Contraception - landscape

This self-assessment study guide has 5 questions, each written using learning objectives from your Contraception lecture. Not all learning objectives are covered. Participation/scores are not monitored. FYI this program makes noise sometimes.

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Question 1

Question 2

Question 2

DS is a 31-year-old female inquiring about contraception. Her primary goal is to prevent pregnancy. However, she and her partner would like to conceive eventually, and would prefer a contraceptive that won’t delay that. She reports using an oral contraceptive in the past that worsened her acne. She rarely misses doses of her sertraline, but isn’t always able to take it at the same time every day due to an unpredictable work schedule. She is open to any formulation of contraception.

Past Medical History

• Generalized anxiety disorder
• Acne

Social History

• No history of smoking

Medications

• Sertraline 50 mg
• Clindamycin 1% gel
• Tretinoin 0.05% cream

Question 2

Question 2

Explanation

The copper IUD is reversible and won’t delay return to fertility (also benefit of adherence). The Depo-Provera injection delays return to fertility. The Opill isn’t a good choice for someone who may have trouble taking it at the same time every day, since a dose is considered missed if it is taken >3 hours late. Also, a progestin-only pill would not be our first choice for DS, since she does not have contraindications to estrogen. Loestrin contains a 1st generation progestin (higher androgenic activity), while Syeda contains a 4th generation progestin (lower androgenic activity). If we wanted to lessen the risk of acne for DS, we would prioritize a progestin component with lower androgenic activity, making Syeda a better choice.

Question 3

VM is a 25-year-old female presenting to clinic for a suspected STI. Her rapid pregnancy test was negative. STI lab results are pending, but you are aware that chlamydia and gonorrhea are very common in your area. While in clinic, she decides she would like to start a contraceptive and would prefer an option that does not require daily administration. She would like to get a prescription today, as she lives 45 minutes away from clinic. She takes no medication and has no other relevant medical history.

Question 3

Click here to go to the full MEC chart

Question 3

Explanation

The patient prefers something she doesn’t have to take every day, which eliminates the oral options (Tri-Sprintec and Slynd). Per the MEC chart, both copper and levonorgestrel IUDs should not be initiated in patients with chlamydia or gonorrhea – it would be risky to start those without ruling out chlamydia/gonorrhea. Nexplanon is the only option that is safe to start and doesn’t require daily administration. (Patient will need to use a backup method of contraception or abstinence if the implant is not given within 5 days of starting menses.)

Question 4

Question 4

Explanation

If the combined oral contraceptive is started more than 5 days since the start of menses, the patient will need to use backup/abstinence for 7 days. The patient's period started on Thursday.Today (Friday)

• 1 day since start of period → no backup needed

Sunday

• 3 days since start of period → no backup needed

Wednesday

• 6 days since start of period → backup needed for 7 days (not 5)

Question 5

Question 5

Explanation

• After taking EC, a patient's next menstrual period may occur one week earlier or later than expected.
• Whether/when a patient should restart depends on the form of EC used.
• If a pregnancy already exist, EC will not harm the embryo.
• Patients with a BMI >26 should be offered EC.

Age: 25 Sex: Female Labs

• Pregnancy: negative
• Chlamydia: pending
• Gonorrhea: pending

Preference: Option that does not require daily administration PMH: N/A Meds: none

Patient DS

• Age: 31
• Sex: female
• PMH: generalized anxiety disorder, acne
• Meds: sertraline 50 mg, clindamycin 1% gel, tretinoin 0.05% cream
• SH: no smoking history
• Reason for contraception: prevent pregnancy
• Adherence: rarely misses doses
• Unable to take at same time every day
• Past trials: oral contraceptive
• Worsened acne
• Preferences
• No delay in ability to conceive
• Open to any formulation