Contraception- REVIEWED

Your patient has been successfully using Depo Provera as birth control for the past six months. She was given an appointment 12 weeks after her last injection but forgot she had it. It is now 3 days past her scheduled appointment and she is requesting her injection. What should your action be? A. Come to the clinic today for another injection B. Wait until her next menstrual cycle starts to restart the Depo C. Use foam and condoms until a normal menses occurs, then come to the clinic for another injection. D. Counsel the patient on another birth control method since she is unreliable

A. Depo Provera should be given every twelve weeks but can be given up to the thirteen week and still be considered a viable form of birth control.

Mrs. Peterson presents to your office today to be fitted for a diaphragm. She has been on numerous hormones in the past and does not like the side effects. When properly fitting a patient for a diaphragm you know: A. Allow a fingertip between it and the pubic arch B. Be small enough to allow for vaginal expansion C. Lie snuggly over the pubic arch and under the cervix. D. Provide firm tension against vaginal walls

A. Diaphragm is a barrier method that may provide six hours of contraception. It is a dome shaped rubber cup with a rim that is flexible. It is inserted into the vagina before intercourse so the posterior rim rests on the posterior portion of the vagina and the anterior rim fits snugly behind the pubic bone. The diaphragm covers the cervix and is used in conjunction with spermacide. When inserted correctly there is just enough space to insert one fingertip between pubic arch and the anterior edge of the diaphragm rim.

All of the following are correct in regards to Implanon except: A. Lasts for five years B. Is a better choice for women with multiple sex partners then an IUD because there is less of a chance of pelvic inflammatory disease C. It is a safe form of birth control for lactating women D. Works by supressing ovulation, thinning the endometrial lining, and thickening the cervical mucus

A. Implanon is a radio opaque that will last for three years if not removed. If not removed after three years it will no longer be active against pregnancy. It is safe during lactation because it is a progesterone only form of contraception.

Which lab test is important to obtain after a 10 year profile of oral contraceptives have been utilized by a patient: A. Liver profile B. Lipid profile C. CBC with diff D. Metabolic panel

A. Liver profile

A twenty seven year old presents for insertion of mirena. She reports that her menses started 3 days ago and is normal. How soon after insertion will be be able to rely on it for protection? A. Immediately B. After forty eight hours C. After one week D. In one month

A. Mirena gives five years protection. It can be inserted anytime during the menstrual cycle but if inserted within the first seven days of menstration it is effective immediately. If inserted any other time during the month another form of birth control should be used for seven consecutive days after insertion.

Sydney is a 21 year old patient who is taking oral contraception. She comes to your office today complaining of acne. How should you adjust the estrogen component of the birth control pill? A. Increase the estrogen content B. Decrease the estrogen content C. Delete the estrogen content D. No adjustment should be made in the estrogen content

A. Patients suffering from acne should have an increase in the estrogen component of the birth control pill or a decrease in the progesterone component. Remember progesterone is androgenic.

If a woman is using basal body temperature as birth control when would you tell her to avoid unprotected sex? A. From the beginning of her cycle until the basal body temp. has been elevated for three days. B. Whenever the Basal body temp. is elevated C. Whenever the basal body temp is lowered D. From the end of the menstrual cycle until the basal body temp has been low for five days.

A. Sex unprotected should be avoided from the beginning of the menstrual cycle until the basal body temp has elevated for three days. Temps are suppressed by estrogen whereas post ovulatory temps increase under the influence of progesterone. Temps usually rise within a day or two after ovulation has occurred and remain elevated until menstration has begun.

All of the following are absolute contraindications of utilizing combined oral contraception in a woman except: A. Smoking B. History of breast cancer C. History of cardiovascular disease D. History of gall bladder disease

A. Smoking is a relative contraindication

Mrs. Henderson inquires about why she needs progesterone added to her estrogen hormone replacement therapy. You explain that women with intact uterus's need to add progesterone to prescribed estrogen because: A. It assists with stopping hot flashes B. Reduces the incidence of endometrial hyperplasia and cancer C. Decreases the risk of osteoporosis D.. Controls mood swings

B. Endometrial hyperplasia and cancer are both associated with long term estrogen use.

Which of the following types of estrogen is secreted in the greatest amounts during the reproductive years and is considered most potent? A. Estrone (E1) B. Estradiol (E2) C. Estriol (E3) D. Potency and secretion of all the above are in equal amounts

B. Estradiol: is the most potent form of estrogen and is secreted in the greatest amounts by the ovaries in the reproductive years.

Which of the following is not an absolute contraindication for the utilization of birth control pills: A. Smoking under 35 with a history of a DVT B. Family history of migraine with aura C. Depression and history of gallbladder disease in pregnancy D. Controlled hypertension with diabetes mellitus with vascular changes

B. Family history of migraine is not the same thing as a personal history of migraine with aura.

You have recently started you patient on oral contraceptives. She followed your instructions and started her first pill on the Sunday after she started her period. She is in your office today for her three month follow-up visit and is complaining of breakthrough bleeding during the first two weeks of her pill cycle. Your next course of action would be: A. Reassure the patient that this is normal and she should continue taking her pill at the same time everyday for the first 21 days of every month. B. Increase the estrogen component of her pill. C. Increase the progesterone component of her pill. D. Lower the progesterone component of the pill. E. Decrease the estrogen component of her pill.

B. Increase the estrogen component of her pill. Breakthrough bleeding from day 1 to 14 of a woman's menstrual cycle indicates that the estrogen component is not high enough. Bleeding irregularities should go away within the first three months of utilizing oral contraception.

Which of the following hormones induces ovulation: A. FSH B. LH C. Estrodiol D. Progesterone

B. LH originates in the anterior pituatary gland. An acute rise in LH triggers ovulation and the development of the corpus luteum.

Recent literature on the long term use of Depo Provera has found that the concern over this topic may not be as much of a concern as previously thought but clinicians should still be aware of this major concern with the prolonged use of progesterone only contraception: A. Increased infection B. Loss of bone density C. Amenorrhea D. Delayed confirmation of pregnancy

B. Loss of bone density

A woman eight weeks post partum comes to your office asking about birth control. She is breastfeeding and wants a reliable birth control method that will not interfere with lactation. You recommend: A. Oral contraceptives B. The Mini pill C. The transdermal contraceptive patch D. The Nuvaring

B. The mini pill is the only option that is progesterone only. All other choices contain estrogen which cannot be given during lactation. Must be given on time everyday and can be given in the absence of menstration. It is 100% effective to prevent pregnancy in lactating women if utilized properly and can be immediately reversed by the patient at anytime making it a better option then Depo-Provera, IUD, or Implanon.

Beth is breast feeding her 3 month old infant without supplementation. She says she has heard that she cannot get pregnant during this time. Your response to her is: A. It is likely you may become pregnant so you need to use birth control. B. Yes, you are safe as long as you breastfeed. C. For the first six months if you breastfeed and have very little supplementation your chances of getting pregnant are less than 2% D. You are at more risk of getting pregnant now because of your fluctuating hormones.

C

Which of the following drugs decreases the effectiveness of oral contraceptives? A. Beta Blockers B. oral anticoagulants C. Antibiotics D. Oral hypoglycemic agents

C- antibiotics, antacids, anticonvulsants, and barbituates can decrease the effectiveness of oral contraceptives.

RJ wants to start Depo-Provera injections as her form of birth control. You find no reasons in her history or physical exam that would be contraindications for using this form of birth control. She is currently not using any birth control form. Her LMP was two weeks ago. What instructions should you giver her to initiate her injections? A. She is able to start injections today without further testing B. She is able to start injections today if her UCG is negative C. She must return the first 5 days after her next menstrual cycle to start injections D. None of the above

C. Depo-Provera can be given anytime within the first five days of menses.

Lynne, comes into your office in tears. She reports to you that she had sex last night unprotected and forgot to take her birth control pill. She wants to know ab0ut the morning after pill. You tell her: A. If your period does not start at the regular time come back and see me. B. I will go ahead and order you the estrogen only postcoital contraceptive pill. C. If you utilize over the counter levonorgestrel 1.5 mg within 72 hours of unprotected sex it will reduce your chance of pregnancy by 75%. S. I will refer you to a gynocologist

C. Emergency contraception should be taken within 72 hours of having unprotected sex. There are 3 regimens available in the U.S.A. (1) Yuzpe regimen - two pills within 72 hours and two 12 hours later is 75% effective (2) Progesterone only levonorgestrel 1.5 mg should be used within 72 hours of unprotected sex - can be purchased over the counter (3) Insertion of copper IUD up to seven days after unprotected sex. Plan B: is 1.5 mg levonorgestrel that will delay or prevent ovulation or interfere with the fertilization of the egg. Plan B One-Step can be purchased over the counter at drugstores without a prescription or proof of age. Because it is most effective when taken as soon as possible (up to 72 hours after sex), consider having a ready supply in your medicine cabinet. If you take it within 72 hours after you've had unprotected sex, Plan B One-Step can reduce the risk of pregnancy by up to 89%. If you take Plan B One-Step within 24 hours, it is about 95% effective. But you should know that Plan B One-Step is not as effective as regular contraception. So don't take it as your main form of birth control. And, it does not protect you against sexually transmitted diseases. Think of it as a backup -- not for routine use. That's why it's called Plan B.

All of the following are absolute contraindications of the birth control pill except: A. Benign hematoma B. History of embolism C. Family history of migraine with aura D. History of gallbladder disease during pregnancy

C. Family history of migraine with aura may not be indicative of a personal history. This would be a relative contraindication.

Which of the following would be a contraindication for using a diaphragm for birth control? A. Heavy, painful menses B. History of PID C. History of recurrent urinary tract infections D. Multiple pregnancies

C. History of recurrent urinary tract infections

One of the major side effects from this form of contraception is abnormal uterine bleed. A. Oral contraceptive pills B. NuvaRing C. Implanon D. Essure

C. Implanon: Is an progesterone only product. Irregular bleeding is the most common side effect especially in the first six to twelve months. For most women periods become fewer and lighter. After one year 1 out of three women who us Implanon will stop having periods completely. Some women may experience heavier, longer periods and spotting b/w periods.

A mechanism of action for progesterone only contraceptives includes thickening of the cervical mucus, production of a thin ednometrium, and ................................. A. Premature degeneration of the Corpus Luteum B. Inhibits FSH production C. Inhibits the LH surge D. Mechanically inhibits implantation

C. Inhibits the LH surge

Women who utilize oral contraceptives are less likely to experience: A. Human papilloma virus B. Migraine headaches C. Iron deficiency anemia D. Herpes simplex virus

C. Iron deficiency anemia: oral contraceptives cause less menstrual bleeding.

A twenty six year old female comes into your office to discuss her options for birth control. Her history includes migraines with aura when on combination oral contraceptives in the past. Which would you advise: A. Combination hormone contraceptive pills B. Ortho Evra Patch C. Mirena IUD D. Vaginal Nuvaring

C. Mirena IUD is the only progesterone only choice. All the other choices contain estrogen. Estrogen can cause migraine headaches with aura.

Patricia has been on oral contraceptives for three months and notes breakthrough bleeding during the third week of pills. You should change her OCP to one that has: A. More estrogenic activity B. Less estrogenic activity C. More progestational activity D. Less progestational activity

C. More progestational activity: In women, progesterone levels are relatively low during the preovulatory phase of the menstrual cycle, rise after ovulation, and are elevated during the luteal phase. Progesterone levels tend to be < 2 ng/ml prior to ovulation, and > 5 ng/ml after ovulation. If pregnancy occurs, human chorionic gonadotropin is released maintaining the corpus luteum allowing it to maintain levels of progesterone.

Wyonna has been breast feeding for the past three months. She reports to you that she has had no menstrual period since her delivery. She is starting to worry about getting pregnant but wants to continue breast feeding. Of the following which would be the best form of contraception for this client? A. Oral contraceptive pills B. NuvaRing C. Progesterone only contraceptive pills D. Ortho Evra patch

C. Progesterone only pills - this is the only option that does not include estrogen.

In a normal menstrual cycle which of the following is produced primarily by the corpus luteum? A. Prolactin B. Estrogen C. Progesterone D. Testosterone

C. Progesterone: During the luteal phase (final phase of the ovarian cycle) the pituitary hormones LH and FSH cause the remaining parts of the dominant follicle to transform into the corpus luteum which produces progesterone.

Which of the following are responsible for symptoms of dysmenorrhea? A. Estrogen B. Human chorionic gonadotropin C. Prostaglandins D. Progestin

C. Prostaglandins - During endometrial sloughing the disintegrating endometrial cells release prostaglandins as menstration begins. Prostaglandins stimulate myometrial contractures, ischemia, and senstization of the nerve endings.

In regards to depo-provera all of the following are correct except: A. That the first injection must be given during the first five days of menses B. You must first get a pregnancy test before starting the medication C. The second injection must be scheduled for 12 weeks but may be given up to 13 weeks of the last injection D. Depo-Provera is an estrogen based form of contraception given by I.M. injection every three months

D. Depo-Provera is a progesterone only form of contraception

All of the following interfere with the metabolism of oral contraception except: A. Tetracycline B. Rifampin C. Dylantin/phenytoin D. Corticosteroids

D. Drugs that effect oral contraception are anticonvulsants, antibiotics, Rifampicin, griseolfulvin, ascorbic acid, and acetominophen

This method of contraception is permanent and requires undergoing a hysteroscopy. A. Tubal ligation B. IUD C. Vasectomy D. Essure

D. Essure: Is a permanent, non-surgical transcervical sterilization procedure for women developed by Conceptus Inc., a subsidiary of Bayer AG. It was approved for use in the United States on November 4, 2002. Hysteroscopy: Small, flexible inserts are placed into the fallopian tubes by a catheter passed from the vagina through the cervix and uterus. The insert contains inner polyethylene terephthalate fibers to induce inflammation causing fibrotic reaction and is held in place by flexible stainless steel inner coil and a dynamic outer nickel titanium alloy coil. Once in place, the device is designed to elicit tissue growth in and around the insert over a period of three months to form an occlusion or blockage in the fallopian tubes; the tissue barrier formed is supposed to prevent sperm from reaching an egg.

Joanne wants to use birth control until she gets married next year. She wants to be able to stop the birth control method after the wedding and wants her fertility restored almost immediately. You recommend: A. Birth control pills B. Vaginal ring C. Depo-provera D. Lea's sheild

D. Lea's shield is the only device that does not contain hormones. It is similar to the diaphragm and the cap. It is dome shaped and silicone that covers the cervix allowing secretions to exit without sperm entering. Spermicide should be utilized with this form of birth control.

How long can a Nuvaring be out of the vagina before a second form of contraception is necessary? A. 12 hours B. 24 hours C. 1 hour D. 3 hours

D. Nuvaring is a soft transparent flexible ring of ethylene vinyl acetate copolymer. Releases 120 mcg of etongestrel and 15 mcg of ethinly estradiol daily. Placed in every 28 days and is removed after 21 days for withdrawl bleed. If it is accidently expelled for less than 3 hours instruct the patient to rinse it off with luke warm H20 and reinstert - no back up is needed. If it has been out of the vagina for more than 3 hours instruct the patient to discard the ring and instert a new ring and utilize a backup method of birth control for seven days or have a withdrawl bleed and insert a new ring no later than 7 days from the time when the last ring was removed.

Emergency contraception refers to: A. Induced abortion in the emergency room B. Quickly starting birth control pills in anticipation of sexual intercourse C. Having a Depo-Provera injection every twelve weeks D. Utilizing plan B, emergency contraceptive pills

D. Plan B keeps the fertilized egg from attaching to the uterus.

Which of the following is a relative contraindication for combo oral contraceptives: A. Undiagnosed vaginal bleeding B. Hepatoma of the liver C. Suspected history of TIAs D. Smoking

D. Smoking is a relative contraindication. All of the rest of the choices are absolute contraindications.

Sharon tells you that she has been douching after sex and believes this is an effective birth control option. You should tell her: A. Douching prevents sperm from entering the uterus B. Douching should be done once monthly after menses C. Douching is a reliable form of contraception D. Douching may increase her risk of ectopic pregnancy

D. Sperm enters the cervical canal as soon as fifteen seconds after ejaculation. Douching has been associated with both pelvic infections as well as ectopic pregnancy and should never be used.

Of all the following contraceptive methods which has the least true life efficacy A. Oral contraceptives B. IUD C. Condoms alone D. Vaginal contraceptive gel

D. Vaginal contraceptive gels (spermacides) should be utilized in conjunction with things like the sponge, a condom, or a diaphragm.

A good choice for long acting reversible contraception for a 30 year old who already has two children could be any of the following except: A. Diaphragm B. Implanon C. Intrauterine device D. Depo-vera

A

Your patient calls your office and states that she thinks that her NuvaRing "fell out" she asks about reinserting it. You know that the maximal amount of time that the NuvaRing can be outside the body before needing to be discarded for lack of efficacy is: A. 3 hours B. 6 hours C. 12 hours D. 24 hours

A

An acceptable option for birth control for an obese 25 year old smoker would be: A. Cervical cap B. Ortho Evra patch C. Depo-vera D. Mini pill

A - because there is no hormones in a cervical cap so less risk as this patient is overweight and smokes

Which of the following drugs may have there effects enhanced when used while taking oral contraceptives? A. Beta Blockers B. Oral anticoagulants C. Antacids D. Anticonvulsants

A. Beta blockers, antidepressants, benzodiazepine, corticosteroids, theophyline, and valium may be enhanced when taken in conjunction with combined oral contraceptives.

A 36 year old female being evaluated for birth control choices. She is a smoker. Has a history of chlamydia cervicitis. She has two small children. The best contraceptive choice for her would be: A. Depo-Provera injections B. Oral contraceptives C. IUD D. Estrogen patches

A. Depo-Provera is the best choice of the four. Because the patient is a smoker she should not be on oral contraception or any other form of estrogen. Because she has had a history significant for chlamydia she should not have an IUD inserted because the number one risk with utilizing IUD is infection.

Which of the following medications given to a nursing mother can cause a reduction in her milk supply? A. Antihistamines B. Antithyroid medication C. Oral contraceptives D. Laxatives

C. Any oral contraceptive containing estrogen may reduce milk supply. The progestin only mini pill can be used.

A college student has missed two days of her birth control pills in a row during the second week of her pill cycle. You should advice her: A. Start a new pill pack and dispose of the old one B. Take two today and two tomorrow and utilize a condom for the rest of the pill cycle C. Stop taking the pills and start a new pill cycle D. Take one pill now and two the next day

B

Which effect is seen in every women using Depo Provera for more than four years? A. Melasma B. Amenorrhea C. Weight loss D. Headaches

B

Your patient calls the clinic stating that she forgot to take her oral contraceptive for a second day. Which of these instructions is most accurate? A. Take your usual dose immediately, and use 2 forms of birth control until the next cycle B. Double your dose today and tomorrow then continue taking the usual dose, and use 2 forms of birth control until the next cycle. C. Throw away the package start over at the next cycle and use 2 forms of birth control until then D. Take a double dose for the next five days, then continue taking the usual dose, and use 2 forms of birth control until the next cycle

B

Which of the following is not a relative indication of oral contraception: A. Active Hep A infection B. Thrombus related to an I.V. Needle C. Undiagnosed vaginal bleed D. Migraines without focal aura

B. Because it was caused by an I.V. needle.

A 17 y.o. requests to start Depo-Provera injections as her method of birth control. She discloses to you that she has had four sexual partners in the last year. Her last menstrual period was twelve days ago. The appropriate management of this patient would be: A. Administer the Depo-Provera injection today B. Advise her to use another method of birth control now and return when she starts her menses. C. Give her an injection after a negative pregnancy test and advise her to utilize condoms for the next seven days D. Giver her and injection and tell her to use a barrier method for seven days.

B. Can be given within 5 days after starting menses and should be repeated every 12 weeks.

Your 25 year old G1P1 patient is requesting oral contraceptives. She is normal weight and does not smoke or have any significant health factors. On history she notes that her menses are heavy and she has difficulty with her pregnancy due to nausea. Your exam reveals cystic breasts, but no other physical findings. The best OCP this patient would benefit from would be: A. High estrogenic activity B. Low estrogenic activity C. High progestational activity D. Low progestational activity

B. Excessive estrogen effects include dysmenorrhea, nausea, chloasma (mask like appearance) CVA, DVT, Thromboembolitic disease, Pulmonary emboli, telangiectasia (spider vein appearance on face), Hepatic adenoma/adenocarcinoma, cervical changes, and breast tenderness secondary to increase of the size.

A 17 year old high school student is considering Seasonale as her method of birth control. Which of the following statements is false regarding Seasonale: A. Taking seasonale will lesson your menses to four yearly B. A menstrual period will occur within seven days of stopping Seasonale C. Is a progesterone only pill D. Must be taken for 84 consecutive days followed by seven days of inert pills.

C. Seasonale is an extended cycle birth control pill containing both levongestrel and estradiol. More spotting occurs in patients taking these pills for the first few months of their use.

All of the following are true of the Transdermal contraceptive patch except: A. Contains ethinyl and estradiol and noregestromin B. Is applied to a fatty area and stays on for 1 week intervals for three consecutive weeks of the month then is kept off for one week to allow for endometrial sloughing. C. Is not as effective as oral contraceptives in preventing pregnancy. D. All of the above

C. The transdermal contraceptive patch is as effective as birth control pills in preventing pregnancy. The advantage of the patch over the pill is that the patient does not have to remember to take a pill at the same time everyday.

All of the following are correct except: A. Oral contraception failure rate is 3% B. Desogesterol belongs to progesterone family of drugs C. New low dose birth control do not require back up during two weeks D. Oral contraceptives are contraindicated in women over the age of 35 that smoke.

C. all oral contraceptives require a 7 day back-up method

All of the following are key educational inclusions when prescribing an oral contraceptive except: A. What to do when you miss a dose B. Common side effects C. Unusual or concerning side effects D. Dietary restrictions

D

A woman who has experienced bleeding during the first two weeks on birth control pills for three consecutive months should be changed to an OCP that has: A. Lower progestational activity B. Higher progestational activity C. Lower estrogenic activity D. Higher estrogenic activity

D.

Combined oral contraception is an effective method of preventing pregnancy. Which of the following conditions not related to pregnancy may warrant the use of birth control pills in a woman? A. Acne B. Ovarian Cancer C. Endometriosis D. All of the above

D. All of the above. Combined oral contraception can decrease a woman's risk for pelvic inflammatory disease, decrease menstrual flow, decrease risk of ovarian cancer, decrease risk of ovarian cysts, decrease hirsutism, decrease incidence of endometrial cancer and endometriosis, decrease risk of pelvic inflammatory disease, decrease risk of osteoporosis.

A 24 year old female asks you about what to do after forgetting to change her patch on the seventh day and she is now on day nine with the same patch on. What advice should you give her? A. If you apply your patch late during the first week then apply a new patch as soon as you remember and make that your new patch day. Use a backup form of birth control for seven days after you apply the new patch. B. If you apply your patch late during week two or three and are one or two days late change it as soon as you remember and utilize a backup form of birth control for seven days C. If you are more than two days late in the second or third week change the patch as soon as you remember and utilize this new day as the day you change your patch. Utilize a secondary form of birth control for seven days. D. All of the above

D. All of the above. If a patient realizes that her patch has fallen off for less than one day and cannot get the patch to restick to her skin then she should apply a new patch and make that her new patch day. She should use a backup method of birth control for seven days.

All of the following are mechanical barrier methods of contraception except: A. Diaphragm with spermicidal gel B. The sponge C. Condoms D. Depo Provera injections

D. Dep-Provera is the brand name for depot medroxyprogesterone acetate (DMPA). It is given intramuscular.

All of the following are mechanical barrier mechanisms of contraception except: A. diaphragm with spermacide B. Sponge C. Condoms D. Depo-provera injections

D. Depo-Provera is an I.M. injection

Which of the following conditions is contraindicated with utilizing a copper IUD? A. History of ectopic pregnancy B. Nulliparity C. Treated cervical dysplasia D. Heart disease

D. Heart disease because a copper IUD may put the patient at risk for bacterial endocarditis. Dysplasia: Abnormality of development or an epithelial anomaly of growth and differentiation Cervical dysplasia: abnormal changes in the cells on the surface of the cervix.

The leading danger of IUDs and the major cause of morbidity associated with their use is: A. Increased menstrual bleeding B. Dysmenorrhea C. Uterine perforation D. Infection

D. Infection: This is why this is not a good method of birth control for women who have multiple sexual partners.