced string
2) Uterine perforation 3) difficult removal 4) Pelvic infection (w/ copper IUD) if STD exposure |
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When to insert IUD?
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Mirena: 7d after menses onset or immediately after early pregnancy loss
Paraguard: insert at any point as long as pt is not pregnant Can insert immediately postpartum, pastabortion, or w/in 6wks postpartum |
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What are advantages of barrier method contraception? (4)
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Protect vs STDs
Don't need much prior planning Easy access No systemic side effects |
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What are disadvantages of barrier method contraception?
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Need high motivation to use
Discomfort Latex allergies Diaphragm: Increased UTI risk |
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What is role of permanent sterilization in contraception?
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One of most widely used methods worldwide
Most common method in U.S. female >30y/o <1% pts will get pregnant after procedure in 1st yr Risk of failure does persist, and varies by method & age. |
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What are normal physiological changes seen in sexual response?
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Vasoconstriction & increased tone in genitals, breasts, skin
Elevation in pulse, BP, respiration |
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What are phases of sexual response cycle? (4)
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1) Excitement
2) Plateau 3) Orgasm 4) Resolution |
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Who describes the phases of the sexual response cycle?
What year? |
1) Masters & Johnson
2) 1966 |
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What are Kaplan's phases of sexual response? (3)
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Desire
Arousal Orgasm |