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How is post-pill amenorrhea managed
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4: General Gynecology
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What injectable contraceptive is available in the United States What is its typical use failure rate in the first year How is DMPA administered When should DMPA be started Depot medroxyprogesterone acetate (DMPA or Depo-Provera) a progestin-only injectable Less than 1% similar (if not lower) to that of a tubal ligation An intramuscular (IM) injection of 150 mg every 3 months DMPA should be begun within 5 days of the onset of menses If received after this time window, another nonhormonal method must be used for the first 7 days Undiagnosed abnormal uterine bleeding; cerebrovascular disease/ coronary artery disease; liver disease; pregnancy; thromboembolic disease/ thrombophlebitis (relative contraindication) Decreased risk of endometrial cancer and pelvic inflammatory disease (PID); decreased volume of menstrual bleeding; decreased pain associated with endometriosis; can be used while breast-feeding and in cases where estrogen is contraindicated Amenorrhea (eventually occurs in most women within 1 year of consistent use); irregular bleeding (spotting); decreased bone density (fully reversed once DMPA is stopped); acne; headache; depression There is no evidence to date that DMPA leads to weight gain How long does it take to restore fertility after DMPA is stopped Most women return to fertility in 9 12 months after their last injection; however fertility can be delayed for up to 18 months after cessation
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Section II: Topics in Gynecology
Hormonal Implants, Patches, and Rings
What are contraceptive implants Small rods placed surgically in the inner part of the upper arm subdermally They release progestin in a controlled manner and can be left in place for 3 5 years, depending on the implant 005% Pregnancy, undiagnosed vaginal bleeding, liver disease, breast cancer, thrombophlebitis/embolism Irregular bleeding (common), amenorrhea, headache, acne, weight gain A transdermal patch that delivers estrogen and progestin in a controlled manner daily It is placed on the buttock, abdomen, upper arm, or upper torso (but not breast) It is changed once per week for 3 weeks, followed by a patch-free week Note: If detached for more than 24 hours, it must be replaced and an additional method of contraception should be used for 7 days What is the overall failure rate for the contraceptive patch What is the main advantage of the patch over OCPs What are the side effects of the contraceptive patch 03 1% Better compliance by avoiding daily pill taking Skin reactions at site of placement; breakthrough bleeding; breast discomfort; dysmenorrhea; headache; abdominal pain; nausea Theoretically, yes The patch delivers a higher dose of estrogen (area under the curve) than typical OCPs and so it may increase the risk for blood clot development However, no studies to date have documented this effect An intravaginal ring that releases estrogen and progestin daily It is inserted within 5 days of the onset of menses and requires an
What is the typical use failure rate in the first year What are the absolute contraindications to hormonal implants What are the main side effects of contraceptive implants What is the contraceptive patch
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What is the contraceptive vaginal ring How is the vaginal ring administered
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4: General Gynecology
additional form of contraception for the first 7 days The ring is taken out after 3 weeks to allow 1 week of withdrawal bleeding Note: If the ring is displaced for more than 3 hours, an additional contraceptive method must be used for 7 days What are the potential side effects of the vaginal ring Device-related discomfort; irregular bleeding; headache; vaginal discharge/irritation; nausea; breast tenderness; mood changes
Emergency Contraception ( Morning-After Pill )
What is emergency contraception (EC) How does EC work A postcoital method of contraception EC works by preventing ovulation and fertilization EC will not terminate a pregnancy if implantation has already occurred High-dose progestin-only contraceptive pills (Plan B) High-dose estrogen and progesterone pills (Yuzpe method) Plan B is routinely recommended over the Yuzpe method How is EC administered It can be taken up to 3 days after unprotected intercourse, but is more effective if taken sooner It is now recommended that both doses of Plan B be taken together ASAP! The Yuzpe method reduces the risk of pregnancy by approximately 75% whereas Plan B reduces the risk of pregnancy by up to 89% Both methods are more effective the closer they are taken to the unprotected act of coitus
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