Contraception 1 Flashcards
A woman must meet 1 of which 6 criteria in order to be reasonably certain that she is not pregnant in order to give birth control
- < 7 days after start of normal menses
- No sex since LMP
- Has been correctly and consistently using reliable method of contraception
- Is < 7d after spontaneous/induced abortion
- W/in 4 weeks postpartum
- Breastfeeding, is amenorrheic and <6months postpartum
If reasonable certainty that patient is not pregnant is unmet, what 2 things should you consider doing
- Emergency contraception then start on chronic contraception
- Consider urine preg test/qualitative HCG
If reasonable certainty that patient is not pregnant is unmet, can you still start contraception? When should you follow up
- Benefits exceed risk even with uncertainty (EXCEPT FOR IUD)–> Start contraception
- F/U for preg test in 2-4 weeks
What are the 3 MOAs of contraception?
- Inhibit ovulation
- Prevent sperm from reaching egg
- Inhibit implantation
What are the 3 combined hormonal contraception options
COCs
Transdermal patch
Vaginal ring
What are the 2 long acting reversible contraception options
- IUDs (copper and levonorgestreal)
- Etonogestrel implant
What are the 3 least effective contraceptive methods
Fertility-awareness based methods
spermicide
What are the 4 MOST effective contraception options
Implants (i.e. Nexplanon)
Vasectomy
Female sterilization
IUDs (copper/levonorgestrel)
Standard days Method is for women with menstrual cycles from ____ - ____ days long
26-32
When should a woman abstain from sexual intercourse on the Standard Days method
Days 8-19
How long must you monitor cycles for the Calendar method?
- For women that dont have regular menses:
- Monitor cycles x6 months
- Avoid sex during fertile period
When should a patient avoid sex if using the Cervical Mucus/Two Day Method?
What is the “Peak Day”?
- “Peak” day= last day of “stretchy”, clear mucus
- Abstinence from time of any cervical secretion until 4d after peak day
- If no secretions x2 days- ok to have sex
When should you abstain from sex if using the Basal Body Temperature method?
from end of menstrual period until 3d after temp increase (0.5-1.0degF= ovulation)
Which 2 fertility awareness methods/natural family planning have the LOWEST typical use failure rate?
- Standard Days (12%)
- Two Day Method (13.7%)
(Calendar, Symptothermal and post-ovulation all have a typical use failure rate of 25%)
Which type of male condom is 2.5-5x more likely to slip or break than latex?
Polyurethane
What type of lubricants should be avoided with male condoms
oil/petroleum based lubricants
How long must female barrier methods (cervical caps, diaphragm, female condoms, sponge, spermicides) stay in place for after sex?
>6hrs but no longer than 24
Which contraceptive method increases risk for HIV transmission and is therefore contraindicated for those that are HIV+ or at high risk for HIV?
Spermicide
Which contraception method increases risk of UTI?
Diaphragm
Which patient population shoud the transdermal patch not be used in
women > 198lbs
What is the MOA of combined hormonal contraception? (4)
- Prevent ovulation (90-95% of MOA)
- Thickening of cervical mucus
- Thin, atrophic endometrium
- Tubal motility slowed
Combined hormonal contraception: No back up needed if start in first __days of bleed
5
Combined hormonal contraception: Monitoring
What is the only test needed prior to starting
Blood pressure
No routine f/u needed
Which contraceptive method has the following pros:
- Decreased blood loss, cramps and more predictable menses
- Decreased acne, hirsutism
Combined hormonal contraception
KNOW
What are the 8 limitations (contraindications) of combined hormonal contraceptives?
- Breast cancer
- Severe HTN or vascular dz
- Complicated DM (or DM >20yrs)
- Heart dz
- Migraine with aura
- Seizure disorder
- Liver/gallbladder diseases
- >15 cigs/day (esp when >35y/o)
What should you tell a pt that has missed 1 pill
Take missed pill ASAP
Take next pill as usual
What should you tell a patient to do if she has missed 2+ pills
- Tke most recent missed pill ASAP
- Remaining pills should be continued at usu. time
- Backup x7 days
- +/- emergency contraception
How long should a pt use backup contraception if they have missed 2+ pills
7 days
What should you tell a patient if missed pills were in the last week of hormonal pills?
Omit the hormone free interval by finishing hormone pills in current pack and starting new pack the next day
When should Progestin pills be started?
No back up is needed if started when?
Can be started at any time
No back up if started in first 5 days of bleed
POPCORN
What is the MOA of progestin pills
- Thickens cervical mucus (main MOA)
- Thin, atrophic endometrium
- Suppresses ovulation (sometimes)
- slows sperm motility
What are 2 side effects of progestin only pills
- Increased spotting/bleeding
- Intermittent Amenorrhea
POPCORN
When is a progestin only pill considered a missed pill?
- after a 3 hour delay
- Vomitting or diarrhea that occurs w/in 3 hrs of taking POP
What are 3 instances when a patient should not be prescribed Progestin only pills?
- Breast cancer
- Liver disease
- Meds that increase hepatic clearance (anticonvulsants, rifampin, griseofulvin, St. Johns Wort)
What should you advise your patient to do if they have missed a Progestin only pill (3 hours late or V/D w/in 3hrs of taking)
- Take another pill, use backup x2 days
- consider emergency contraception
Progestin only injectables:
- When can they be initiated?
- No back up needed if started when?
Start any time
No back up if started in first 7d of bleed
Progestin only injectables should be repeated how often
q 13 weeks
What are the 2 side effects of Progestin only injectibles that most commonly the cause of patients discontinuing use
- Heavy bleeding/spotting
- Weight gain
Which contraceptive option can cause a decrease in bone mineral density, especially in adolescents
Progestin only injectables
(reversable if discontinued)
How long can it take to resume normal ovulation after discontinuing Progesin only injectables?
1 year
What 6 medical conditions would cause you to not want to prescribe Progestin only injectables?
- Breast cancer
- Severe HTN
- Heart disease
- Vascular disease
- Migraine with aura
- Liver diseases
