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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|Prompt=A 37 year old woman is seeking her gynecologist’s advice for contraception. She already has 3 children and does not wish to have any more. She explains that her husband doesn’t always agree to wear a condom and she was considering either tubal ligation or oral contraception as possible alternatives. Which of the following characteristics would make oral contraception contraindicated in this patient?
|MainCategory=Pharmacology
|Explanation=Oral contraception is a common and relatively safe means of contraception that usally combines both estrogen and progestin in different doses. OCPs work by inhibiting the positive estrogen feedback loop that leads to the LH surge and eventual ovulation. OCPs have been shown to be safe and not associated with an increased risk of cancer or thromboembolism in the general population. OCPs are usually contraindicated in cetain sub-populations at higher risk including patients with the following characteristics:
|SubCategory=Reproductive
- Smoker >35 years of age
|MainCategory=Pharmacology
- Previous personal history of DVT, PE, or stroke
|SubCategory=Reproductive
- Previous personal history of estrogen dependent breast cancer
|MainCategory=Pharmacology
 
|SubCategory=Reproductive
 
|MainCategory=Pharmacology
Learning objective: OCPs are contraindicated in female smokers >35 years of age due to the increased risk of cardiovascular events.
|MainCategory=Pharmacology
 
|MainCategory=Pharmacology
 
|SubCategory=Reproductive
References:
|MainCategory=Pharmacology
 
|SubCategory=Reproductive
Marchbanks PA, Mcdonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002;346(26):2025-32.
|MainCategory=Pharmacology
 
|SubCategory=Reproductive
Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol. 2008;83(2):97-102.
|MainCategory=Pharmacology
 
|SubCategory=Reproductive
Shapiro S, Rosenberg L, Slone D, Kaufman D, Stolley P, Miettinen O. ORAL-CONTRACEPTIVE USE IN RELATION TO MYOCARDIAL INFARCTION. The Lancet. 1979;313(8119):743-747.
|MainCategory=Pharmacology
 
|MainCategory=Pharmacology
|SubCategory=Reproductive
|Prompt=A 37-year-old woman is seeking her gynecologist’s advice for contraception. She already has 3 children and does not wish to have any more. She explains that her husband doesn’t always agree to wear a condom and she was considering either tubal ligation or oral contraception as possible alternatives. Which of the following characteristics would make oral contraception contraindicated in this patient?
|Explanation=Oral contraception is a common and relatively safe means of contraception that usally combines both estrogen and progestin in different doses. OCPs work by inhibiting the positive estrogen feedback loop that leads to the LH surge and eventual ovulation. OCPs have been shown to be safe and are not associated with an increased risk of cancer or thromboembolism in the general population. OCPs are usually contraindicated in certain sub-populations at higher risk of adverse events including patients with the following characteristics:
* Smokers >35 years of age
* Previous personal history of DVT, PE, or stroke
* Previous personal history of estrogen dependent breast cancer
|AnswerA=Family history of heart disease
|AnswerA=Family history of heart disease
|AnswerAExp=Family history is never a contraindication to OCP prescription.
|AnswerAExp=Family history is never a contraindication to OCP prescription.
|AnswerB=Family history of breast cancer
|AnswerB=Family history of breast cancer
|AnswerBExp=Family history is never a contraindication to OCP prescription.
|AnswerBExp=Family history is never a contraindication to OCP prescription.
|AnswerC=Current smoker
|AnswerC=Current smoker
|AnswerCExp=Female smokers >35 years of age should not be prescribed OCPs due to the increased risk of cardiovascular events.
|AnswerCExp=Female smokers >35 years of age should not be prescribed OCPs due to the increased risk of cardiovascular events.
|AnswerD=Varicose veins
|AnswerD=Varicose veins
|AnswerDExp=Varicose veins are not a contraindication to OCP prescription.
|AnswerDExp=Varicose veins are not a contraindication to OCP prescription.
|AnswerE=History of pelvic inflammatory disease
|AnswerE=History of pelvic inflammatory disease
|AnswerEExp=History of pelvic inflammatory disease is not a contraindication to OCP prescription.
|AnswerEExp=History of pelvic inflammatory disease is not a contraindication to OCP prescription.
|EducationalObjectives=OCPs are contraindicated in female smokers >35 years of age due to the increased risk of cardiovascular events.
|References=Marchbanks PA, Mcdonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002;346(26):2025-32.<br>
Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol. 2008;83(2):97-102.<br>
Shapiro S, Rosenberg L, Slone D, Kaufman D, Stolley P, Miettinen O. Oral contraceptive use in relation to myocardial infarction. The Lancet. 1979;313(8119):743-747.<br>
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=OCPs, contraception, contraindications
|WBRKeyword=OCPs, Contraception, Contraindications,
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 01:42, 28 October 2020
Author [[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Reproductive
Prompt [[Prompt::A 37-year-old woman is seeking her gynecologist’s advice for contraception. She already has 3 children and does not wish to have any more. She explains that her husband doesn’t always agree to wear a condom and she was considering either tubal ligation or oral contraception as possible alternatives. Which of the following characteristics would make oral contraception contraindicated in this patient?]]
Answer A AnswerA::Family history of heart disease
Answer A Explanation AnswerAExp::Family history is never a contraindication to OCP prescription.
Answer B AnswerB::Family history of breast cancer
Answer B Explanation AnswerBExp::Family history is never a contraindication to OCP prescription.
Answer C AnswerC::Current smoker
Answer C Explanation [[AnswerCExp::Female smokers >35 years of age should not be prescribed OCPs due to the increased risk of cardiovascular events.]]
Answer D AnswerD::Varicose veins
Answer D Explanation AnswerDExp::Varicose veins are not a contraindication to OCP prescription.
Answer E AnswerE::History of pelvic inflammatory disease
Answer E Explanation AnswerEExp::History of pelvic inflammatory disease is not a contraindication to OCP prescription.
Right Answer RightAnswer::C
Explanation [[Explanation::Oral contraception is a common and relatively safe means of contraception that usally combines both estrogen and progestin in different doses. OCPs work by inhibiting the positive estrogen feedback loop that leads to the LH surge and eventual ovulation. OCPs have been shown to be safe and are not associated with an increased risk of cancer or thromboembolism in the general population. OCPs are usually contraindicated in certain sub-populations at higher risk of adverse events including patients with the following characteristics:
  • Smokers >35 years of age
  • Previous personal history of DVT, PE, or stroke
  • Previous personal history of estrogen dependent breast cancer

Educational Objective: OCPs are contraindicated in female smokers >35 years of age due to the increased risk of cardiovascular events.
References: Marchbanks PA, Mcdonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002;346(26):2025-32.
Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol. 2008;83(2):97-102.
Shapiro S, Rosenberg L, Slone D, Kaufman D, Stolley P, Miettinen O. Oral contraceptive use in relation to myocardial infarction. The Lancet. 1979;313(8119):743-747.
]]

Approved Approved::Yes
Keyword WBRKeyword::OCPs, WBRKeyword::Contraception, WBRKeyword::Contraindications
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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