Gynecology Trivia Quiz: What Do You Know About Contraception?

The primary mechanism by which oral contraceptive pills (OCs) prevent pregnancy is by inhibiting serum follicle-stimulating hormone (FSH) levels. FSH is responsible for stimulating the growth and development of ovarian follicles. By suppressing FSH levels, OCs prevent the maturation of ovarian follicles, thereby preventing ovulation and the release of an egg for fertilization. This is the main way OCs prevent pregnancy. The other options mentioned in the question, such as inhibiting serum luteinizing hormone (LH) levels, inducing endometrial atrophy, and inducing lymphocytic endometritis, are not the primary mechanisms of action for OCs.

Vasectomy has a lower failure (pregnancy) rate compared to female sterilization. This means that the chances of a woman getting pregnant after her partner undergoes a vasectomy are lower than the chances of a woman getting pregnant after undergoing female sterilization.

Currently available spermicides destroy spermatozoa primarily by disrupting cell membranes. This means that they cause damage to the outer layer of the sperm cells, making them unable to function properly and preventing them from reaching the uterus. This method of action is effective in reducing the chances of pregnancy.

IUCDs (Intrauterine Contraceptive Devices) primarily prevent pregnancy by preventing fertilization. These devices work by creating an environment in the uterus that is hostile to sperm, making it difficult for them to reach and fertilize an egg. They do not cause abortions as they do not interfere with a fertilized egg. Instead, they act as a barrier method, preventing sperm from reaching the egg in the first place.

The copper-containing IUCD is most closely associated with an increase in dysmenorrhea. The IUCD, also known as the copper coil or copper T, is a form of long-acting reversible contraception that is inserted into the uterus. The copper in the IUCD acts as a spermicide and prevents fertilization. However, it can also cause heavier and more painful periods, which can exacerbate dysmenorrhea symptoms. This is why it is important to consider the patient's history of dysmenorrhea when choosing a contraceptive method.

The correct answer is IUCD. An IUCD (intrauterine contraceptive device) would be relatively or absolutely contraindicated in a woman with a history of ectopic pregnancy. This is because the presence of an IUCD can increase the risk of recurrent ectopic pregnancies. Therefore, alternative contraceptive methods should be considered for this patient.

Adding the BBT curve can help determine when ovulation has occurred because there is a slight increase in basal body temperature after ovulation due to the release of progesterone. In Figure 17-1, point C shows a clear and significant increase in temperature compared to the previous days, indicating that ovulation may have occurred around that time.

The administration of RU-486 (mifepristone) results in abortion when given in early pregnancy. RU-486 is a medication used to terminate a pregnancy by blocking the hormone progesterone, which is necessary for maintaining pregnancy. By blocking progesterone, RU-486 causes the lining of the uterus to break down, leading to the expulsion of the embryo and termination of the pregnancy.

The most common reason for failure of condoms as a barrier contraceptive method is inconsistent use. This means that the couple does not consistently and correctly use condoms during every sexual encounter. Inconsistent use can increase the risk of pregnancy or transmission of sexually transmitted diseases (STDs) because it leaves room for unprotected sexual contact. It is important for the couple to understand the importance of using condoms consistently and correctly to ensure their effectiveness as a contraceptive method.

In this scenario, the woman is unable to feel the string of her IUCD, indicating that the IUCD may have migrated or become displaced. Since her serum pregnancy test is negative, it is unlikely that the IUCD has been expelled due to pregnancy. The most appropriate next step would be to probe the cervical canal gently to locate and pull down the string. This will help determine the position of the IUCD and assess if any further intervention is required. Obtaining an abdominal radiogram, pelvic ultrasound, or performing a hysterosalpingogram may be considered if the IUCD cannot be located or if there are other concerns. Inserting another IUCD should only be done after confirming the position of the existing one.

Toxic shock syndrome has been associated with the use of cervical caps. This is because cervical caps are inserted into the vagina and cover the cervix, creating a potential breeding ground for bacteria. If the cap is not properly cleaned and maintained, harmful bacteria can grow and release toxins, leading to toxic shock syndrome. Other contraceptive methods listed, such as OCs, progestin-only pills, male condoms, and IUCDs, have not been specifically linked to toxic shock syndrome.

Long-acting progestins (Depo-Provera) have the lowest pregnancy rate in 100 women using the method perfectly for 1 year. This is because Depo-Provera is a highly effective contraceptive method that involves receiving an injection of progestin every three months. It is more reliable than other options such as the copper-containing intrauterine contraceptive device (IUCD), diaphragm, oral contraceptives (OCs), and spermicidal cream, which have higher failure rates due to factors like user error or lower efficacy. Therefore, Depo-Provera is the most reliable contraceptive method in terms of preventing pregnancy.

Given her variable menstrual cycle length ranging from 26 to 32 days and without measuring basal body temperature (BBT) or using other tracking methods, it's challenging to pinpoint the exact fertile window accurately. However, you can make a rough estimate based on typical fertile windows.

In a typical menstrual cycle, the fertile window often falls approximately between Day 10 and Day 17, with Day 1 being the first day of menstruation. Given her variable cycle lengths:

The earliest estimate for her fertility window would be between Day 6 and Day 14 (assuming a 26-day cycle).

Prescribing a brief course of levonorgestrel is the most appropriate next step in managing the fear of pregnancy in this case. Levonorgestrel is a progestin-only emergency contraceptive that can be taken within 72 hours of unprotected intercourse to prevent pregnancy. It is highly effective in reducing the risk of pregnancy when taken as directed. Advising the patient to await her next menses before taking any action may result in a missed opportunity for preventing an unwanted pregnancy. The other options, such as advising her about the risk of pregnancy or prescribing intravaginal misoprostol or immediate douching, are not supported by evidence and may not be effective in preventing pregnancy.

The decrease in the estrogen component of the oral contraceptive pill has led to an increase in breakthrough bleeding (BTB). This is because estrogen helps to stabilize the lining of the uterus, and a decrease in estrogen can lead to shedding of the uterine lining and breakthrough bleeding. Therefore, reducing the estrogen content of oral contraceptives can result in an increased occurrence of breakthrough bleeding.

Smoking is the primary contraindication for the use of combined oral contraceptives (OCs) in this case. Smoking increases the risk of cardiovascular complications, including blood clots, heart attacks, and strokes. The patient's blood pressure is also slightly elevated, which further increases the risk. The patient's age, cholesterol levels, hypertension, and diabetes are not the primary factors that contraindicate the use of OCs in this case.

Based on the given information, the woman occasionally experiences severe migraine headaches. It is known that oral contraceptive (OC) use can increase the frequency and severity of migraines in some individuals. Therefore, advising her that OC use will increase her risk of migraine headache is the correct answer.

The correct answer is to continue her current use until after the procedure. This is because oral contraceptives (OCs) do not increase the risk of deep vein thrombosis (DVT) or pulmonary embolism (PE) in the perioperative period. Therefore, there is no need to discontinue OCs prior to the surgery.

Based on the risk factors present in this patient, such as obesity, a strong family history of heart disease, and being sexually active with multiple partners, the indicated test would be a fasting serum cholesterol. This is because these risk factors increase the likelihood of developing cardiovascular disease, and measuring the fasting serum cholesterol can help assess the patient's risk for developing heart disease.

When fitting a contraceptive diaphragm, it should sit comfortably between the pubic symphysis (the front part of the pelvis) and the posterior vaginal fornix (the deepest part of the vagina towards the back). This ensures proper placement and effectiveness of the diaphragm as a contraceptive method. The other options mentioned in the question are incorrect as they do not describe the correct placement for the diaphragm.

Emergency contraception can be effective if administered up until 5 days after intercourse. This means that if someone has had unprotected sex or their usual method of contraception has failed, they can still take emergency contraception within this timeframe to reduce the risk of pregnancy. It is important to note that the effectiveness of emergency contraception decreases with time, so it is best to take it as soon as possible after intercourse.

The most appropriate contraceptive method for this patient would be DMPA (depot medroxyprogesterone acetate). This is because the patient has a 12-14 week, irregular uterus suggestive of uterine leiomyomata (fibroids). DMPA is a progestin-only contraceptive method that can help to control the growth of fibroids and reduce symptoms such as heavy menstrual bleeding. It is an injectable contraceptive that is given every 3 months and does not contain estrogen, making it a suitable option for women with fibroids.

Contraceptive use can lead to an improved socioeconomic status. When individuals have access to and use contraceptives, they have greater control over their reproductive choices. This allows them to plan their families and have children when they are financially stable and ready. With fewer unintended pregnancies, individuals can invest more in their education, careers, and overall economic well-being. This can lead to increased income, improved living conditions, and better opportunities for themselves and their families, ultimately resulting in an improved socioeconomic status.

Progestin-only OCs (minipills) are less likely to cause gonadotropin suppression compared to combination OCs. Gonadotropins are hormones that stimulate the ovaries to produce eggs and regulate the menstrual cycle. Combination OCs contain both estrogen and progestin, which can suppress the release of gonadotropins and inhibit ovulation. However, progestin-only OCs primarily work by thickening the cervical mucus and thinning the lining of the uterus, making it less likely for fertilization and implantation to occur. Therefore, users of progestin-only OCs are less likely to experience gonadotropin suppression.

The presence of an intrauterine contraceptive device (IUCD) increases the risk of spontaneous abortion in this patient. This is because the IUCD can cause irritation or inflammation in the uterus, which can interfere with the implantation and development of the embryo. Additionally, the IUCD may disrupt the normal hormonal environment in the uterus, further increasing the risk of spontaneous abortion.

The correct answer is hepatic adenoma. While the pill has many benefits, it can rarely increase the risk of developing hepatic adenoma.

The most appropriate management for this patient is to obtain a dual-energy x-ray absorptiometry (DXA) scan. Depot medroxyprogesterone acetate (DMPA) is known to cause bone loss, and the patient's amenorrhea for the past 6 months may indicate decreased estrogen levels, which can further contribute to bone loss. Therefore, a DXA scan is necessary to assess her bone mineral density and determine if any interventions are needed to prevent osteoporosis.

Sterilization is the most common contraceptive method used by women of reproductive age and their partners in the United States. Sterilization involves permanent contraception through surgical procedures such as tubal ligation for women and vasectomy for men. This method is highly effective and provides long-term contraception, making it a popular choice for individuals who do not want to have children in the future. It eliminates the need for other temporary contraceptive methods and allows for a worry-free sexual experience.