Contraception Flashcards
Natural Methods
Avoid intercourse and/or ejaculation around time of ovulation to prevent conception from occuring
- requires female with regular, predictable cycles
Ovulation Timing
ovulation occurs 14 days prior to 1st day of menses
- avoid intercourse 5 days prior and 3 days after ovulation
- need to determine cycle variability
- can use body temps –> if pregnant, body temp will stay elevated
- cervical mucous -> most abundant, watery, and egg-whitey at time of ovulation
Barrier Method
prevent sperm from fertilizing egg by use of physical or pharmacologic barrier
Condoms
BEST STI PROTECTION
- male is more effective and more common
- most effective when used with spermicide
Diaphragm
requires fitting by trained physician
- decreases STIs, must take out within 24 hours to avoid bad infection
Cervical Cap
silicone rubber cap, needs to be fitted, take out within 24 hours to avoid infection
- increased risk of toxic shock
Sponge
circular disc that you moisten with tap water and insert into vagina, leave in place for 24 hrs
- increased rate of yeast infections, UTIs, and Toxic Shock Syndrome
Spermicides
foams, creams, jellies
- damages cell membranes of sperm cells and bacteria
Combined Estrogen/Progesterone
Pill, Ring, Patch
- estrogen/progesterone induced inhibition of midcycle surge of gonadotropin secretion –> ovulation does not occur
Absolute Contraindications = thromboembolic stroke, CAD, estrogen dependent tumor, liver disease, pregs, uterine bleeding, smoker, migrains
Combined Non-contraceptive benefits
Reduction in dysmenorrea
Reduction in menorrhagia
Reduction of ovarian, endometrial, colorectal cancers
Improves osteopenia and osteoporosis
Oral Combined “The Pill”
Estrogen -> ethinyl estrdiol
Progestin -> 1st and 2nd generation -> more androgenic, the newer ones are less androgenic (S.E. include increased LDL and decreased HDL)
General S.E. = breast tenderness, nausea, headaches, moody, irregular bleeding, weight change
Drospirenone
spironolactone analog -> improves weight stability/water retention
- may increase serum K
Phases of Combined Pill
Monophasic -> 3 weeks, then week off
Biphasic and Triphasic -> varying doses for 3 weeks, then week off
- use week off to avoid endometrial metaplasia/hyperplasia
Common side effects of combined pill
Breakthrough bleeding
- first 10 day -> estrogen
- after 10 days -> progestin
Combined Vaginal Ring
worn intravaginally for 3 weeks, then out for 1
- can put back in if it falls out
- comparable efficacy to oral
- lower dose of hormone
- rapid return to ovulation
Combined Patch
change once a week for 3 weeks, then one week patch free
- similar efficacy, greater failure rate in heavier women
- more breakthrough bleeding and breast discomfort
Progesterone Only Method
inhibition of ovulation -> progestin effect also causes changes to endometrium and cervical mucous –> decreased sperm transport and implantation
Progesterone Oral
patients who want effective contraception but want/need to avoid estrogen
- nursing moms
Issues to consider -> irregular bleeding, other SE, duration of effect and return to fertility, chance of breakthrough ovulation if pill missed
Progesterone non-contraceptive benefits
eventual reduction of menstrual flow
- no increased risk of stroke, MI, or thromboembolic event
- reduced risk of endometrial cancer and PID
Progesterone Only Pill
Start: first day of menses, or sunday, or immediate
- take it daily at same time!
- timing is critical - within 3 hours or back up needed
Progesterone Only Injection
Medroxyprogesterone acetate (Depo)
- return to fertility is longer!!!
- concern with bone health
Progesterone Only Implants
Rods implanted subcutaneously under skin
- remove once no longer effective
Male Hormonal Contraception
in development -> stay tuned
Emergency Contraception
Prevention of pregnancy within 72-120 hrs of unprotected intercourse of failed contraception method
Mechanism - inhibit ovulation of prevent fertilization
Emergency Contraception Formulas
Plan B - progestin only
Ella - Ulipristal Acetate
Combo pack - estrogen and progestin
*Reduces pregnancy 75-95%, politcally controversial, state/pharmacy variability
IUDs
Copper - pre-fertilization effect -> induces reaction of endometrium resulting in inflammatory response preventing viable sperm from reaching tubes
Mirean - slow release progesterone -> inhibits ovulation and inhibits sperm survival and implantation
Skyla - lower dose -> same as mirena
Screening for IUD use
Copper - want regular periods, no hormones, no hx dysmenorrhea, no hx menorrhagia
Mirena - OK w/ irregular periods, OK w/ amenorrhea, hx dysmenorrhea, hx of menorrhagia
Myths about IUDs
Not abortifacients Don't cause ectopic pregnancies Don't cause pelvic infection Don't increase risk of fertility Aren't big Can be used in nulliparous women
Contraindications for IUD
- pregnancy, congenital or acquired uterine cavity malformation
- acute STD, cervicitis, vaginitis
- known or suspected cervical neoplasia
- liver disease
- immunodeficienct
Sterilization
should be considered permanent -> appropriate counseling and selection, reversible procedures do exist but come with limited success
Tubal or Vasectomy
Surgical Tubal Occlusion
laproscopic procedure
- ligation, section removal, clips, rings, coils, plugs, cautery
Nonsurgical -> microinserts placed into proximal fallopian tubes, or radiofrequency delivered to fallopian tubes
Vasectomy
procedure that results in ligation of vas deferens
- under local anesthesia
- safe, effective
- need 20 ejaculations or 3 months following of sperm analysis
