Contraception

Question 1

For women on OCP’s, why do most unintended pregnancies occur?

Answer 1

Most unintended pregnancies occur when women fail to use contraceptives or use their method inconsistently.

Question 2

In what group has unintended pregnancies risen?

Answer 2

low income compared to high income

Question 3

what are some other reasons that unintended pregnancies occur?

Answer 3

o Contraceptive failures–No method is perfect. For example, even after surgical sterilization, one woman out of every 200 becomes pregnant. Contraceptives are not easy to use exactly right–pregnancies happen when condoms break, or pills stay in their package.
o Contraceptives are unavailable, difficult to obtain or too expensive—For ex. a woman may run out of birth control pills or not be able to get refill promptly; insurance may not cover her birth control or she may be uninsured.
o Lack of understanding of reproduction/fertility –Many women do not understand when risk of pregnancy is greatest.
o Sexual assault/abuse/coercion
o A woman’ s religion or her partner may forbid her to use contraception
o Emotional/psychological reasons: Denial about the possibility of getting pregnant, ambivalence about having a child or the desire to be sure she is fertile sometimes lead women to have unplanned pregnancies.
o Finally: Many women still don’t know about or aren’t able to get emergency contraception!

Question 4

What is the emergency contraception available?

Answer 4

o Levonorgestrel (Plan B)

Question 5

Describe Levonorgestrel (Plan B)

Answer 5

• Levonorgestrel is a progestin.
• It works by delaying ovulation.
• It doesn’t disrupt an implanted pregnancy, and it’s not teratogenic.
• Its efficacy declines over the 5-day window after unprotected intercourse: the sooner it’s taken, the more effective it is. Take both pills at once!!!
• New forms, generic and “One Step” - remember that patients under age 17 need a prescription.

Question 6

What do you technically need before prescribing BC?

Answer 6

o Medical History is required
o Blood pressure is recommended

o	Not required:
•	Pap smear
•	Pelvic/breast exam
•	STI testing
•	Hemoglobin

Question 7

who can’t have just estrogen?

Answer 7

o	Estrogen contraindications:  
•	  Migraine with aura
- estrogen responsive tumor
•	  Uncontrolled hypertension
•	  Postpartum < 6 weeks
•	  History of DVT
o	Smoking:  NOT a contraindication in women/teens under age 35

Question 8

Explain Quick start:

Answer 8

• After a negative hcg:
• Pills started on the day of the visit instead of the Sunday after the next period
o Westoff studies showed more women on the pill by month 3, and fewer pregnancies
o If OCs are prescribed with Sunday or 1st-day-of-menses start, as many as 25% of women do not start.
• No increased bleeding or spotting
• OCPs not teratogenic
• Can use quickstart immediately following miscarriage or abortion
o Don’t rely on birth control until after a week of taking it.
o Unless you start it on the first day of the period, then it is effective immediately

Question 9

Describe the vaginal ring:

Answer 9

o	Active for at least 3 weeks 
o	Lowest estrogen dose: 15 mcg / day 
o	Same efficacy and contraindications as OCs 
o	May remove for up to 3 hours 
o	QuickStart same as with OCs

Question 10

Describe the patch:

Answer 10

• Estrogen / Progestin Patch
o 1 patch weekly for 3 weeks, then one week off
o Same efficacy & contraindications as OCs
o OK to shower, swim, exercise with patch on
o Failures in trials were in women over 198 pounds, but still rare