1: Contraception Safety and Side Effects

Question 1

There are no health concerns, but certain circumstances or conditions complicate their use. These factors include the postpartum period, breastfeeding, having an abortion immediately before their use, recent menarche or perimenopause when cycles may be irregular, medications that alter the regularity of cycles or fertility signs, vaginal discharge, irregular vaginal bleeding, and conditions associated with elevated body temperature.

Answer 1

Fertility Awareness Based (FAB)

Question 2

• Not recommended for those who can’t take COCs.
• Side effects similar to COCs, such as breakthrough bleeding and nausea.
• Increased incidence of vaginitis and leukorrhea.

Answer 2

Vaginal Ring (NuvaRing)

Question 3

• Questions about their safety center on infection, future fertility, ectopic pregnancy, and risk of uterine perforation.
• A transient increase in infection rates occurs in the first 20 days.
• The cervical mucus barrier and atrophic endometrium may actually protect the user from PID.
• Decreased ectopic pregnancies. However, if pregnancy does occur, it’s more likely to be ectopic.
• No decrease in fertility.
• Small risk of perforation of the uterus. Higher risk in postpartum and breastfeeding women.
• While unscheduled bleeding can occur, frequently leads to ammenorrhea.
• Other side effects include lower abdominal pain, complexion changes, back pain, breast tenderness, headaches, mood changes, and nausea, although all of these effects decline with time, and they are noted in only a minority of women.
• Benign functional ovarian cysts are common. Most cysts are asymptomatic and resolve spontaneously.

Answer 3

Progestin / Levonorgestrel (Mirena, Skyla, Liletta)

Question 4

There are no contraindications to LAM, but not recommended for women who are HIV positive in countries such as the United States, or for women who are taking medications that could be harmful to the infant.

Answer 4

Lactational Amenorrhea (Breastfeeding)

Question 5

• Risk of VTE.
• May increase blood pressure in some women through an increase in plasma angiotensin.
• Metabolic effects may include development of benign hepatocellular adenomas.
• Changes in mood and libido.
• Depression.

Answer 5

Combined Oral Contraceptives (COCs)

Question 6

• Increases risk of ectopic pregnancy IF pregnancy occurs.
• Infection, hemorrhage, anesthesia complications, and surgical trauma or injury.

Answer 6

Female Sterilization

A “post-tubal syndrome” has been described, which typically includes increased dysmenorrhea and abnormalities in the menstrual cycle. Research indicates it’s not likely related to the procedure.

Question 7

Decreased effectiveness is possible when these agents are used in combination with:

• Rifampin
• Rifabutin

Answer 7

POPs

Question 8

• Tend to discontinue use of this method at higher rates than women who use the diaphragm.
• Allergic-type reactions, such as dermatitis, erythema, irritation, and vaginal itching.
• Small chance of Toxic Shock Syndrome (TSS).

Answer 8

Vaginal Sponges

Question 9

• Not recommended for those who can’t take COCs.
• Associated with heightened concern about an increased risk of VTE.
• Skin irritation.
• Side effects similar to COCs, such as breakthrough bleeding and nausea.

Answer 9

The Patch (OrthoEvra [discountinued], Xulane)

Question 10

• Significantly fewer urinary tract infections (7.5%) than those in the diaphragm group (12.4%).
• In this same study, there were no differences in vaginitis, irritation, dysmenorrhea, or Pap test changes between the groups.

Answer 10

Cervical Caps

Question 11

• Have the fewest contraindications of all hormonal methods.
• Unscheduled bleeding and spotting.

Answer 11

Progestin-Only Pills (POPs)

Question 12

• Headaches
• Hypertension
• Breast tenderness

Answer 12

• Estrogen
• Progestin

Question 13

• Nausea
• Cervical ectopy and leukorrhea
• Telangiectasis
• Chloasma (darkening of sun-exposed skin)
• Growth of breast tissue (ductal tissue or fat deposition)
• Increased cholesterol content within the bile (which can lead to gallstones)
• Benign hepatocellular adenomas
• Changes in the clotting cascade

Answer 13

Estrogen

Question 14

• Risk of infection
• Future fertility questions
• Ectopic pregnancy (decreased incidence but if pregnancy occurs more likely to be ectopic)
• Risk of perforation
• No decrease in fertility.
• Increases bleeding and dysmenorrhea (up to 50% increase in bleeding).

Answer 14

Copper IUD

Question 15

• Irritation or even abrasions of the vaginal mucosa have been noted in women with improper sizes or prolonged retention.
• Use during menses is discouraged.
• Urinary tract infections are more common.

Answer 15

Diaphragms

Question 16

• Associated with similar side effects for all progestin methods, such as irregular bleeding and amenorrhea.
• Unscheduled bleeding is more common and persistent than in LNG-IUS users and is the most common reason for discontinuation.
• Because ovarian activity is not completely suppressed, persistent follicles and small ovarian cysts have been reported in a small percentage.
• Side effects of the method include bruising and irritation at the insertion site, breast tenderness, and weight gain.

Answer 16

Subdermal Implant (Implanon, Nexplanon [newer])

Question 17

• Weight gain, glucose intolerance.
• Can be used by many who are contraindicated for estrogen use.
• Bone loss can occur and is increased in continued use. May not be completely reversible but current research indicates it is reversible.
• For this reason, FDA reccomends against use longer than 2 years, unless other methods are inadequate.

Answer 17

Depot medroxyprogesterone acetate injection (DMPA or Depo-Provera)

Question 18

• Increased appetite
• Weight gain
• Mood changes and depression
• Fatigue
• Complexion changes
• Changes in carbohydrate metabolism
• Increased low-density lipoprotein (LDL) and decreased high-density lipoprotein (HDL) cholesterol
• Decreased libido
• Pruritus

Answer 18

Progestin

Question 19

• Discomfort.
• Infection and scrotal hematoma occur on rare occasions.
• Possible chronic testicular pain.
• Antisperm antibodies more common.

Answer 19

Male Sterilization

Question 20

• It is a surfactant, and surfactants can disrupt cell membranes.
• It is an irritant to both animal and human tissue.
• Frequent use is associated with increased reports of vaginal irritation.
• Potential to disrupt or damage epithelial tissue in both the vagina and the rectum. The risk of this disruption increases with frequency of use and dose.
• Use could potentially increase the risk of transmission of infection by causing microabrasions in the epithelium.
• Does not reduce STIs among sex workers or women attending STI clinics.
• In fact, some research suggests that it can even increase the risk of HIV acquisition in high-risk women.
• It should not be used rectally.

Answer 20

Spermicides (N-9)