contraception Flashcards
Perfect Use vs Typical Use
COC 0.3/8.7
POP 0.5/3
Mirena 0.1/0.1 - best
Cu IUD 0.6/1
Implanon 0.05/1
DMPA 0.3/0.3
Withdrawal 4/18.4
Condom Male 2/17.4
Lap sterilization
unipolar/bipolar coag
fislhie clip (yung parang ipit lang na walang teeth –> best, titanium)
silastic/yoon (yung ring na rubber)
hulka (yung may teeth na plastic)
types of BTL
Pomeroy
Irving
Uchida
best vasectomy reversal
if within 3 yrs from procedure
predictors of success reversal BTL
age at reversal
4cm remaining tube
OCP VTE risk
low dose OCP regardless of progestin has inc vte risk in the first to second yr
risk inc with age and weight
estrogen inc clotting factors while progestin no effect
OCP MI/Stroke
no inc risk regardless of age if nonsmoker and EE<50mcg
OCP and cancers
(-) endom Ca
(-) ovarian Ca
(-) colorectal
+ cervical – inc CIS
+ liver Ca – hepatocellular ca
+ breast CA – uncertain
(-) = protective
+ = inc risk
DMPA special indication
sickle cell disease
seizure disorder
DMPA disadvantages
must ensure PT negative or else IUGR associated neonatal death
9 month delay to ovulation
PID highest in IUD
20 days after insertion
can be inserted post partum
but if not inserted due to infection, 4-5weeks post partum
DMPA backup
if not started during menses, backup x 7 days
can be late for up to 2 weeks
Diaphragm/cap/sponge/female condom
when to insert
6/6/24/8
Diaphragm/cap/sponge/female condom
duration post coitus
6/8/6/6
Diaphragm/cap/sponge/female condom
max
24/48/30/8
1st generation estrane
norethisterone, lynestrenol, norethyndronel, ethynodiol diacetate
1st generation pregnane
MPA, megace
2nd generation
levonorgestrel, norgestrel
3rd generation
gestodene, norgestimate, desogestrel, etonogestrel, norelgestromin
4th generation estrane
dienogest
drosperinone
4th generation pregnane
nomegestrol acetate
nesterone
trimgestrone
19-nortestosterone hormones
androgenic, progestational, estrogenic
inc insulin resistance, dec glucose tolerance
norethindrone
norethyndronel
ethyndronel diacetate
lynestrenol
extended regimen
24 day products to:
decrease ovarian activity
dec breakthrough bleeding
greatest incidence of breakthrough bleeding
first 3 months 10-30%
patch backup algorithm
week 1 - backup x 7 days
week 2/3 - <48 hrs - no backup
week 2/3 - >48 hrs - backup x 7 days
week 4 - kebs
MOA OCP
Progestin - inhibit LH surge - no ovulation
Estrogen - stabilize endometrium to prevent BB + inhibit FSH so no dominant follicle + help inc LH receptors
MOA OCP progestin
atrophy EM
thickens cervical mucus
alters tubal secretion/peristalsis
prevents ovulation
max length of protection of breastfeeding
10 weeks
LAM (bellagio consensus)
no menses
baby <6 months
exclusive breastfeeding (>5 feedings >65mins/day)
98% efficacy
when to start breastfeeding
miscarriage
<12 weeks - start immediately
>12 weeks - after 3 weeks
FT/PT/SVD/CS
no BF - after 3 weeks (POP), 7 weeks (COC)
BF - 3 months
postpill amenorrhea
0.7-0.8%
MOA breakthrough bleeding
decidualized/atrophic EM = EM fragility
fluctuations of estrogen levels associated with estrogen growth and demise
Treatment for BB in OCPs
1) estrogen x 7 days regardless of day in cycle
2) stop pill x 1 week then restart
3) switch to extended regumen 24 days
heavy smokers
> 15 sticks
POP MOA
thickens cervical mucus and EM hostile to implantation
gonadotropins not suppressed consistently
must be given same time daily
22hrs wear off effects, 24 hrs = sperm penetration
major cause of d/c pills
breakthrough bleeding
backup algorithm POP
> 3 hrs late = backup x 48 hrs
if missed pill, drink pill = backup x 48 hrs
if 2 or more missed, (-) menses = do PT
backup algorithm OCPs
1 pill missed - take as soon as possible, no backup
2 pills missed:
week 1/2 - take 2 pills, backup x 7 days
week 3 - start new pack, backup x 7 days
week 3 missed pills = start new pack + backup x 7 days
Yuzpe
4 pills 12 hours apart x 2 doses
best if within 72 hours
EC
Yuzpe
Ovral - EE 30mcg + 0.15mg LNG
Alesse EE 20mcg + 0.10mg LNG = 5tabs q12 x 2 doses
Nordette - EE 30mcg + 0.15mg LNG = 4 tabs q12 hrs x 2 doses
Plan B 0.75mg LNG q12 x 2 doses
Plan B 1step 1.5mg x 1 dose
Mifepristone 600mg
Ullipristal Acetate 30mg
Copper IUD
MOA IUD copper
spermicidal intrauterine environment
MOA EC
delays ovulation and prevents fertilization
does not prevent implantation/not abortifacent
MOA IUD Mirena
spermicidal
inhibit implantation, sperm capacitation, penetration, survival
in bariatric patients
transvaginal route
pregnancy not allowed within 18months from surgery
ileostomy patients
pills absorbed in small intestine so pwede
maabsorb pa din
DMPA and sickle cell disease
inhibition of
sickling and improvement in anemia in patients with sickle cell disease
absolute CI OCPs
1.
2.
Thrombophlebitis, thromboembolic disorders (including a close family history, parent or sibling, suggestive of an inherited susceptibility for venous thrombosis), cerebral vascular disease, coronary occlusion, or a past history of these conditions, or conditions predisposing to these problems.
Markedly impaired liver function or liver cancer. Steroid hormones are contraindicated in patients with hepatitis until liver function tests return to normal.
3. History of coronary heart disease or cerebrovascular disease. 4. Migraine headaches with aura.
5. Diabetes mellitus with vascular disease.
6. Known or suspected breast cancer.
7. Undiagnosed abnormal vaginal bleeding.
8. Known or suspected pregnancy.
9. Smokers over the age of 35.
10. Severe hypercholesterolemia or hypertriglyceridemia. 11. Uncontrolled hypertension.
12. Breast-feeding and less than 21 days postpartum. 13. Surgery with prolonged nonmobility.
14. History of peripartum cardiomyopathy.
relative CI OCPs
- Migraine headaches without aura 2. Controlled hypertension
- Gestational diabetes
- Diabetes mellitus
- Seizure disorders
- Obstructive jaundice in pregnancy
- Sickle cell disease or sickle C disease 8. Gallbladder disease
- Mitral valve prolapse
- Systemic lupus erythematosus
- Hyperlipidemia
- Smoking younger than 35
- Hepatic disease
