ch 1 female repro contraception Flashcards
3 layers of uterus from inner to outer
endometrium
myometrium
perimetrium
clusters of epithelial cells within lobules of breasts that secrete colostrum and milk
clusters of acini
changes in breasts throughout menstrual cycle (3)
sensitivity
size
nodularity
when should women do self breast exams
5-7 days after period ends
regularity of menstrual cycle influenced by (4)
age
physical health/fitness
psychosocial/emotional status
environment
menarche
first menstruation
puberty
transitional stage between childhood and sexual maturity
“normal” cycle average
28 days (1st day of flow to 1st day of next flow)
variation in menstrual cycles (cycle of duration and # days)
21-35 days cycle
2-6 days flow
normal blood loss during cycle
20-60 mL
3 cycles within menstrual cycle
- chemical cycle (steroidogenesis) - brain
- ovarian cycle - ovary
- endometrial cycle - endometrium
hormones within chemical style of menstruation
GnRH
FSH
LH
hormones within ovarian cycle of menstruation
estrogen
progesterone
purpose of LH
maturation and release of 1 ova (ovulation)
endometrial response to increased progesterone and estrogen from ovaries
mature, edematous, vascular and glandular secretions ready for implantation of zygote
endometrial response to no fertilization, corpus luteum regresses, decreased progesterone and estrogen
vasospasm and vasoconstriction, necrosis of tissues, sloughing (menses)
effect of HCG (human chorionic gonadotropin) on corpus luteum
keeps corpus luteum alive for 12 weeks through progesterone
indicators of ovulation
- basal body temp increases 0.5-1 degree F for 10-12 days
- cervical secretions change (increased, spinnbarkeit, ferning)
- cervical os dilation
- mittelschmerz
what is spinnbarkeit
cervical mucus stretches > 6 cm
egg white
what is ferning during ovulation
dried, crystalline pattern of cervical mucus
what is mittelschmerz during ovulation
sharp lower abdominal pain during ovulation
lifespan of corpeus luteum if HCG is not present
14 days
pituitary: primary hormone during 1st half of cycle
FSH
what hormone is critical for maintaining zygote/embryo
progesterone
pituitary: primary hormone during 2nd half of cycle
LH
ovarian: primary hormone during 1st half of cycle
follicular
- estrogen dominant
- maturation of ovarian follicle
ovarian: primary hormone during 2nd half of cycle
luteal
- progesterone dominant
- follicle after ovulation
endometrial: 2 stages during 1st half of cycle
- menstrual: shedding of endometrium
- proliferative: building up of endometrium
endometrial: 2 stages during 2nd half of cycle
- secretory: endometrium mature and functional
- ischemic: vasospasm and death of functional layer
how long do you have to go without a period to be considered in menopause
12 months in a row
climacteric
transitional phase during which ovarian function and hormone production decline
perimenopause
period of time preceding menopause, lasts about 4 years
average onset is 51-52 years
physical changes during perimenopause (4)
- bleeding
- genital changes
- vasomotor instability (hot flash)
- mood and behavioral changes
health risks for perimenopausal women (3)
- osteoporosis
- coronary heart disease
- UTIs
factors to consider when choosing contraception
- side effects/risk of use
- reliability
- ease of use
- relative cost
- STI protection
- woman’s comfort level with method
- partner’s willingness to use
- culture and religion
informed consent - BRAIDED
Benefits Risks Alternatives Inquiries and questions Decisions, may change mind Explanations Documentation
methods of contraception
- coitus interruptus (withdrawal)
- temporary methods (FAMs, barrier, hormonal)
- long acting reversible (IUC/IUD, hormonal)
- permanent (sterilization)
FAMs
fertility awareness methods
-relies on avoidance of sex during ovulation
how long can ova live
12-24 hr
how long can sperm live
24-28 hr
when does ovulation occur
14 days before next period begins
billing method
using cervical secretions to determine fertility
temporary methods: barriers (5)
- spermicides
- condoms (male/female)
- diaphragm
- cervical caps
- contraceptive sponges
method of action of spermicides
- reduces sperm mobility
- destroys sperm cell membrane
advantages of spermicides
- safe
- OTC
- no male involvement
important teaching for pt using spermicides
read instructions (varies)
disadvantage of spermicides
-contradicted in those at high risk for HIV
important teaching for pt using condoms
- correct use is critical
- teach pt how to use condom
teaching for pt using female condom
can’t use female and male condom at same time
danger of using diaphragm/sponge
can lead to toxic shock syndrome
teaching for use of diaphragm
- leave in for atleast 6 hours after sex (but no more than 8 hours)
- must be fitted by provider
two categories hormonal methods
- combined estrogen and progestin
- progestin only
what type of birth control prevents ovulation
combined hormonal
meds that interfere with combined oral contraceptive (5)
- anticonvulsants
- anti TB
- antifungals
- anti HIV
- st johns wort
contraindications for combined oral contraceptives (5)
- pregnant/breastfeeding
- Hx of thromboembolic disorders
- breast cancer
- smoking and over 35 yrs
- diabetes with known vascular complications
teaching for use of combined oral contraceptive patch
- replaced every month
- less effective if >198 lbs
warning signs for complications of using combined hormonal contraceptives - ACHES
abdominal pain chest pain headache eye problems severe leg pain
teaching for use of oral progestins (minipill)
must be taken at same time every day
teaching for use of injectable progestins
do not massage site
long acting reversible contraceptives
- injectable progestin
- implantable progestin
- intrauterine contraceptive: progestin and copper
cautions before inserting IUC/IUD (3)
- undiagnosed vaginal bleeding
- pregnancy
- active/recent infection
teaching for IUD/IUC
- check strings
- no signs of infection
- don’t remove yourself
warning signs IUD - PAINS
period late abdominal pain infection exposure not feeling well strings
permanent methods of contraception
female sterilization:
- tubal occlusion
- tubal reconstruction
male:
- vasectomy
teaching for breastfeeding (lactational amenorrheal method) method of contraception
- 6 months
- no more than 4 hours between feeds during day
- no more than 6 hours between feeds during night
- no supplementation
pregnancy that ends before 20 weeks
abortion
least effective methods of contraception
fertility based awareness methods
spermicides
(withdrawal method)
most effective methods of contraception
reversible:
- implant
- IUD
permanent:
- male sterilization vasectomy
- female sterilization
