Contraception Flashcards
Contraception
Intentional prevention of preg during sexual intercourse
Factor:
* Must. be used correctly and consistently
* Reliable
* Cost
* Protection from STI’s
* Comfort with method
Note on Fertility Control
Highly individualized
Preference may depend on variety of factors
* Medical contraindication
* Desire for children
* religious, cultural, and personal belief
* Financial means
* Ability to choose
Forms of Contraception
Barrier, Hormonal, Spermicidal, Permanent, Natural Family Planning, Abstinence, Nothing
Barrier Method
Male Condoms
Types: Latex, polyurethane, processed animal skin (lambskin)
Multiple texture and colors
Lubricated and non-lub
Efficacy
* Perfect use - 98%
* Typical use - 88%
Pro’s ( Male Condoms)
Does not req exam
Inexpensive
Wide variety of choices
Protects from HIV and other STI’s
When used correctly, prevents unplanned preg
Non-hormonal
Con’s (Male Condoms)
Requires partner compliance
Does not protect from HPV or HSV
Do’s and Don’ts (MC)
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
Barrier Method
Internal Condom
Female condom
Placed in vag or anus
Made of nitrile
Efficacy: 79-95%
Barrier Method
Diaphragm
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%
Barrier Method
Cervical Cap
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%
Barrier Method
Contraceptive Sponge
One and Done
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%
Spermicide
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
Toxic Shock Syndrome
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
Oral Contraceptives (OCPs; “The Pill)
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%
Two types of OCPs
Combined Estrogen/Progesterone Pills
More freq prescribed
More Effective in preventing preg
Offer non-contraceptive benefits of estrogen
around the same time/dy
Two types of OCPs
Progesterone Only Pills
mini pill; POPs; Opill
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
Contraindications to OCP use
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
OCP’s
Common Side Effects
Nausea
Altered Menstural Cycle
* Break through bleeding (BTB)
* Amenorrhea
Water weight gain
Breast fullness/tenderness
Increased vag discharged
Major Adverse Reactions
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 !!!!
Signs of Complications w/ OCPs
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)
Starting OCPs
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
Preventing Preg while taking OCPs
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 ?
Non-Contraceptive Benefits OCPs
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
OCPs
Pro’s
Female controlled
Easily concealed
Approximately same cost as condoms
Wide variety of choice
OCPs
Con’s
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)
Emergency Contraception
“The Morning After Pill”
Post-Coital Contraception
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
How EC Works ?
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
EC
Pro’s
Post-coital contrac.
Does not req partner
no Med exam
Few contraindication
May become OTC
EC
Con’s
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
Injectable Contraception
Depo-Provera (DEPO; “The Shot”)
**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,
Contraindication DEPO
Preg
Liver disease
Caution in women w/ history of Depression
People who have not tolerated progesterone well in the past
Osteoporosis
Side Effects of DEPO
Altered menses
* Irreg cycle (freq BTB first 3 months) (Amenorrhea)
Weight GAIN
Depression
Osteoporosis
Vag Dryness
Hair loss
Hormonal Method
Intrauterine Device (IUD)
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
IUD
Pro’s
Female controlled
Local not systemic
Easily concealed
No compliance issues past insertion
Effective for 1-10yrs
98-99%
IUD
Con’s
Req medical exam
Insert related risk
* Expulsion
* Infection
Altered Menses
Cramps common
Increased risk of ectopic Preg
No protection from STIs
Initial cost expensive
Implantable Contraception
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
Transdermal Contraceptioin (‘The Patch’) Ortho-Evra
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
Vaginal Rings ( Nuva Ring)
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
Permanent Contraception
Tubal Ligation
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
Female Sterilization
Pro’s
Female controlled
Permanent form of contraception
May be performed with c/s
Female Sterilization
Con’s
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
Male Sterilization
Vasectomy
Low failure rate
* 99.8%
No adherence req
Performed on outpatient basis
Risk of post-op infection
cuts the vas defen
Male Sterilizations
Pro’s
Minor surgery
Recovery time min
Male Ster
Con’s
Partner compliance
* Machismo (manly)
* Fear
Requires trust in partner
No protection in STIs
Natural Family Planning
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 ?
Cervical Mucus Chart
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)
