Contraception Flashcards
rate of pregnancy in a year without contraception
85%
what works best to prevent STDs?
condoms
abstinence
How do OCPs work? (combined estrogen and progesterone)
-inhibit follicle development
-inhibit ovulation
-change endometrial quality
increase cervical mucus to -inhibit sperm transporation
-prevent fertilization and implantation
with ideal use, 99% effectiveness
Side effects of OCP:
nausea HA bloating mood changes increased risk of blood clots
NOT weight gain
Contraindications to using OCPs
pregnancy (accidental use in early pregnancy is not associated with congenital anomalies)
history of thromboembolism (DVT, PE), or inherited thrombophilia
history of estrogen- dependent tumor (endometrial or breast carcinoma)
cerebrovascular disease (history of stroke) or CAD
poorly- controlled hypertension
smokers >35yo
hepatic disease/neoplasm (adenoma, cancer, hepatitis, cirrhosis)
abnormal vaginal bleeding of unknown etiology
migraine with aura, neurologic or vascular involvement (increased risk of stroke)
Advantages of combination OCPs
Reliable (
Disadvantages of OCPs
daily dosing
do not protect against STDs
breakthrough bleeding
estrogen SE:bloating, breast tenderness, nausea, HA
Progesterone SE: depression, acne, hypertension
increased risk of DVT
elevated TG
What type of liver pathology is associated with OCP use?
reversible cholestasis
hepatic adenoma
- benign liver tumor which may undergo malignant transformation
- incidence 3-4 per 100,000 longterm users, vs. 0.1 per 100,000 in the general population
- development typically requires high-dose estrogen for >5 years
Budd- Chiari syndrome from hepatic vein thrombosis or IVC thrombosis
Veno-occlusive disease of the terminal hepatic venules and hepatic sinusoids (similar to Budd-Chiari)
Hepatocellular carcinoma
Resulting cirrhosis, portal hypertenion, or liver failure from one of the above
What medications reduce effectiveness of OCP by inducing CYP450 metabolism?
Guiness, Coronas, PBRs, induce chronic alcoholism
Griseofulvin Carbamazepine Phenytoin Barbiturates Rifampin St. John's Wart chronic alcoholism
Use back up contraception during this time
Other antiepileptics: phenobarbitol, phenytoin, carbamazepine, topiramate, oxcarbazepine, primidone
Progesin-only contraceptives
pill
IM injection
implant (implanon)
these work primarily by thickening the cervical mucus
Progestin- only pill
ideal effectiveness of 92-95%
IM progestin (Depo-Provera)
causes 3-5 pounds of weight gain, primarily through water retention
high dose progestin can stimulate appetite
irregular bleeding
difficult to predict return to ovulation (may accidentally give a year’s worth)
osteoporosis, so stop depo every 2 years to allow bones to regenerate
Progestin implant (implanon)
lasts for 3 years
almost 100% effective
breakthrough bleeding
Transdermal patch
estrogen-progesterone into the skin, worn for ~3 weeks, then go a week without it
skips first- pass metabolism, so there may be higher rates of estrogen- related side effect- we aren’t sure
patch less effective in heavier women
intravaginal ring
estrogen/progesterone release for 3 weeks
Emergency contraception
- high-dose combined OCP
- Levanorgestrel (Plan B)
-prevents ovulation so that there is no egg to fertilize - Copper IUD, placed within 5 days with high effectiveness, likely due to strong inflammatory response
- Mifepristone
progesterone antagonist
Barrier methods don’t work well
condoms are the most widely used
diaphragms
chemical- contraceptive sponge (25% failure rate)
spermicide (30% failure rate)
Sexual practice methods
abstinence
rhythm method
withdrawal method
lactation
Copper IUD
10 year device
inflammatory device
Progesterone IUD
5 years
What are the contraindications to IUD placement?
Current vaginal or cervical infection
Known pregnancy or desire for pregnancy in the near future
Severe uterine distorion (bicornuate uterus, cervical stenosis, fibroids distorting the uterine cavity)
Uterine bleeding that has not yet been worked up
Copper allergy or Wilson disease- avoid copper IUD
Breast cancer- avoid progesterone IUD
Surgical methods
vasectomy
tubal ligation
tubal occlusion
99.5% effectiveness
increased risk of ectopic pregnancy
