24. Contraception & Sterilization Flashcards
Natural methods of contraception
-
Periodic Abstinence
- Emphasizes fertility awareness and abstinence shortly before and after estimated ovulation period
-
Coitus Interruptus
- Withdrawal of penis from vagina before ejaculation
- Failure rate: 27%
-
Lactational Amenorrhea
- After delivery, nursing-induced hypothalamic suppression of ovulation
- Prolactin-induced inhibition of pulsatile gonadotrophin-releasing hormone (GnRH) from hypothalamus
- After delivery, nursing-induced hypothalamic suppression of ovulation
Barrier Methods and Spermicides
- Male condoms
- Female condoms
- Diaphragm
- Cervical cap (must be used with a spermicidal jelly)
- IUDs
- Intrauterine Copper-T IUD (ParaGard)
- Copper hampers sperm motility and capitation so sperm rarely reach the fallopian tube
-
Levonorgestrel intrauterine system (Mirena)
- Progesterone thickens cervical mucus and atrophies endometrium to prevent implantation
- Intrauterine Copper-T IUD (ParaGard)
Contraindications for IUD use
Absolute & Relative contraindications
Best contraceptive device to decrease menorrhagia and dysmenorrhea
Mirena IUD
Hormonal Contraceptive Methods
- Combined (estrogen and porgesterone)
- Progesterone only
Available in oral, injectable, implantable, and intrauterine forms
Place the body in a pseudo-pregnancy state by interfering with the pulsatile release of FSH and LH from the anterior pituitary. –> suppresses ovulation and prevents pregnancy from occurring
Several medications are thought to interact with OCPs resulting in reduced effectiveness of the pill. There is only one abx which lowers the effectiveness of OCPs. Conversely, OCPs can also reduce the efficacy of many meds.
Complications associated with OCPs
Cardiovascular (5)
Other (5)
CV: (OCPs w/ estrogen doses greater than 50 mg can increase coagulability….)
- DVT
- PE
- CVA
- MI
- HTN
Other:
- Cholelithiasis
- Cholecystitis
- Benign liver adenomas (rare)
- Cervical adenocarcinoma (rare)
- Retinal thrombosis (rare)
Contraindications to combo estrogen-progesterone contraceptives
The progestins in OCPs have been found to raise LDLs while lowering HDLs in pill users smoking more than one pack per day. For these reasons, OCPs are contraindicated in women over age 35 years who smoke 15 or more cigarettes a day.
Noncontraceptive health benefits of OCPs
Transdermal Estrogen and Progestin Hormonal Contraception:
Ortho Evra
MOA: the patch releases 150 mg per day of progestin, norelgestromin, and 20 mg per day of ethinyl estradiol
The overall avg estrogen concentration is higher in Ortho Evra users compared to women taking standard OCPs. Therefore, these patients should be made aware of the increased risk of thromboembolism, specifically DVT and PE
**Decreased effectiveness in markedly overweight women (>198 lb or 90 kg)
Injectable Progesterone-Only contraception
Depo-Provera
injected IM every 3 mo that allows the slow release of progestin over a 3-month period
–> acts by suppressing ovulation, thickening cervical mucus, making the endometrium unsuitable for implantation/reducing tubal motility
Women using DMPA for more than 2 years may experience _______________.
a reversible decrease in bone mineralization
Encourage to take calcium, vitamin D, weight-bearing exercises, smoking cessation
Emergency Contraceptive Pills
-
Plan B (progestin only)
- Most effective when taken within 72 hours of unprotected sex
-
Ulipristal (Ella, EllaOne)
- Selective progesterone receptor modular (SPRM) with agonist/antagonist effects at progesterone receptor sites
- MOA: delay ovulation (follicular rupture) and inhibit implantation into the endometrial lining
- Selective progesterone receptor modular (SPRM) with agonist/antagonist effects at progesterone receptor sites
Nexplanon
Radiopaque, single-rod, subdermal implant of etonogestrel that is placed in the upper arm of the patient
Provides 3 years of contraception w/o impacting the patient’s bone density, weight, or mood
