Birth Control options Flashcards
Implant - nexplanon (etonogestrel)
Efficacy - >99%
Hormones- Progestin
administration- sub-dermal plastic rod, protection for up to 3 years
How to start- if inserted more than 5 days after period use the backup method for 7 days
Late dose?- take out within 3 years and new can be inserted immediately if desired
Side effects- Serious: mood changes headaches and acne : Common: pain with insertion, irregular bleeding for first 6-12 months
benefits - protection for up to 3 years, don’t have to remember daily dosing
Return to fertility - May be delayed or rapid (within 6 months)
Levonorgestrel IUD
Efficacy - >99%
Hormones- progestin
administration- insert into the uterus, protection up to 3-7 years
How to start- use a backup method for 7 days after insertion
Late dose?- remove within 3-7 years and new one can be immediately inserted if desired
Side effects- Serious: uterine perforation, expulsion, and infection : Common: cramping with insertion, spotting for first 3 months , period may become lighter
benefits - don’t have to remember daily dose, lower risk of uterine cancer, lighter periods, long term protection
Return to fertility - immediately
Copper IUD
Efficacy - >99%
Hormones- none
administration- inserted into the uterus and provides protection for up to 10 years
How to start- no backup method, effective immediately
Late dose?- take out withing 10 years and new one can be inserted immediately if desired
Side effects- Serious: expulsion, infection, uterine perforation : Common: cramping with insertion, period may become heavier
benefits - lower risk of uterine cancer, safe to breastfeed, long term protection
Return to fertility - immediately
SHOT (depot medroxyprogesterone acetate)
Efficacy - 94%
Hormones- progestin
administration- 150mg IM or 104mg subQ every 3 months
How to start- Quick start: start today and use protection for first 7 days, next period: take within 7 days of period
Late dose?- > 15 weeks use back up protection for 7 days after shot, > 15 weeks and unprotected sex - use emergency contraception
Side effects- lower bone density, heavy bleeding, common: weight gain change in acne or mood
benefits - lower risk for uterine cancer, less painful and lighter periods, safe to breastfeed
Return to fertility - possible delayed return
PILL combined oral contraception
Efficacy - 91%
Hormones- progestin and estrogen
Very low does = 20-25 mcg EE
Low dose = 30-35 mcg EE
high dose = 50 mcg EE
administration- oral tablet take once daily at same time and most packs have 4-7 placebo pills
How to start- quick start: start today and if more than 5 days after period use backup for next 7 days, Next period: start withing 5 days of period, Wait 5 days to start if ulipristal acetate (ella) used
Late dose?- one pill: take as soon as possible, 2 or more pills: Take 1 ASAP; take next pill at usual time; use backup for 7 days
Side effects- serious: blood clots, stroke, common: nausea, spotting, change in mood and headaches
benefits - improved acne, lower risk of ovarian/ uterine cancer, more regular periods
Return to fertility - immediate
Mini-pill norethindrone
Efficacy - <91%
Hormones- progestin
administration- oral tablet take one each day within 3 hours of the same time and no placebo pills
How to start- Quick start: start today and if more than 5 days after period use protection for 2 days, Next period: start within 5 days or period, wait 5 days to start if ulipristal acetate used
Late dose?- >3 hours later: take asap and use backup for 2 days, miss 1 or more pill: take 1 asap, take the next pill at the usual time and use backup for 2 days
Side effects- serious: severe headaches, heavy bleeding, ectopic pregnancy, common: spotting and menstrual changes
benefits - safe to breastfeed, lack of estrogen related side effects
Return to fertility - immediate
POP - drospirenone 4mg
Efficacy - <91%
Hormones- progestin
administration- oral tablet, daily and 4 placebo in pack
How to start- quick start: start today and if more than 5 days after period use backup for 7 days, next period: start within 5 days of period, wait 5 days to start if ulipristal acetate used
Late dose?- one pill- take as soon as possible, 2 or more pills: take 1 asap and take the next pill at usual time, use backup for 7 days
Side effects- serious: severe headaches, heavy bleeding, hyperkalemia, common: spotting and menstrual changes
benefits - safe to breastfeed, lack of estrogen related side effects
Return to fertility - immediate
Disposable vaginal ring - etonogestrel and EE (nuva ring, eluryng)
Efficacy - 91%
Hormones- progestin and estrogen (releases 15mcg EE per day)
administration- flexible ring self inserted into vagina util no longer felt, left in place for 3 weeks removed for 1 week, new ring inserted after 7 days
How to start- quick start; start today and if more than 1 day after period use backup for 7 days, next period: start on first day or period, Wait 5 days to start if ulipristal acetate used
Late dose?-out for >3 hours reinsert and use backup for 7 days, in for > 3 weeks but <4 weeks remove ring and put in new ring 7 days later, in for > 4 weeks remove ring and put new ring immediately and use backup for 7 days
Side effects- serious: blood clots, stroke: Common: nausea, spotting, breast discomfort, change in mood or headaches
benefits - improved acne, more regular, lighter, less painful periods
Return to fertility - immediate
Reusable vaginal ring - segesterone and EE (annovera)
Efficacy - 97%
Hormones- progestin and estrogen (releases 13 mcg EE per day)
administration- flexible ring self inserted into vagina until no longer felt, left in place for 3 weeks and removed for 1 week, wash with mild soap..warm water, pat dry and place in case reinsert into vagina after cleaning
How to start- quick start: start today if more than 5 days after period use backup for 7 days, next period: start on days 2-5 of period, wait 5 days to start if ulipristal acetate used
Late dose?- out for <2 hours - reinsert, out for >2 hours: reinster use back up until in for 7 consecutive day, in for >3 weeks: remove ring: reinsert 7 days later
Side effects- serious: blood clots, stroke, common: headache/migrane, nausea/ vomiting, infection
benefits -improve acne, more regular and lighter periods, dont have to take daily pill, lower risk of ovarian/ uterine cancer
Return to fertility - immediate
Patch - norelgestromin and EE (xulane and zafemy)
Efficacy - 91%
Hormones- progestin and estrogen (release 35mcg EE per day)
administration- transdermal patch, new patch every week for 3 weeks then patch free for 7 days, apply new patch
How to start- quick start: start today if more than 5 days after period use backup for 7 days, next period: start within 5 days of period, wait 5 days to start if ulipristal acetate use
Late dose?- off >24 hours apply new patch and use backup for 7 days, on for >9 days apply new patch and use backup for 7 days
Side effects- serious: blood clots, common: nausea spotting, skin irritation, change in mood
benefits - improve acne, dont need to remember daily dose, lower risk of ovarian/uterine cancer
Return to fertility -immediate
Patch - Levonorgestrel and EE (twirla)
Efficacy - less effective as BMI increases
Hormones- progestin and estrogen (releases 30mcg EE per day)
administration- transdermal patch, new patch every week for 3 weeks and patch free for 7 days and apply new patch
How to start- next period: on first day of period use back up hormonal contraception for the first 7 days of first cycle, wait 5 days to start if ulipristal acetate used
Late dose?-off <24 hours apply new patch and no backup needed, off >24 hours apply new patch and start new four week cycle and use backup for 7 days
Side effects- serious: blood clotsm common: nausea, increased weight, skin irritation, change in mood or headaches
benefits - improve acne, lower risk of ovarian. uterine cancer, more regular lighter less painful periods
Return to fertility - immediate
Knowledge Check
A patient calls your pharmacy around 10:00 AM and says that she forgot to take her COC yesterday afternoon, which she usually takes around 1:00 PM. She tells you she only forgot one pill. What should she do?
A. Take her pill ASAP and use a form of backup for 7 days
B. Take a pregnancy test before taking any more pills
C. Take her pill ASAP; no backup is needed
D. Take her pill ASAP and use a form of backup for 2 days
A patient calls your pharmacy around 10:00 AM and says that she forgot to take her COC yesterday afternoon, which she usually takes around 1:00 PM. She tells you she only forgot one pill. What should she do?
C. Take her pill ASAP; no backup is needed
PT is on a combined oral pill and only forgot one pill and should take it as soon as possible
Knowledge Check
Would you give different advice if the patient was taking a norethindrone mini-pill? If so, what would you tell the patient?
A.Take her pill ASAP and use a form of backup for 7 days
B.Take a pregnancy test before taking any more pills
C.Take her pill ASAP; no backup is needed
D. Take her pill ASAP and use a form of backup for 2 days
D. Take her pill ASAP and use a form of backup for 2 days
if patient was on mini pill and missed a dose it would depend on if she was in the 3-hour window of dowsing. Since she is outside that 3-hour window of her usual doing she should take her pill ASAP and use form of backup for 2 days
Knowledge Check
Jessica comes to your pharmacy to pick up a new prescription for Annovera. How would you counsel the patient on how to clean the ring?
A. Rinse with water when you remove for the hormone-free week. Keep in the case until ready to re-insert.
B. Wash with mild soap and warm water when you remove for the hormone-free week. Keep in the case until ready to re-insert.
C. This method does not need to be cleaned. Dispose of the ring and
pick up a new one each month.
B. Wash with mild soap and warm water when you remove for the hormone-free week. Keep in the case until ready to re-insert.
PT is on a Reusable vaginal ring. For cleaning you would use mild soap and warm water and place in case
Serious side effects from estrogen (ACHES)
A- Abdominal pain ( Would be worried about the liver problem, gallbladder, clot)
C- Chest pain: SOB, coughing (would be worried about pulmonary embolism, Myocardial infarction
H- Headache: severe including sudden vomiting or weakness/numbness on one side (would be worried about stroke, HTN, Migraines)
E- Eye problems: double vision, blurry, vision (would be worried about stroke, HTN, blood clot in eye)
S- Swelling or sudden leg pain: in calf or thigh (would be worried about deep vein thrombosis)
