Contraception Flashcards
WHO-Category 1
No restriction on use of the contraceptive method
WHO-Category 2
Advantages generally outweigh the theoretical or proven risks
WHO-Category 3
Theoretical or proven risks usually outweigh the advantages of using the method
WHO-Category 4
Condition that represents unacceptable health risk if the contraceptive method is used
What are contraindications for IUDs?
Recent exposure to STDs, Hx of pelvic inflammatory disease
CA of the cervix
Abnormalities of the uterine cavity
Plan B (Morning-after Pill)
Pill contains an elevated dose of a progesterone-like hormone, WILL NOT AFFECT AN EXISTING PREGANCY
How does Plan B work?
- Egg release from ovary could be prevented
- Could prevent fertilization of egg
- Could prevent fertilized egg from attaching to uterus
What is the time limit that someone can use Plan B after having unprotected sex?
3 days (72 hours)
What are risks involved with contraception in women over 35?
Risks for myocardial infarction stroke, VTE, Breast CA, osteoporosis and bone fx
What test should women at risk for osteoporosis get?
Women should get a bone mineral density (Densitometry)
Contraceptive use along with Current breast cancer…
Category 4 risk
Contraceptive use along with past breast cancer in remission for 5 years….
Category 3 risk
ACOG and the CDC on osteoporosis
ACOG and the CDC do not place a resriction on the use of DMPA related to older women
DMPA is associated with a decrease in bone mineral density, with is reversible in younger women.
Benefits to non-contraceptive
CHC can help regulate periods and decrease blood loss from heavy, prolonged, unpredictable bleeding
Reduction on endometrial cancer
CHC can help with hot flashes
ACOG recommends against use of CHC in women age 35 and older if the patient…
Smokes Has HTN DM Migraines headaches Uncontrolled dyslipidemia
Contraindications for IUDS
Recent exposure to STDs, Hx of pelvic inflammatory disease, CA of the cervix, abnormalities of the uterine cavity
IUD
Copper causes sperm dysfunction and prevents fertilization
How long does the copper IUD last for?
5-10 years
If patient cannot find IUD strings…
- The pt should take a urine pregnancy test, if negative, a cytology brush should be used to try and locate the strings
Expulsion rate after initial expulsion of IUD…
Expulsion rate of 30%
What is CHC?
Combined hormonal contraceptives
CBC+Diabetes
CHC use by women who have diabetes > 20 years or vascular disease is a category 3 or 4
CHC with no vascular disease is category 2
Progestin only pills, implants, or IUDs are category 2
CBC+Obesity
Use of combined hormonal contraceptives (CHC) in women with a BMI > 35 is contraindicated because of the contribution to cardiovascular issues
The ACOG recommends that CHC be used with caution in obese women over 35 because of the increased risk of VTE
Bariatric surgery may reduce absorption
Eating disorders to avoid weight gain may reduce absorption
Obesity+Contraceptive effectivess
Body fat can effect hormonal contraception through increased basal metabolic rate, increased hepatic enzyme metabolism, and drug sequestration in fat
Transdermal methods may be less effective in obese women
Can LNG-IUDs and DMPA cause weight gain?
IUDs have not shown significant weight gain
DMPA the evidence is not conclusive
Sickle Cell Disease
DMPA reduces the number of painful crises
Reduced bleeding with DMPA improves hemoglobin levels and erythrocyte expectancy
Crohn’s Disease+ Contraception
Nausea and diarrhea reduces the reliability of absorption by the oral route
Injectable, patches, or IUDs may be a better choice
Polycystic Ovarian Syndrome+Contraception
Combination contraceptive helps regulate the menses cycle, helps with acne, unwanted hair growth, and protects against endometrial cancer
Low dose COC that contain progestogens provide the best results
Medications metabolized by the liver+contraception
Medications that induce liver enzymes may reduce the effectiveness of combined hormone medications, and progesterone only medications
Lamotrigine, some HIV medications, and TB medications affect progesterone only contraception
DMPA, Mirena, and non-hormonal contraceptives are not effected
Diagphragms
Diaphragms need to fitted by a trained NP
Diaphragms need to be inserted 1 hour before and remain 6 hours after sexual intercourse
The pill
Prevents ovulation by suppressing secretion of gonadotropins
Causes changes in the cervical mucosa, endometrium, and fallopian tubes
Taken in 3 week cycles with a 7 day break from hormones
Consider BMI and BP before prescribing
Transdermal Patch
Prevents ovulation by suppressing secretion of gonadotropins
Causes changes in the cervical mucosa, endometrium, and fallopian tubes
Taken in 3 week cycles with a 7 day break from hormones
Consider BMI and BP before prescribing
DO NOT APPLY TO BREASTS
Contraceptive vaginal ring
Delivered via small, flexible, plastic ring that is placed in the vagina for 3 weeks and removed for the 4th week
Prevents ovulation by suppressing secretion of gonadotropins
Causes changes in the cervical mucosa, endometrium, and fallopian tubes
Side Effects for Pill/Patch/Ring
Breast tenderness Spotting between periods Nausea Mood swings Weight gain headaches
Contraindications for pill,patch, and ring
Over 35 BMI greater than 35 Elevated BP Family history of DVT, stroke, heart disease Hyperlipidemia Migraines Gallbladder disease History of/or current Breast Cancer
Mini pill
Consist of only progesterone. Works by thickening the cervical mucosa and can sometimes suppress ovulation.
Can be used if combination pill is contraindicated.
Contraindications for mini pill
Current or past history of : stroke, heart disease, liver disease, systemic lupus, current breast cancer, breast cancer within the past five years
DMPA (Depo Provera)
150 mg of medroxyprogesterone acetate.
Given every 12 weeks as deep IM. Can cause amenorrhea
LASTS FOR 5-10 years
