B8.012 Contraception Flashcards
what imparts a greater risk than any method of contraception?
pregnancy
method of emergency contraception with ethinyl estadiol
100 mcg within 72 hours of intercourse
inhibits ovulation, disrupts follicle development, interferes with maturation of corpus luteum
does NOT prevent implantation of fertilized egg (not abortive)
best results within 12 hrs
other emergency methods of contraceptions
0.75 mg levonorgestrel (plan b, next step, one step)
ulipristal
copper IUD
0.75 mg levonorgestrel
2 pills 12 hr apart or a single dose
up to 72 hours after intercourse
OTC for age >17
ulipristal
slightly more effective, can use up to 120 hours
prescription needed
binds to progesterone receptors and delays ovulation
copper IUD insertion for emergency contraception
within 7 days of intercourse
prevents fertilization, but also blocks implantation of fertilized egg
10 years of BC
general principle about emergency methods of contraception
better if available
**write script in advance if someone wants it
components of precontraceptive evaulation
history pregnancy test (if indicated) BP, weight, BMI chlamydia screen pap/pelvic if >21
is a pap/pelvic required for BC?
no
not for anyone <21
if you want an IUD there will be a pelvic exam and cervical inspection prior to insertion
when is a pregnancy test NOT indicated
<7 days after start of normal menses
no intercourse since last menses
correctly using reliable method
<7 days after spontaneous or induced abortion
<4 weeks post partum
breastfeeding and amenorrheic and <6 months post partum
sterilization methods
tubal ligation and vasectomy
failure rates <1%
advantages of sterilization
permanent
cost effective over time
safe
disadvantages of sterilization
permanent
expensive up front
no STI protection
intrauterine device
inhibits sperm motility
prevents implantation
approval rate 98%
20x more effective than OCPs with no increased risk of thromboembolism
IUD options
copper TCu-380A levonorgestrel releasing devices: thins uterine lining, less bleeding mirena skyla liletta
copper IUD
no hormone
more bleeding/cramping than others
good for 12 years
mirena
good for 7 yeas
20 mcg/day
good choice for breastfeeding moms
skyla
good for 3 years
smaller than mirena
14 mcg/day
liletta
good for 4 years
19 mcg/day
available for $75 for low income women
insertion of IUD
at end of menses or 6-8 wks after childbirth
no harm to future fertility
can be inserted immediated after childbirth
risks of IUD
uterine rupture
infection
side effects of IUD
copper: increased bleeding and cramping
LNG: amenorrhea or spotting
contraindications to IUD
pregnancy undiagnosed vaginal bleeding unresolved pap/suspected cancer active genital infection distorted uterine cavity high risk for STI decreased resistance to infection wilson's/ copper allergy sickle cell: increased bleeding
etonogestrel implant
nexplanon
subQ progesterone
thickens cervical mucus, prevents endometrial thickening, suppresses ovulation
lowest failure rate for reversible contraception
insertion of nexplanon
1st 5 cays of cycle or immediately postpartum
good 24 hours to 5 years
side effects of nexplanon
heavy menses
amenorrhea
spotting
weight gain
medroxyprogresterone (depo shot)
inhibits ovulation by decreasing gonadotropins
thickens cervical mucus
dose 150 mg IM every 3 months
pregnancy rate 1/100 women
who is the depo shot good for
chronic medical problems
sickle cell (decreases crises)
forgets pills or cant take estrogen
side effects of depo shot
amenorrhea spotting weight gain bone loss hair loss nausea delayed return to fertility depressed mood
black box warning on depo shot
should be used for >2 years only if other methods are inadequate
loss of bone density
contraindications to depo shot
thromboembolic or liver disease stroke vaginal bleeding/pregnancy MI breast cancer severe hypertension
combo OCPs
estrogen/progesterone pills estrogen is usually ethinyl estradiol -high dose: 50 mcg -low dose: 15-35 mcg multiple types of progesterone may be started at any time id reasonably certain that patient is not pregnant
when should you not use combo OCPs
first 4-6 weeks postpartum, even longer if breastfeeding
progesterone types of OCPs
1st gen: norethindrone
2nd gen: levonorgestrol, norgestrel
3rd gen: norgestimate, desogestrel
4th gen: drospirenone
1st gen progesterone OCPs
norethindrone
lowest rate of thromboembolism
2nd gen progesterone OCPs
levonorgestrel, norgestrel
most start with these, best tolerated
3rd gen progesterone OCPs
norgestimate, desogestrel
less androgenic, longer half life, less metabolic effects on carbohydrates and lipids
4th gen progesterone OCPs
drospirenone
spironolactone analogue, less bloating
increased risk for VTE
mechanism of action of OCPs
negative feedback to HP axis -inhibits mid cycle LH surge -prevents ovulation thickens cervical mucus slows fallopian tube motility make uterus inhospitable pregnancy rate 5/100 women highest failure rates in 15-24 year olds
benefits of OCPs
protective against ovarian/uterine cancer
fewer ectopics
relieve dysmenorrhea
increase bone mass
decrease acne
decrease fibrocystic breast disease/ breast pain
decrease PID
decrease functional ovarian cysts, fibroids
decrease iron deficiency anemia
may decrease RA
improve symptoms of PCOD (hirsutism)
risks/side effects of OCPs
serious risks rare VTE -greatest in first 2 years -increased risk with drospirenone stroke and MI -risk in smokers >35 -HTN important additive risk -smokers with migraine have 6x stroke risk NO proves risk for breast cancer increase in chlamydia infections decrease in PID
drugs that cause OCP failure
rifampin
anticonvulsants
griseofulvin
HIV meds
minor side effects of OCPs
headache breakthrough bleeding amenorrhea decreased libido acne breast tenderness nausea erythema nodosum
contraindications for OCPs
smokers >35 migrain w aura migraine without aura but with other risk factors thromboembolic disorders cerebral vascular disease poorly controlled HTN cancer -breast -endometrial -liver tumors
pills w decreased number of cycles
seasonale / seasonique / jolessa / quasense
-active pills for 84 days then 7 or 4 days of inactive
-4 periods per year
lybrel/ quartette
-active pills for entire year
-expect breakthrough bleeding and/or amenorrhea
transdermal hormones
transdermal patch to trunk or upper outer arm weekly for 3 weeks of cycle
3x risk thromboembolism
lower efficacy in obese women
vaginal ring
insert into vagina and stays for 3 weeks of cycle
can remove for intercourse
ethinyl estradiol 15 mcg and estonogestrel 120 mcg
more vaginal discharge
progestin only “minipill”
affects cervical mucus viscosity, fallopian tube mobility, endometrial thickness
does not reliably inhibit mid cycle LH surge (not good)
good w breast feeding
more spotting, acne, hirsutism, oily skin
specific uses for progestin only contraceptives
sickle cell disease
coronary artery disease
SLE (lupus)
people w risk factors that preclude them from using combined OCPs
barrier methods
condoms diaphragm cervical cap vaginal pouch sponge spermicides
condoms
44% of sexually active women use
pros: accessible, STI protection, erectile enhancement, prevent sperm allergy, inexpensive
cons: reduced sensitivity, interruption, decreased pleasure, latex allergy, breakage
diaphragm
latex cup with flexible rim, holds spermicide and covers cervix
repeated intercourse requires more spermicide, must remain in place for 6 hours
15/100 pregnancy rate
diaphragm advantages
no systemic side effects
prevents STIs
decreases risk of cervical dysplasia
diaphragm disadvantages
interruption
latex or spermicide allergy
inability to correctly insert
increased incidence of UTIs
vaginal pouch
long thin polyurethane sheath with flexible ring for cervix and outer ring for labia
stronger than latex
may insert up to 8 hours prior to intercourse
20/100 preg rate
vaginal pouch advantages
good protection for both partners
does not require erect penis
can use oil based lubricants
vaginal pouch disadvantages
cumbersome
may be used only once
sponge
soft sponge like device, slightly smaller in diameter than diaphragm
16-32/100 pregnancy rate
spermicides
foam, creams, gels, films
may be used alone or with barrier method
failure rate 6-21%
spermicide advantages
over the counter
good back up method
add lubrication
quickly inserted
spermicide disadvantages
allergies, increased yeast infections
pregnancy rate 30/100
