Which of the following are true about the copper IUD? Select all that apply.
Non-hormonal
Duration of up to 10–12 years
Lighter menstrual bleeding
High efficacy (>99%)
Requires daily monitoring
Correct Answer : A,B,D
Copper intrauterine device is a non-hormonal long-acting reversible contraceptive that releases copper ions, creating a spermicidal uterine environment by increasing inflammatory reaction in the endometrium and altering cervical mucus. It is effective for up to 10–12 years, with pregnancy rates <1% per year. Normal menstrual blood loss is 30–40 mL per cycle, and copper IUDs can increase this volume, potentially causing anemia if hemoglobin falls below the normal range of 12–16 g/dL in females.
Rationale for correct answers
1. The copper IUD contains no hormones; contraception is achieved through copper ion release, which is toxic to sperm and ova, preventing fertilization without systemic hormonal effects.
2. Copper IUDs provide long-term contraception for up to 10–12 years, depending on the brand, due to sustained copper ion release maintaining spermicidal activity over time.
4. Copper IUDs have a contraceptive efficacy exceeding 99% due to their continuous local effect on sperm motility and viability, making them among the most effective reversible contraceptive methods.
Rationale for incorrect answers
3. Copper IUDs typically increase, not decrease, menstrual bleeding and cramping, especially in the first months after insertion, due to endometrial inflammation; this contrasts with levonorgestrel IUDs, which can reduce bleeding.
5. Copper IUDs do not require daily monitoring; they only require monthly self-checks for string position and routine medical follow-up, unlike methods such as oral contraceptives that demand daily adherence.
Take home points
- Copper IUDs are hormone-free, highly effective, and long-acting reversible contraceptives.
- They may increase menstrual bleeding and dysmenorrhea.
- Efficacy remains >99% for up to 10–12 years.
- They require minimal maintenance, with only monthly string checks.
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Related Questions
Correct Answer is C
Explanation
Progestin-only contraceptionprovides effective pregnancy prevention without estrogen exposure, making it suitable for women with migraine with auradue to the increased risk of ischemic stroke with estrogen-containing methods. Depot medroxyprogesterone acetate suppresses ovulation, thickens cervical mucus, and thins the endometrium. Ovulation typically occurs when luteinizing hormone (LH) surges above 10–12 mIU/mL, which DMPA effectively prevents. Serum progesterone levels remain <3 ng/mL in anovulatory states. Injection efficacy exceeds 99% with correct use.
Rationale for correct answers
3.Depot medroxyprogesterone acetate is a progestin-only injectable given every 12 weeks, offering long-acting contraception without estrogen. It is appropriate for clients with migraine with aura due to the absence of thromboembolic risk from estrogen. It maintains high efficacy (>99%) without daily adherence and is safe in estrogen contraindications.
Rationale for incorrect answers
1.Combined oral contraceptives contain both estrogen and progestin, increasing the risk of ischemic stroke in women with migraine with aura. Estrogen elevates hepatic production of clotting factors II, VII, IX, X, and fibrinogen, promoting a hypercoagulable state. This makes them contraindicated in such patients despite high contraceptive efficacy.
2.Transdermal contraceptive patches deliver systemic estrogen and progestin, carrying the same thromboembolic and cerebrovascular risks as COCs. They are contraindicated in women with migraine with aura due to estrogen’s vascular effects, even though they avoid daily pill intake.
4.Vaginal contraceptive rings release estrogen and progestin locally but still achieve systemic estrogen absorption comparable to COCs. This retains the same contraindications in women with migraine with aura due to increased stroke risk, making them inappropriate despite convenience and high efficacy.
Take home points
- Migraine with aura is an absolute contraindication to estrogen-containing contraceptives due to increased ischemic stroke risk.
- Progestin-only methods are safer in women with vascular risk factors.
- Depot medroxyprogesterone acetate provides long-acting, highly effective contraception without daily use.
- Estrogen-containing methods include pills, patches, and vaginal rings and should be avoided in high-risk patients.
Correct Answer is B
Explanation
Barrier contraceptionis a primary method to prevent both pregnancyand sexually transmitted infections(STIs). Male condoms provide a physical barrier that blocks sperm and pathogens, reducing transmission of Neisseria gonorrhoeae, Chlamydia trachomatis, HIV, and other organisms. Typical-use pregnancy prevention rate is 82% effective, with correct use up to 98%. Semen pH is normally 7.2–8.0, and vaginal pH is 3.8–4.5, which supports the barrier's role in reducing sperm motility.
Rationale for correct answers
2.Male condoms provide both contraception and STI prevention by preventing contact between genital mucosa and infectious secretions. Their latex or polyurethane structure blocks sperm entry into the vagina and physically prevents transmission of viruses and bacteria. They are effective against infections spread via semen, vaginal fluid, and genital contact.
Rationale for incorrect answers
1.Combined oral contraceptives prevent pregnancy by inhibiting ovulation through suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) but have no protective effect against STIs. They do not prevent pathogen transmission because they act systemically rather than as a physical barrier.
3.Intrauterine devices (IUDs) prevent pregnancy by causing a local inflammatory reaction toxic to sperm and ova or releasing hormones to thicken cervical mucus. They do not prevent STIs and can increase the risk of pelvic inflammatory disease if inserted in women with an active infection.
4.Contraceptive implants release progestin to inhibit ovulation and thicken cervical mucus. While highly effective for pregnancy prevention, they do not prevent exposure to pathogens during sexual activity and thus offer no protection from STIs.
Take home points
- Male condoms are the only contraceptive method that reliably prevents both pregnancy and STIs.
- Hormonal contraceptives prevent pregnancy but not STIs.
- IUDs are highly effective for pregnancy prevention but not infection prevention.
- STI prevention requires a barrier method or abstinence, regardless of hormonal contraceptive use.
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