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WRH - Exam 4
Birth Control, Abortion, and more
| Question | Answer |
|---|---|
| What are COCs? Are there different formulations? Do they have to be taken at a certain time of day? | - combined oral contraceptives; contain estrogen and a progestin - yes, monophasic and multiphasic - no, just every day |
| How do COCs prevent pregnancy? | combination birth control pills suppress ovulation (they keep ovaries from releasing eggs) |
| What are POPs? Are there different formulations? Do they have to be taken at a certain time of day? | - progestin-only pills, AKA the "minipill;" - no - yes, there is only a 3-hr window for error |
| How do POPs prevent pregnancy? | - (progestin level consistently high, so:) - mucus in the cervix thickens, making it difficult for sperm to enter the uterus/fertilize an egg - thin the lining of the uterus = less likely that a fertilized egg can attach - stop ovulation (sometimes) |
| What is the patch? What does it contain? How is it used? | - thin, beige, plastic patch that sticks to the skin provides estrogen and progesterone - replace one patch each week for 3 weeks; followed by 1 patch-free week |
| What is the ring? What does it contain? How is it used? | - small flexible ring that provides estrogen and progesterone - inserted into vagina for 3 weeks each month; followed by 1 ring-free week |
| What's more effective: COCs, the patch, or the NuvaRing? | none; they all have the same effectiveness because their active components (E and P) are the same |
| COCs/POPs, the patch, and the ring are rapidly and completely ___. | reversible |
| COCs/POPs, the patch, and the ring protect against ___. | ovarian and endometrial cancer |
| COCs/POPs, the patch, and the ring are no different than placebos for ___ and ___. | - depression - weight gain |
| There are many myths concerning who should and should not use COCs/POPs, the patch, and the ring, especially when it comes to people who smoke, are diabetic, and/or fat. What are the facts? | COCs/POPs/patch/ring can all be used by: - smokers under 35 - most diabetics - fat people |
| Early use of COCs/POPs, the patch, or the ring will not disturb development of the hypothalamic-pituitary-ovarian axis. T or F? | true; they do not disrupt maturation |
| The risks from COCs/POPs, the patch, and the ring are ___. | extremely low (more likely to die playing football, driving a car, being run over by a car, giving birth, etc.) |
| Progestins inhibit ovulation by ___. | - suppressing release of GnRH from the hypothalamus - suppressing the LH surge (cause no E surge also) from the pituitary that induces ovulation |
| Estrogen decreases folliculogenesis by ___. | Suppressing the release of FSH from the pituitary (so follicles don’t grow) |
| COCs/POPs, the patch, and the ring do NOT protect against ___. | STDs |
| With the advent of the decreasing doses in 28-day cycles, it is now recommended that the active pills ___ in number and placebo pills ___ in number. | - increase (21 -> 24) - decrease (7 -> 4) |
| What does monophasic mean when it comes to pills? | there are fixed amounts of estrogen and progestin in each pill [21 active pills + 7 placebo pills] |
| What does multiphasic mean when it comes to pills? | the amounts of hormones in the active pills vary [21 active pills + 7 placebo pills] to simulate normal fluctuations |
| What are extended-cycle COCs? | - monophasic combined oral contraceptives - Seasonale, for example, consists of 84 active pills and 7 placebo pills |
| What are the advantages of COCs? | - highly effective - extremely safe for most people - rapid reversibility - reduces maternal deaths (by reducing unintended pregnancies) - reduces ectopic pregnancies (by reducing unintended pregnancies) |
| What are the menstrually-related health benefits of COCs? | - decreased dysmenorrhea - decreased menstrual blood loss - regulates bleeding - reduced risk of formation of post-ovulatory ovarian cysts (esp. w/ extended cycle COCs) - improvement of menstrual migraines (caused by E withdrawal) w/ ECCOCs |
| What are the general health benefits of COCs? | - reduces risk of ovarian and endometrial cancer - decreased risk of benign breast conditions - improvement of acne and hirsutism b/c less T - ext. or cont. COC use: reduces symptoms of endometriosis, fewer episodes of sickle cell crises and asthma |
| What are the disadvantages of COCs? | - must be taken daily - may be expensive - requires a prescription - increased risk of stroke / heart attack in smokers >35 - increased risk of blood clots - increased risk of cervical cancer with >5y use (with persistent HPV infections) |
| What are the contraindications of COCs, the patch, and the ring? | - those prone to blood clots - artery diseases - heart diseases - hypertension - migraines with aura - breast cancer - major surgery with prolonged immobilization |
| What are warning signs to pay attention to when using COCs, the patch, and the ring? | - abdominal pain - chest pain - headaches - eye problems - severe leg pain |
| What drugs decrease the effectiveness of COCs/POPs, the patch, and the ring? | - tuberculosis drug (rifampin) - antifungal drug (griseofulvin) - some anticonvulsants, st. john's wort, antiretrovirals |
| Who benefits the most from using POPs? | - people with diabetes mellitus who also have a high risk of cardiovascular disease - people who are breastfeeding - people who experience headaches or high blood pressure (estrogen component side effects) |
| What are the advantages of POPs? | - does NOT increase risk of thrombosis, hypertension, cardiovascular disease or breast cancer - simple, fixed daily regimen - immediately reversible |
| What are the disadvantages of POPs? | - episodes of irregular, unpredictable spotting and breakthrough bleeding. - may exacerbate or cause acne (androgen action) - increases risk of coronary heart disease - must be taken the same time every day - increases incidence of ovarian cysts |
| What are the advantages unique to the patch? | - easy to apply - adheres well - forgiving (hormone levels remain therapeutic for at least 9 days after application of the second patch) - only have to remember once every week instead of day |
| What are the disadvantages unique to the patch? | - can have rash at site of patch - designed for light-skinned women; no darker color available - people weighing >198 lbs may be at higher risk of pregnancy when using the patch |
| The ring releases ___ estrogen and progestin than COCs or the Patch. | less |
| What are the advantages unique to the ring? | - easy to insert; comfortable; easy to remove - forgiving (hormone levels remain therapeutic for at least 35 days after application of the second ring) - vaginal hormone delivery increases its bioavailability (so can use a lower dose of hormones) |
| What are the disadvantages unique to the ring? | - headache (6% of users) - may accidentally be expelled - toxic shock syndrome (but very rare; ring might not have even been the cause) |
| How long are COCs/POPs/patches/rings effective? | as long as they are being used correctly (eg. take pills every day [same time for POPs], change patches/rings on time) |
| emergency contraception | - contraceptives intended to be used after sexual intercourse in order to prevent pregnancy - anything that prevents or disrupts ovulation, fertilization, embryo transport, sperm function, or endometrial receptivity/implantation |
| pregnancy | the physiologic state of a woman that follows implantation of a blastocyst |
| medication abortion | the administration of medication intended to terminate a pregnancy |
| shared decision making | a collaborative process between the patient and the provider, taking into account the best scientific evidence available as well as patients' values/preferences |
| List contraceptive methods from most to least effective. | implant (Nexplanon), vasectomy, tubal ligation, IUD; shot (Depo-Provera), pill, patch, ring, diaphragm; condom, sponge, withdrawal, spermicides, fertility awareness |
| How long is the Mirena IUD effective? | 5 years (if not replaced) |
| How long is the Paragard IUD effective? | at least 10 years (if not replaced) |
| What are the progestin-only methods of birth control? | - Depo-Provera (the shot) - Nexplanon (the implant) - Mirena or Skyla IUDs - progestin-only pills |
| Who should use progestin-only methods of birth control? | - people susceptible to headaches or high blood pressure - people over 35 who smoke - people who are breastfeeding - people who have migraines with aura - basically, people who can't take estrogen |
| How do Depo-Provera and Nexplanon work? | - inhibit ovulation by suppressing LH - thicken cervical mucous (so sperm can't swim through it well) - create a thin endometrium (so more difficult for embryos to implant) |
| How long is Nexplanon effective? | 3 years (if not replaced) |
| How long is Depo-Provera effective? | 3 months (if not replaced) |
| What are the primary side effects of Nexplanon? | - menstrual change (either no period or irregular/prolonged bleeding) - weight gain - rare insertion/removal complications |
| What are the primary side effects of Depo-Provera? | - menstrual change (either no period or irregular/prolonged bleeding) - weight gain - bone density issue |
| What are the barriers to the copper IUD as a form of emergency contraception? | - timing (must be before implantation; so within 5 days after sex) - time and cost - awareness of the option - misconceptions about IUDs - availability of skilled providers |
| reproductive justice | - everyone* has equal rights and access to rep. health services, as well as the right to make informed decisions about whether or when to have children - *regardless of race, age, ability, national origin, income, sexual orientation, or gender expression |
| How does the Paragard IUD work? | - by inhibiting sperm motility - copper ions create a hostile environment for both sperm and fertilized eggs |
| How do reproductive health programs encourage men to be supportive partners? | - focus on the + influence that men can have on women's SRH - recognize that men play a major role in decision-making, planning and resource allocation - engage men in maternal health, family planning, neonatal care, and HIV/AIDS |
| What are gender-sensitive/accommodating programs? | those that accommodate gender differences in pursuit of health and demographic outcomes |
| What are gender-transformative programs? | those that seek to transform gender relations to promote equity as a means to reach health outcomes |
| sexual racism | the prioritization of possible romantic and/or intimate partners based on race in a way that reinforces racial hierarchy or stereotypes |
| maternal morbidity | illness or disability occurring as a result of or in relation to pregnancy, childbirth, or in the postpartum period |
| obstetric fistula | - a hole in the birth canal caused by prolonged labor without prompt medical intervention (such as a c-section) - blood flow cut off to bladder and/or rectum = fistula - the woman is left with chronic incontinence and, in most cases, a stillborn baby |
| Describe how combined oral contraceptives interact with: broad-spectrum antibiotics; rifampin (to treat TB) and griseofulvin (antifungal); other drugs such as St. Johns Wort, anticonvulsants and antiretrovirals. | - BSAa don't decrease COC effectiveness - rifampin/griseofulvin activate liver clearance of sex steroids, so E/P have no effect (for at least 1 month after use!) - other drugs may affect the levels of hormones, but can be offset by adjusting COC dose |
| What is the aim of contraceptive counseling? | to assist the patient in making an informed decision that supports their reproductive goals |
| Name factors that affect contraceptive method choice. | - effectiveness - possible negative side effects - non-contraceptive benefits - cost - duration of action - method of administration - privacy - degree of adherence required - STI protection - partner - mechanism of action |
| Be able to describe how oral and intrauterine methods of emergency contraception work to prevent pregnancy after unprotected intercourse. | - Plan B/Next Choice (LNG) block ovulation only before LH surge - Ella (UPA) blocks ovulation even after LH surge - copper IUD makes hostile environment to sperm and eggs |
| List the methods of emergency contraception from lest to most effective. | Plan B/Next Choice (LNG), Ella (UPA), copper IUD |
| Who has abortions (which age group accounts for the most)? Which parenting status (with kids or without) accounts for the most? Safety of abortion? | - most people getting abortions are: in their 20s, have one or more children, are white, have incomes below poverty level - abortion safer than pregnancy, much more so the sooner people get it done |
| Law & policy (specifically Roe v. Wade and Planned Parenthood v. Casey)? | - Roe v. Wade: SC ruled that women have a constitutionally protected right to have an abortion - Planned Parenthood v. Casey: reaffirmed the right to abortion, but weakened the legal protections previously afforded women and physicians; "undue burden" |
| Name and describe examples of abortion restrictions enacted by state legislatures and impacts of those restrictions. | - supply-side restrictions target abortion providers (like TRAP laws) - demand-side restrictions target women seeking abortion (like 24-hr waiting periods, required visits, stigmatization, "feminine ideals", misinformation) |
| How did the Contraceptive CHOICE Project make IUCs and implants more accessible to women? | - by removing cost barriers - by providing contraceptive counseling that promoted these methods - by allowing women to obtain their chosen method on the same day as their counseling |
| Describe the types of gender transformative activities programs promote. | - develop awareness, question, and redefine gender norms - explore vulnerabilities and costs that rigid gender norms create - use ecological approach - develop + messages that see men as part of solution, rather than problem - intersectionality |
Created by:
jessica.gvc
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