Contraception

Question 1

Contraception

Answer 1

Intentional prevention of preg during sexual intercourse
Factor:
* Must. be used correctly and consistently
* Reliable
* Cost
* Protection from STI’s
* Comfort with method

Question 2

Note on Fertility Control

Answer 2

Highly individualized
Preference may depend on variety of factors
* Medical contraindication
* Desire for children
* religious, cultural, and personal belief
* Financial means
* Ability to choose

Question 3

Forms of Contraception

Answer 3

Barrier, Hormonal, Spermicidal, Permanent, Natural Family Planning, Abstinence, Nothing

Question 4

Barrier Method

Male Condoms

Answer 4

Types: Latex, polyurethane, processed animal skin (lambskin)
Multiple texture and colors
Lubricated and non-lub
Efficacy
* Perfect use - 98%
* Typical use - 88%

Question 5

Pro’s ( Male Condoms)

Answer 5

Does not req exam
Inexpensive
Wide variety of choices
Protects from HIV and other STI’s
When used correctly, prevents unplanned preg
Non-hormonal

Question 6

Con’s (Male Condoms)

Answer 6

Requires partner compliance
Does not protect from HPV or HSV

Question 7

Do’s and Don’ts (MC)

Answer 7

Do’s
* Apply before ANY penetration occurs
* Leave a reservior tip
* Consider using spermicidal lubricant in addition to condoms
* Know that if a condom breaks, seek Emergency contraception (EC)
* Effective way to reduce your risk of contracting most STI’s as well as pregnancy

Don’ts
* Unroll before applying
* Use the same condom more than once
* Use a condom that has expired
* Use oil based lub
* Store in a wallet or hot place
* Use a condom that causes burning or itching… may be sensitive to latext or spermicidial lub

Question 8

Barrier Method

Internal Condom

Answer 8

Female condom
Placed in vag or anus
Made of nitrile
Efficacy: 79-95%

Question 9

Barrier Method

Diaphragm

Answer 9

Reusable dome-shaped, silicone cup that covers the cervix; insert in vag b/4 sex to prevent preg
Should be used w/ spermicide to block sperm
Must remain in place at least 6 hours after intercourse
Need fitting to the size of the cerivx
Needs refitting after delivery or if pt loses/gain weight (>10lbs)
Efficacy with spermicide: 92-96%

Question 10

Barrier Method

Cervical Cap

Answer 10

Made of soft silicone
Covers the cervix
Must be used with spermicide
Can be left in up to 2 dys
Need fitting/ refitting after delivery or weight loss/ gain
Efficacy: 71-88%

Question 11

Barrier Method

Contraceptive Sponge

One and Done

Answer 11

Soft, disk-shaped device made of polyurethane foam that contains spermicide
Inserted in the vag before sex to prevent sperm from entering the uterus
Efficacy: 76-88%

Question 12

Spermicide

Answer 12

Gels, foams, films, cream, suppositories
Nonoxynol-9: protects against chlamydia and gonorrhea but not HIV
Inserted into the vag before every act of intercourse
No presription needed
Efficacy
* Perfect use- 95-97%
* Typical use- 82%

can casue skin breakdown if used to many times, higher risk for STI

Question 13

Toxic Shock Syndrome

Answer 13

Life threatening bacterial infection (straph, strep, etc)
Bacteria release toxin into the bloodstream
Link to superabsorbent tampons or tampons left in place for too long
Scratches in the vag allow bacteria to enter
Patient w/ history of TSS should avoid using the contraceptive sponge, diaphram, vag ring, and tampons

Question 14

Oral Contraceptives (OCPs; “The Pill)

Answer 14

Hormonal contraception
Contain sythetic estrogen and progesterone
One pill taken every dy/month
Prevent pregnancy in three ways:
* Inhibts ovulations
* Alter cervical mucus
* Alter endometrial lining

Efficacy: 98-99.5%

Question 15

Two types of OCPs

Combined Estrogen/Progesterone Pills

Answer 15

More freq prescribed
More Effective in preventing preg
Offer non-contraceptive benefits of estrogen

around the same time/dy

Question 16

Two types of OCPs

Progesterone Only Pills

mini pill; POPs; Opill

Answer 16

Used in patients who can’t tolerate combined OCPs or are breastfeeding women
Active pills taken every day- no placebo week
Must be more vigilant in use; less effective than combined OCPs
**Menses likely irregular **
* Example: Micronor

Have to take it at the same time every day

Question 17

Contraindications to OCP use

Answer 17

Preg
Undiagnosed vag bledding
Active liver diease/ Cloting disorder
Migraines w/ neurological symptoms
* Blurred vision/loss of vision
* Numbness/tingling in face or hand

Estrogen dependent carinoma
Uncontrolled hypretension
Over 35 and smoker
Depression that worsens with OCP’s use
History of DVT

if sucide depression a lot then no OCP

Question 18

OCP’s

Common Side Effects

Answer 18

Nausea
Altered Menstural Cycle
* Break through bleeding (BTB)
* Amenorrhea

Water weight gain
Breast fullness/tenderness
Increased vag discharged

Question 19

Major Adverse Reactions

Answer 19

Severe abdominal pain
Sudden change in eyesight
Coughing up blood
Yellowing of skin or eyes
Pain in calves or legs
Weakness/numbness on one side of the body
Severe, recurrent, or presistent headaches

The adverse reactions are more likely to occur in smokers !!!!

Question 20

Signs of Complications w/ OCPs

Answer 20

A: abd pain
C: chest pain
H: headaches
E: eye problems
S: severe leg pain

not so good pts for OCP who can’t remember to take it (teenagers)

Question 21

Starting OCPs

Answer 21

Must be initiated with menses ( NOT PREG)
* First day of cycle ( protected from first pill)
* First sunday in cycle ( protected after 7dys of active pills)

Break through bleeding common in first three months
* Pt need reassurance that this is normal and will stop

Question 22

Preventing Preg while taking OCPs

Answer 22

Find out other med interact with OCPs
May decrease effectiveness of OCPs
* Phenytoin ( Dilantin)
* Carbamazepine ( Tegretol)
* Phenobarbital
* Topiramate ( Topamax)

Use back- up method 7days if you:
* Restart your pill
* Have vomitting or diarrhea
* Forget to take your pill

Take pills at the same time each day

If you miss one pill, take two the next day… if you miss three start a new pack ?

Question 23

Non-Contraceptive Benefits OCPs

Answer 23

Regulates menstrual cycle
Decreases
* Dysmenorrhea
* Blood loss during menses
* risk of endometrial/ovarian cancer
* Risk of ectopic preg
* Risk of Toxic Shock Syn
* Risk of ovarian cysts
* Risk of benign breast disease
* Risk of osteoporosis

Question 24

OCPs

Pro’s

Answer 24

Female controlled
Easily concealed
Approximately same cost as condoms
Wide variety of choice

Question 25

OCPs

Con’s

Answer 25

Requires yearly medical exams
Requires daily compliance
Does not protect from STI’s when used alone
Cost-may be partially covered by insurance ( $5-10/month)

Question 26

Emergency Contraception

“The Morning After Pill”
Post-Coital Contraception

Answer 26

Hormonal Method
Take within 120 hours (3-5 dys) of unprotected sex
* No contraception
* Contraceptive failure
* Sexual assault

Two main types
* Ella (ulipristal acetate) Need prescription
* Plan B (Levonorgestrel) Over the counter, best if taken w/in 72 hrs of unprotected sex but can take up to 5dys

The closer to intercourse the better

Question 27

How EC Works ?

Answer 27

Prevents preg by:
* Inhibting ovulation
* Altering the endometrial lining
* Thickening cervical mucus

Does not cause an abortion
Will not disrupt an implanted preg
No major contraindication

don’t use every month or daily

EC may postpone ovulation
Side Effects:
* N/V (must take it w/ food), generally offered anti-emetic (tigan), Avoid Alcohol

Question 28

EC

Pro’s

Answer 28

Post-coital contrac.
Does not req partner
no Med exam
Few contraindication
May become OTC

Question 29

EC

Con’s

Answer 29

Efficacy time dependent
No protection from STIs
May be costly
Side effects include N/V
Some pharmacies do not provide
Mistaken for RU-486(Mifepristone- blocks projesterone)
Misinformation among healthcare providers

Question 30

Injectable Contraception

Depo-Provera (DEPO; “The Shot”)

Answer 30

**Hormonal method **
Injectable contraceptive
* Depo-Provera Medroxyprogesterone Acetate (DMPA)
* 150 mg progest IM Q3 mos
* Self Admin subq available
* Inhibts ovulation and alters cervical mucus

Good choice for women who:
* Are unable to take estrogen
* Need to conceal contraceptive use
* Would benefit from freq visits to healthcare provider

Poor choice for women who:
* Have history of depression
* Desire preg in < 1yr ( slow return to fertility)
* Can’t follow up with HCP Q3 mos
* At high risk for STI’s
* Have poor bone density

Efficacy 98-99.5%, weight gain 7-8lbs

no more than 2yrs of taking it,

Question 31

Contraindication DEPO

Answer 31

Preg
Liver disease
Caution in women w/ history of Depression
People who have not tolerated progesterone well in the past
Osteoporosis

Question 32

Side Effects of DEPO

Answer 32

Altered menses
* Irreg cycle (freq BTB first 3 months) (Amenorrhea)

Weight GAIN
Depression
Osteoporosis
Vag Dryness
Hair loss

Question 33

Hormonal Method

Intrauterine Device (IUD)

Answer 33

Hormonal Method
Most commonly used method of contraceptive WW
IUD inserted into uterus
* Copper IUD: replaced q 10yrs
* Mirena: replaced q 5yrs

Creates foreign body inflammation reaction that prevents implantation
* Good for parous women w/ low STI risk and no history of dsymenorrhea
* Contraindicated if risk of STIs/ PID; history of endocarditis

no inreased risk for TSS

Question 34

IUD

Pro’s

Answer 34

Female controlled
Local not systemic
Easily concealed
No compliance issues past insertion
Effective for 1-10yrs
98-99%

Question 35

IUD

Con’s

Answer 35

Req medical exam
Insert related risk
* Expulsion
* Infection

Altered Menses
Cramps common
Increased risk of ectopic Preg
No protection from STIs
Initial cost expensive

Question 36

Implantable Contraception

Answer 36

Hormonal method (Nexplanon)
A small, thin, flexible rod inserted under the skin of woman’s upper arm
Invisible; prevent preg for up to 3-5 yrs
Release progestin; prevents preg in two ways
* Thicken the mucus of the cervix, which stops sperm form swimmin through to the eggs
* Stops ovuloation, so theres no egg to fertilize

99%

Can cause a keloid, or pt who BMI is higher than 35, or full selve tattoos

Question 37

Transdermal Contraceptioin (‘The Patch’) Ortho-Evra

Answer 37

Hormonal Method
Sustained release transdermal contrac.
* Estrogen/progesterone
Available in US in 2002
* Patch placed on skin
* Lower abdomen, upper outer arm, upper toro, or buttock

Very effective (< 1% failure rate)
New patch eq 3 wks
* patch changed same day each week
* One week without patch
* May continue ADL’s while using

Similar side effects and contrain as combined OCPs
May cause applications site reactions

Question 38

Vaginal Rings ( Nuva Ring)

Answer 38

Small, flexible ring worn in the vag
Contains estrogen and progestin which inhibits ovulations
Diff schedules (w/ or w/o periods)
* Wear ring for 3 wks (21dy), 4 wk (28dy), or 5 wk (35dys), take out for the next week (7dys), get period; after 7 free-ring days, put in new ring
* Keep ring in at all times, changing it for new one q 3-5wks, and skip periods

it increases vag discharged

Question 39

Permanent Contraception

Tubal Ligation

Answer 39

Common form of contraception
Freq performed after birth (PPS)
* Abd surgery (tubes sent to pathology)
* Very low failure rate: efficacy (99.6%)
* No adherence requirement
* No protection from STIs

Question 40

Female Sterilization

Pro’s

Answer 40

Female controlled
Permanent form of contraception
May be performed with c/s

Question 41

Female Sterilization

Con’s

Answer 41

Major surgery
Expensive
Scar visible
Reversal diffcult and associated w/ ectopic preg
No protection from STIs
Altered menses
Assoicated in some countires /populations
with ethnic cleansing

Question 42

Male Sterilization

Vasectomy

Answer 42

Low failure rate
* 99.8%

No adherence req
Performed on outpatient basis
Risk of post-op infection

cuts the vas defen

Question 43

Male Sterilizations

Pro’s

Answer 43

Minor surgery
Recovery time min

Question 44

Male Ster

Con’s

Answer 44

Partner compliance
* Machismo (manly)
* Fear

Requires trust in partner
No protection in STIs

Question 45

Natural Family Planning

Answer 45

Periodic abstinence during the time of cycle when preg is most likely to occur ovulation

taking temp ( basal body temp), Cervical mucus chart, Mar pain ?

Question 46

Cervical Mucus Chart

Answer 46

DRY Phase: (not fertile) 1-3 after period (dry)
Sticky Phase ( not fertile) 4-6 (white, cloudy, small sticky)
Creamy Phase (semi fertile) 7-9 (cream, cloudy, thick)
Clear Phase ( fertile) 10-14 (egg white)