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WRH - Exam 4

Birth Control, Abortion, and more

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