Contraception Flashcards
Condoms
physical barrier
cheap
no script
protects against STIs
non hormonal
90-98% effective
reduces spontaneity
rx of breaking (rare)
allergic reaction to latex
CI: difficulty maintaining erection, allergic reaction
Diaphragm
Silicone cup inserted into vagina to occlude the cervix
inserted prior to sex
$70-90, multiple uses
80-85% effective
non hormonal, no script
no STI protection
RX of cystitis
learning how to use effectively is hard
vaginal/penile irritation
CI: 6wk post partum, prone to UTI
Copper IUD
long term and emergency contraception
Copper repels sperm entry into the uterus and augments their maturation in the vagina, thickens cervical mucus and creates a toxic environment for an fertilised egg in the uterus
Small plastic T shaped device inserted into cervix by trained healthcare professional
10y in situ
99.5%
reliable, long term, non hormonal, easily reversible
no STI protection
procedural, painful (especially if nulliparous)
uterine damage
may fall out
infection, heavy/irregular bleeding (first 3-6mo worst)
spotting in first 3-6mo
CI: recent PID, irregular bleeding, wilson’s disease, heavy menses
fertility awareness
Temperature - take temperature every morning before getting out of bed
Cervical mucus - log cervical mucus daily
Calendar - chart cycles
use condoms/avoids sex on fertile days
Free, can use app to keep track
75-85% effective
no hormones, no ADRs, no CX, no CI
COCP
Indicated for dysmenorrhea, contraception, HMB, endometriosis, acne, PCOS, PMS/PMDD, perimenopause
high levels of E and P prevent ovulation and thicken cervical mucus to prevent sperm penetration
21 days of hormones pills followed by 7 days of placebo.
Daily pill taken at the same time. takes 7 days to become effective (use condoms)
missed pill/vomited or diarrhea <2 since ingestion
- <24h -> take when remembered (even if have to take 2 at once)
- > 24h -> take when remembered + next pill at the normal time + condoms for 7days
- < 7 hormone pills left -> skip sugar + use condoms for 7d
- > 1missed pill in first 7 days -> take emergency contraception + use condoms for first 7 days
cost depends on brand
99.7% effective w perfect use. 91% typically
easily reversible, accessible, easy to manipulate cycles with continuous use, avoid PMS, avoid HMB and dysmenorrhea
reduced rx of endometrial, ovarian and bowel cancer
reduces cyst formation
decreases cramping
no protection against STI
daily at same time
Drug interactions. inform prescribing doc that your are taking the COCP
ADRs: P sx: headaches, Breast tenderness, N, increased appetite, bloating, VTE rx, irregular bleeding/spotting in first few months
COCP CI
<6wk postpartum + breast feeding (E inhibits prolactin + high rx of DVT)
Smoking >15/day + >35y -> RX of VTE
multiple CVS rx factors
BP >160 and or >95
vascular disease or IHD -> E causes plaque rupture
Major surgery -> VTE
BCA
Migraine w aura -> RX of stroke
Thrombophilia -> Rx of VTE
DM w macro or microvascular CX
CLD
Carbamazepine, phenytoin
Combined Vaginal Ring (NuvaRing)
same as COCP, sits in the vagina
Benefit: dont forget to take it
never the answer
Combined Vaginal Ring (NuvaRing)
same as COCP, sits in the vagina
Benefit: dont forget to take it
never the answer
Mini Pill
Progesterone only -> thickens cervical mucus -> prevent sperm penetration
Used for contraception, breast feeding, HMB
Daily pill
if missed 3hour window -> take when remember and use condoms for 3days. consider emergency contraception
(Slinder has a 12hour window)
93%-99.5%
less ADRs as less hormones
reduce RX of endometrial cancer
Amenorrhea: no proliferation of the endometrium
immediate return of fertility
no STI protection
same time everyday
irregular bleeding
Progesterone SX
CI: BCA, severe liver disease, carbamazepine, phenytoin
Levonogestrel releasing IUD: mirena/kylena
usually the answer on EX
Indication: contraception while breastfeeding, HMB, dysmenorrhea, Endometriosis, perimenopause
Progestin augments sperm maturation in the vagina, thickens cervical mucus to prevent sperm penetration and thins the endometrial lining.
Inserted into the uterus by trained healthcare profession
avoid insertion 2-6wk postpartum (uterine perforation)
condoms for 1wk post insertion
$37 covered by Medicare. need to pay for cost of insertion
5y in situ
99.7-99.9% effective reliable, long term no or very light periods easily reversible Uterine and ovarian cancer protective
no STI protection
procedure to insert (painful if nullip)
may come out
ADRS: infections, irregular menstruation, progesterone ADRs
CI: BCA, severe Liver disease, recent PID, irregular bleeding, abnormally shaped uterus
Implanon (implant)
when breastfeeding, contraception, dysmenorrhea
prevents ovulation and thickens mucus
4cm plastic stick inserted into arm by GP. can be inserted immediately post partum. 7d condom use post insertion.
$37 covered by Medicare
3y, 99.95% insitu
reliable, long term easily reversible light bleeding or amenorrhea cheap uterine and ovarian CA protection
no STI protection
irregular bleeding RX for first few months
P ADRs
CI: BCA, severe liver disease, AUB, Carbamazepine, Phenytoin
Injection
I: contraception, breastfeeding, dysmenorrhea
progesterone injection that prevents ovulation and thins endometrial lining
injection every 12wk
96%-99%
reliable, long term, light bleeding/amenorrhea, easily reversible
no STI protection, delayed return to fertility, P Sx, decreased BMD RX
CI: severe liver disease, abnormal bleeding, CV RXs
Levonorgestrel Emergency contraception
Progestin that prevents/delays ovulation
Pill within 72 hours 84% effective no script safe while breast feeding
vomiting 5%, repeat dose in 2h
CI: allergy, severe liver disease, confirmed pregnancy, carbamazepine, phenytoin
Copper IUD Emergency Contraception
Spermicidal and prevents implantation of fertilized ovum
emergency contraception within 120h (5days)
most effective form of emergency contraception
preferred in women with large BMI as MOA is not affected by BMI
requires insertion which can be costly
CI: confirmed pregnancy, current STIs or PID
needs to be >4wk post partum
Ulipristal Acetate (ella one)
Emergency Contraception
Selective progesterone receptor modulator -> promotes contraction and expulsion
Pill, do not need script
with 120 hours
84% effective, no script
1%vomiting, repeat dose in 3hours
cramping, vaginal bleeding
if BF need to express and discard milk for 1 week
CI: allergy, severe liver disease, confirmed pregnancy, severe uncontrolled asthma, carbamazepine, phenytoin
