Deck 22: Hormonal Contraception

Question 1

A 24-year-old female consults you for advice. She had intercourse 4 days ago and experienced condom breakage. She fears she may have conceived and would terminate a pregnancy if this occurs. Her menstrual cycle ended 3 days before the incident; she has regular cycles of 28-day intervals that last 4 days. She would also like a more reliable birth control method and would accept any method. After testing for sexually transmitted infections, you review the options for postcoital contraception. What would be the most appropriate action?

A) Wait for menses, and begin contraception of her choice. If menses delayed, return for urine pregnancy test.
B) Immediate insertion of copper IUD
C) Prescribe ulipristal to begin today
D) Prescribe levonorgestrel containing emergency contraceptive pill (ECP) to begin today

Answer 1

B

Question 2

Combined oral contraceptives have four biological activities: endometrial activity, estrogenic activity, progestational activity, and androgenic activity. Match the following biologic activity to the side effect they may produce:

A) Progestational 1) Increased libido
B) Androgenic 2) Fluid retention
C) Endometrial 3) Appetite stimulation
D) Estrogenic 4) Decreased menstrual flow

Answer 2

A

Question 3

The effect of combined oral contraceptives on high- and low-density lipoprotein cholesterol is mainly related to the type of progestin.

Answer 3

False

Question 4

A 35-year-old 1 ppd smoker consults you for contraceptive advice. She has very heavy and prolonged menses and has become anemic. What would you advise?

A) Combined oral contraceptive pill with 20 mcg or less of estrogen
B) Progesterone only pill
C) Mirena IUD
D) Depo-Provera

Question 5

Which contraceptive method has the highest efficacy?

A) Mirena IUD
B) Tubal ligation
C) Nexplanon implant
D) Depo-Provera
E) Contraceptive patch

Question 6

An 18-year-old G1 P1 comes to you for advice on contraception. Her greatest fear is that she will gain weight. Her menstrual periods are irregular, and this worries her. She has had a difficult time remembering to take birth control pills in the past. What would you advise?

A) Depo-Provera
B) Vaginal contraceptive ring
C) Mirena IUD
D) Nexplanon implant

Question 7

Which of the following medical conditions is not an absolute contraindication to combined hormonal contraceptive use?

A) Newly diagnosed breast cancer
B) Deep vein thrombosis
C) Adequately controlled hypertension
D) Migraine with aura
E) Ischemic heart disease

Question 8

A woman with a strong family history of breast cancer can safely use combined hormonal contraception.

Question 9

A 40-year-oldld woman with recurring painful ovarian cyst formation seeks advice on contraception. She weighs 215 pounds and is actively trying to lose weight. What type of contraception would you recommend?

A) Mirena IUD
B) Low-dose combined oral contraception
C) Transdermal patch
D) Depo-Provera

Question 10

Women using continuous combined hormonal contraception should be advised to allow for withdrawal bleeding every 3 months to prevent endometrial hyperplasia.