11. Contraception Flashcards
Informed Consent Acronym
BRAIDED
Benefits Risks Alternatives Inquiries Decision Explanation Documentation
Natural Family Planning Methods (4)
- Coitus interuptus (Withdrawal)
- Periodic abstinence (NFP)
- Cervical mucus method
- Symptothermal method (Combo of all)
Two methods of periodic abstinence (NFP)
- Rhythm method (Calendar method)
* Basal body temperature method
What is the rhythm method?
• Type
• Must have what?
- Form of periodic abstinence
* Must have regular, predictable cycles
Basal body temperature method (3)
• Taken immediately after waking and before getting out of bed.
• Temps recorded on the graph to document trend
• Observe for Thermal shift
o Abstinence from day of temp drop x3days
Thermal shift with BBT (2)
- Right before ovulation: Slight drop in temp
* With ovulation the temp rises 0.2-0.4*C
Outside factors that affect BBT
- Alcohol
- # of hours of sleep
- Infection
When do you start observation for cervical mucus method?
Last day of the menstrual flow
Cervical mucus method: What are you looking for?
Spinnbarkheit
mucus thin and watery like egg whites prior to ovulation
What is the most effective method of NFP?
Symptothermal – a combo of all methods
Standard days method: Def
Standardized version of calendar method
Requirement for standardized days method
Must have a cycle of 26-32 days
When are the fertile days for the standardized days method
8-19 – avoid unprotected intercourse
Predictor test for ovulation: What is it testing for?
Detects LH surge prior to ovulation
Predictor Test for ovulation: Benefit
Not affected by illlness, emotional upset or physical activity
Pre-ovulation mucus characteristics (4)
- Thick
- Cloudy
- Sticky
- Slippery
Ovulation mucus characteristics (4)
- Clear
- Wet
- Sticky
- Slippery
Types of barrier methods (4)
- Condoms (male and female)
- Diaphragm
- Cervical cap
- Lea’s Shield / Fem Cap
Patient teaching: Male condom (3)
- Must counsel about proper use / application
- Apply the condom on the penis after it is erect and before intimate contact
- Lubricants: Do not use petroleum-based products because they cause the condom to break
Male Condom side effects (2)
- Irritation
* Allergy (latex)
Female condom patient teaching (3)
- Female controlled
- Can insert 8 hours prior
- Must remove after
Female condom side effects (2)
- Irritation
* Polyurethane
When would a patient need a new diaphragm (2)
o Requires fitting and refitting if excessive weight gain or loss (20%)
o Replace every 2 years
By Rx only
Diaphragm: Method
o Works by covering the cervix to prevent sperm from entering and killing sperm with spermicide application
Diaphragm insertion and removal (3)
- Diaphragm is used every time you have intercourse
- Must be left in place for six hours after intercourse
- Check device for integrity
Diaphragm patient teaching
o Efficacy diminishes with increased frequency of intercourse
Cervical cap characteristics (4)
o No longer in US
o Fitting, use and efficacy similar to diaphragm
o Must use with spermicide
o Efficacy decreases with parity
• Other Cervical Barriers: Lea’s Shield, Fem Cap (6 characteristics)
o Use is similar to diaphragm, cap o Requires prescription o Femcap requires fitting o Reusable o Silicone o Use with spermicide
Contraceptive sponge (3 characteristics)
o Female controlled
o Available OTC
o Insertion and removal
Types of intravaginal spermicides (6 - don’t memorize)
o Foams o Tablets o Suppositories o Creams o Films o Gel
Spermicides – side effects (3)
o Irritations
o Rash
o Microlacerations
What is the most commonly used spermicidal chemical in the US?
N-9
Mechanism of N-9
o Surfactant that destroys the sperm cell membrane on the surface
When must spermicide be used?
Just before intercourse
How many different contraceptive formulations are available in the US?
More than 30
What do hormonal contraceptives consist of?
Estrogen-progesterone or just progesterone
Hormonal contraceptives: Mechanism of action (3)
o Estrogen suppresses production of FSH and LH, suppressing ovulation
o Endometrium remains thin
o Cervical mucus is thick
Hormonal contraceptive contraindications: Cardiovascular / blood (4)
o Thromboembolitic Disorders
o Coronary artery or cerebral vascular disease
o Severe diabetes (with vascular involvement)
o Uncontrolled HTN
Hormonal contraceptive contraindications: Hormonal (3)
o Breast cancer (estrogen positive tumors)
o Estrogen dependent tumors
Hormonal contraceptive contraindications: Other things (3)
o Currently impaired liver function or liver tumor o Smoking (>35 y/o) o Migraines with neurologic symptoms
Hormonal contraceptive contraindications: Related to childbearing
o Lactation (no combined contraceptive pills) o Pregnancy
Possible side effects of Hormonal Contraceptives
• Estrogen excess
What are the symptoms of estrogen excess? (8)
- N/V
- Dizziness
- Edema
- Increased breast size
- chloasma
- Visual changes
- Hypertension
- Vascular HA
Sxs of estrogen deficiency (7)
- Early spotting (days 1-14)
- Hypomenorrhea
- Nervousness
- Vaginal dryness
- Breast tenderness
- Oily skin and scalp
- Hiritruism
Sxs of progesterone deficiency (3)
- Late spotting (days 15-21)
- Heavy flow with clots
- Increased breast size
Hormonal contraception warning signs (5)
A - Abdominal Pains
C - Chest pain
H - Headache
E - Eye changes
S - Severe leg pain
Contraceptive warning signs: Abdominal pain
May indicate a problem with the liver or gall bladder
Contraceptive warning signs: Chest pain
Chest pain or shortness of breath may indicate possible clot problems within the lung or heart
Contraceptive warning signs: Headache (2)
- May be sudden or persistent
* May be caused by CVA or HTN
Contraceptive warning signs: Severe leg pain
May indicate a thromboembolitic process
How are combined oral contraceptives packaged?
21 or 28 days
When should you start taking oral contraceptives?
The first sunday after menses starts
What causes failures with oral contraceptives?
Missed pills
Side effects from oral bc (5)
- Nausea
- Breast tenderness
- Fluid retention
- Chloasma
- Early spotting (lo estrogen)
What is OrthoEvra
A transdermal contraceptive patch
Transdermal Contraceptive patch - what is it?
Delivers continuous levels of hormones
What is lunelle?
A combined monthly injection (IM)
Lunelle - mechanism (2)
- Works the same way as other combination hormonal contraceptives (pill, patch, ring)
- Prevents ovulation so that no sperm can fertilize an egg
Vaginal / nuva ring - patient counseling (3 components)
o The ring is thought to be as effective as oral contraceptives
o The first time the vaginal ring is used, it is inserted during the first five days of menstruation
o Effectiveness of a vaginal ring is lowered when taken with certain medications
Extended use regimens • When approved • Contents • Time frame • Brand name
- Approved by the FDA in 2003
- Contains both estrogen and progestin and is taken in 3-month cycles
- 12 weeks of active pills followed by 1 week of inactive pills
- Brand name: “Seasonale”
Progestin only contraceptives - benefit
• Eliminates side-effects of estrogen
Progestin only contraceptives: Mechanism of action (3)
o Inhibits ovulation
o Thickens and decreases the amount of cervical mucus
o Thinning endometrium
What is Depo-Provera?
Injectable Progestin
Emergency Contraception: Def
High doses of oral contraception taken to prevent ovulation or implantation
Emergency Contraception: Effectiveness
75-89% effective
2 protocols of emergency contraception
- Split or single dose
- 72 or 120 hours
Emergency contraception: Mechanism
High hormonal levels prevent or delay ovulation, thicken the cervical mucus and later the sperm transport in order to prevent fertilization.
Emergency contraception – must be used before…
IMPLANTATION
Intrauterine contraception – mechanism of action (3)
o Damages sperm in transit to tubes
o Uterine lining inhospitable
o Effect mucus and endometrial maturation
Two types of IUDs
o Copper T: Approved for 10 years
o Progesterone based: Approved for 5 years
Contraindications of IUDs (8)
o Not monogamous o Pregnant o HIV + o Undiagnosed vaginal bleeding o Pelvic infections o Recent endometritis o Uterine / cervical cancer o Allergy to copper
What is Mirena?
A Type of IUD
Mechanism of Mirena (4)
- Thickens cervical mucus
- Impairs sperm migration
- Alters the endometrium to prevent implantation
- Inhibits ovulation
Mirena – Contraindications (3)
- Breast cancer
- Undiagnosed vaginal bleeding
- Liver disease
IUD Warning Signs
P - Period Late A - Abdominal Pain I - Infection Exposure N - Not feeling well S - String missing / changes in length
Male / Female sterilization:
Female: Tubal Ligation
Male: Vasectomy
Induced abortion - types
Elective or therapeutic,
Medical or surgical
Medical abortion: Timing
7-9 weeks or earlier
Surgical abortion: Types and Timing (3)
- Manual Vacuum Aspiration (MVA) <14 weeks
* Dilation and evacuation (D+E) up to 20 weeks
• Method (2 components)
o Complete abstinence during fertile period
o To determine fertile period, must record menses for 6 mo
Rhythm method:
• How to calculate
How to calculate:
• Length of shortest cycle minus 18 days (start of fertile period)
• Length of longest cycle minus 11 days (end of fertile period)
