CH 17 Family Planning Flashcards
most effective birth control
implant, IUD, sterility
2nd tier: 6-12 pregnancies per 100
injectable, pill, patch, nuva ring, diaphragm
medical eligibility critera (MEC) for contraceptive use categories
1: no restriction
2: advantages outweigh risks’; can use
3: theoretical or proven risk usu outweigh advantages, usu not rec unless more appropriate methods are not available or acceptable; gen do not use
4: unacceptable health risk; don’t use
combined hormonal contraceptives (CHC): low dose ethinyl estradio, COC, Patch (Ortho Evra), Nuva Ring,
g
progestin and estrogen
low dose of progestin and estrogen = suppresses pituitary function and prevents LH spike to cause ovulation
-mimics early pregnancy (stops ovulating so don’t make another egg)
progestin action
-thickens cervical mucus
-inhibits LH surger and prevent ovulation
estrogen action
-thinning mucus
-ovarian inhibition
-endometrial proliferation
-pituitary inhibition
16-year-old Nulliparous Young Woman Denies history of venous thrombotic
event, non smoker, generally healthy.
Her LMP ended about 4 days ago, was
NL timing and flow. Her boyfriend lives
in another state and she has not seen
him since LMP began nor had
intercourse with another partner.
MEC? need preg test?
MEC 1
consider a long term and not daily pill since teens have high fail rate cus forgetful
depo shot max use for how many years?
2 years
recommendations and tests prior ot starting contraceptions
class A: essential and mandatory
class B: nice if could, do best
class C: does not contribute to safe contraceptive methods
class A for testing before contraceptive methods
-bimanual examination and cervical inspection for LNG/copper IUD and diaphragm/cervical cap = to size the uterus to insert IUD and examine cervix for cervicitis (tx first)
-BP for COC
when do u NOT need a pregnancy test before giving contraceptives?
when there’s no sx’s of pregnancy AND…
- < 7 days after start of normal menses
- no sex since last menses
- correctly/consistently used a reliable contraception
- < 7 days after spontaneous or induced abortion
- within 4 weeks postpartum
- breastfeeding fully, amenorrheic, < 6 months postpartum
methods to start BC
Standard Method (COC, patch, ring)
-sunday start after menses begin. with hormone free week monthly
-backup method for the first 7 days
First day of menses start
-start COC, patch, ring on 1st day of period, no back up needed (ovulation occurs, women has enough BC hormones that ovulation is suppressed)
Quick start method
-make sure not preggos, start same day, back up 7 days
Jump start
-good if unprotected sex since LMP
-give emergency contraception
-start BC, back up for 7 days
who is NOT a combined oral contracpetive (estrogen/progestin) pills candidate?
-Hypertension (good control still a no (category 3)) & poor control is category 4 (NO)
rifampin (the ONLY antibiotic that lowers contraceptive efficacy) - multipathway cytocome inducer - causes estrogen/p to offload and reduction effectiveness
ONLY to systemic forms of contraception (NOT IUD)
advice for women taking a potentially interacting medication with BC
- continue contracption EVEN if spotting occurs. Spotting doesn’t mean BC is failing
- use back up c method for duration of time taking the interacting medication plus an additional 7 days
androgens = male hormones/testosterone
-B: acne vulgaris
lowers androgen levels causes improvement in acne
Category 3 for COC?
gastric bypass ! removal of the duodenum (where most meds are absorbed) resulting in less contraceptive benefits/absoprtion
which contraceptive NOT recommended in early PP and breast feeding
no COC for the first 1-2 weeks bc PP is in high thrombotic state and adding estrogen can more likely to clot.
-Estrogen PP can also effect breast milk production
-CAN give IUD right away PP/delivery room
-Depo shot can be given 1 day PP
Tier 1: long acting reversible contraceptive (LARC)
Copper IUD (Paragard), Levonorgestrel IUD
“forgettable contraception”
1st line for nulliparous and parous women including teens (won’t interrupt an implanted pregnancy)
Copper IUD & Levonorgestrel IUD MOA
foreign body in intrauterine cavity causing sterile inflammatory response that is toxic to sperm, ova which impairs implantation
LNG-IUD (Mirena) MOA
- local uterine changes enhanced by presence of progestin = causes thickening of cervial mucus, causing a physical barrier to prevent sperm from entering
- endometrial thinning
choosing Copper IUD & Levonorgestrel
provide all info to pt
- copper gives heavier menses
- LNG more scant menses to none
Copper IUD & LNG IUD duration of action
Copper (Paragard) - approved for 10 years, likely effective for 20 yrs
Mirena- approved for 5 years, likely longer
Skyla - approved for 3 years
Implant Etonogestrel (Nexplanon, Implanon)
MOA, effective, AE?
daily constant release of low dose progestin
effective for 3 years
AE: spotting, irregular bleeding
can be managed with COC use x 3 mo or timed NSAID x 2 weeks
Emergency contraception (EC)
anytime unprotected sex including ptoential method failure (late for or missed pills, late for depo, misplaced diaphragms, condom break, expelled IUD) etc
-preg rate 0.09%
EC options
- Copper IUD insertion (most $$$) most effective
- Ella (Ulipristal acetate (UPA) = take within 5 days, Rx only
- Plan B (levonorgestrel/progestins) in 1-2 doses (OTC) = take within 3 days, OTC
Ella (Ulipristal acetate) MOA
progesterone agonist/antagonist = direct inhibitory effect on follicular development and ovum release
-causes changes in endometrium **
in over 95% of women using progestin only EC..
next menses occurs within 3 weeks of taking medication.
get preg test if menses delayed over 1 week of anticipated onset date
Levonorgesterol (Plan B) MOA
-inhibit or delays ovulation
-inhibits tubal trasnprot of sperm AND egg
Copper IUD as EC, pros and contraindication
-can be left for 10 years
-NO in active uterine infection
lower efficiacy with what EC in obese pts?
hormonal LNG containing options (NOT copper IUD)
BMI 30+
with hormonal emergency contraception… will an established preg be interrupted or higher rate of birth defect?
NO too early
MEC for age and smoking on COC
< 35 years old, no smoking: Category 1
> 35, < 15 cigs/day: Cat 3 (risk outweigh)
> 35, > 15 cigs/day: Cat 4 (NO)
