Contraception Flashcards
What is the reproductive lifespan of a man?
10-12 years old until death as long as vas deferens intact and able to ejaculate
Emergency contraception: Highest probability at what time of the month?
Highest probability of conception is 1-2 days before ovulation
What are the drugs that are available for emergency contraception?
4
- Plan B: levonorgestrel 0.75 mg two pills to be taken 12 hrs apart. Can be taken up to 24 hours apart
- Plan B One Step or Next Choice One Dose and other branded generics: a single levonorgestrel 150 mg pill
- Ella: ulipristal 30 mg: Single dose; prescription
- Formulated using a variety of combination oral contraceptives to achieve ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg, 2 doses in 12 hours (Yuzpe 1974) - Oral Hormonal EC (Levonorgestrel)
Levonorgestrel: SE?
3
Effective up to how long after the event but take as soon as possible?
- N 24% & V 9% (higher with use of combined oral contraceptives or the Yuzpe method)
- irregular bleeding the month after treatment
- less common: dizziness, fatigue, HA, breast tenderness,
Effective up to 120 hours after the event but take as soon as possible*
Emergency contraception: Pregnancy should be excluded before administration of what?
2
- ulipristal or
2. insertion of Cu IUD
EC Mechanism of Action
- Oral methods?
- Copper IUD? 2
- Use of ORAL HORMONAL EC affects an already pregnant woman how? 2
- Oral methods: Inhibiting or delaying ovulation
- Levonorgestrel is ineffective after ovulation has occurred - Copper IUD:
- Interfering with fertilization or tubal transport
- Preventing implantation by altering endometrial receptivity - does not interrupt a pregnancy and
- has no known adverse effects on pregnancy or fetus
EC counseling:
4
- Obtain pregnancy test if no menses 3-4 weeks after EC
- Discuss risk of pregnancy and STIs with unprotected sex
- Encourage patient to start a regular contraceptive method or review correct use of current one
- EC is a back-up,not a primary contraceptive method
Considerations for Choosing a Contraceptive Method
7
- Efficacy (failure rate)
- Safety (risks with consideration of health history)
- Side effects (to include effect on menses)
- Convenience ( correct use and access to care)
- Cost
- Personal lifestyle and pattern of sexual activity
- Reversibility
What are the categories for contraception?
4
- Hormonal
- IUD (IUC)
- Barrier
- Permanent
Contraception Failure
is often due to?
3
- Inappropriate use
- Failure to use (influence of cost and access)
- Failure of method (“correct use” failure rate)
What are the hormonal methods of contraception? 6
- Oral pills
- Transdermal patch
- Injections
- Intrauterine devices
- Subdermal implants
- Intravaginal
OCP: MOA?
The influence of estrogen (ethinyl estradiol):
2
- SUPPRESSION of GnRH (Hypothalamus)
2. Stabilizes endometrium to minimize breakthrough bleeding
What does the suppression of GnRH in the hypothalamus lead to that works in contraception?
4
- INHIBITS the midcycle surge of gonadotropin LH
- PREVENTS ovulation
- SUPPRESSES FSH secretion
- PREVENTS ovarian folliculogenesis
- What are considered low dose OCP doses?
2. High doses?
- “Low dose” 20 or 30 or 35 mcg
2. “High dose” 50 mcg
OCP: Mechanism of Action
Influence of progestin (a 19-nortestosterone or drospirenone)?
4
- Suppresses LH secretion and therefore, suppresses ovulation (less potent than estradiol)
- Thickens cervical mucus which inhibits sperm migration
- Creates an atrophic endometrium unfavorable to implantation
- Impairs normal tubal motility/ peristalsis
Progestin Component
Several progestins (typical dose 0.15-1 mg):
1. Older more androgenic ones? 3
2. Advantage?
- Newer progestestins (less androgenic effects)? 3
- Advantage? 2
- Possible increase of what?
Older more androgenic ones
- Norethindrone,
- norethindrone acetate,
- levonorgestrel
- Lower HDL cholesterol
Newer progestins—less androgenic effects
- Norgestimate,
- desogestrel,
- drospirenone
- Less effect on carbohydrate & lipid metabolism
- More effective at reducing acne & hirsutism
- Possibly increased risk of thromboembolism
Examples of Progestins
1. First generation? 2
- Second generation? 2
- Third generation? 3
- Unclassified? 1
- First generation:
- Norethindrone (acetate),
- ethynodiol diacetate - Second generation:
- Levonorgestrel and
- dl-Norgestrel (higher androgenic but more effective than 3rd in countering thrombotic effects of estrogen) - Third generation:
- desogestrel (? Increased of VTE)
- norgestimate - Unclassified:
- drospirenone (in Yasmin and Yaz) less androgenic but risk of VTE up to 3x compared to levonorgestrel (FDA revised label in 2012)
Other Advantages of New Progestins
4
- Higher HDL cholesterol/lower LDL cholesterol
- Higher sex hormone binding globulin (SHBG) which results in decreased free testosterone levels and estrogen effects)
- Greater affinity to progesterone binding sites
- Reduced amenorrhea
*OCP: Non-contraceptive Use *
9
- Endometriosis: reduce pelvic pain
- Treatment for acne or hirsutism
- Treatment for heavy, painful or irregular menstrual periods
- Reduce occurrence of recurrent ovarian cysts
- PCOS (acne, hirsutism, unopposed estrogen influence to endometrium)
- PMS/PMDD
- Decreased risk of ovarian cancer
- Decreased risk of colon cancer
- Decrease menstrual migraine (with continuous or extended cycle)
Higher Dose Estrogen Pills
50mcg
- Spotting or absence of withdrawal bleeding cannot be managed on what?
- Treatment of other problems? 2
- lower dose pill
- Dysfunctional uterine bleeding
- Reduce recurrent ovarian cysts
OCP Preparations
4
- Monophasic
- Multiphasic (biphasic or triphasic)
- Extended cycle (withdrawal flow every 12 weeks)
- Progestin-only pill (POP or “mini-pill”)
OCP cycles? 3
- 21 days on, 7 days off (most formulations)
- 24 days on, 4 days off (drospirenone containing forms)
- 84 days on, 7 days off—extended cycle
Who uses the 84 days on, 7 days off—extended cycle specifically? 3
(Seasonale, Introvale, and Quasense (estradiol & levonorgestrel) 84 days of active pills and 7 days of placebo.)
Use:
- patients w/ endometriosis,
- premenstrual dysphoric disorder and
- women who prefer less frequent menses
Choosing a Pill Formulation
1. Typically start with _______ in a younger or less compliant patient but generally it doesn’t matter much
- ____________ women are usually started on a lower estradiol pill
- Androgenic influence of ___________ may be taken into consideration
- Breastfeeding women?
If they have used a formulation in the past that’s worked, be reluctant to mess with success!
- monophasic
- Perimenopausal
- progestin
- progesterone only pill
Three methods for starting for COC
- Quick Start: start the day of RX regardless of day of cycle once pregnancy is ruled out
- “Sunday” Start: start 1st Sunday after period begins
- Start 1st day of menses
With Quick Start or Sunday Start, must use backup method for _________ after starting the pill
A what should be started in first 5 days of menses?
7 days
progesterone only pill (POP)
Contraceptive Patch
Ortho-Evra
1. Transdermal patch— changed how often?
- Delivers constant level of 20 mcg ____________ and 150 mcg of ____________ daily
- Resultant serum levels of ___ 66% higher than 35 mcg oral pill. In 2008, FDA revised labeling to state possible higher risk of thromboembolism.
- every 7 days for 3 weeks and then1 week off for menses
- ethinyl estradiol, norelgestromin
- EE
Vaginal Ring
(NuvaRing)
1. Delivers 15 mcg _________ and 120 mcg _________ daily for 3 weeks intravaginally
- Remove for ______ then insert new one
- If it falls out or needs to be removed, rinse with cold or warm (not hot) water and reinsert when?
- estradiol, estonogestrel
- 1 week
- within 3 hours
Absolute Contraindications for Estrogen Contraception
13
- Hx of thromboembolic event or stroke or known thrombogenic mutation (Factor V Leiden)
- Known CVD, cardiomyopathy,
- BP 160/100 or greater,
- complicated valvular heart disease
- SLE with positive antiphospholipid antibodies
- Women 35 or older who smoke
- Migraines with aura
- Women 35 or older with migraines
- Hx of cholestatic jaundice with pill use
- Hepatic carcinoma or benign adenoma; any active liver disease or severe cirrhosis
- Breast cancer (current)
- First 21 days postpartum (increased risk of clotting)
- Undiagnosed abnormal uterine bleeding
Careful consideration before use of Estrogen
9
- HTN (less than 35 yo, nonsmoker, evaluate cumulative risk factors for CAD/stroke)
- Anticonvulsant therapy (see drug interactions)
- Migraines without aura (less than 35 yo,evaluate cumulative risk factors for CAD/stroke)
- Diabetes (evaluate cumulative risk factors for CAD/stroke)
- Hx of bariatric surgery with malabsorptive procedure like
- Roux en Y (possible decreased efficacy with oral pills)
- Psychotic depression
- Ulcerative colitis (may increase with years of use)
- Obese, > 35 yo
Hormonal Pills, Patch and Ring
Failure rates
1. Theoretical/Correct use?
2. Typical use?
- less than 1%
2. 9%
HC Side Effects
8
- Nausea/bloating
- Breast tenderness
- Spotting/ break through bleeding (BTB): most common (10-30% in first three months)
- Amenorrhea (about 5% after several years; more common with 20 mcg estradiol pill) (Goal with extended or continuous delivery.)
- Fatigue
- Headache: may occur in early cycles and generally improve with subsequent cycles
- Depression/moodiness
- Decreased libido
- Early/Acute SE of HC? 4
- What is the most common SE of HC?
- This is independant of what?
- Early SE:
- Bloating,
- nausea,
- breast tenderness, &
- mood changes (do not cause weight gain) - Breakthrough bleeding
- Most common side effect - Independent of progestin
- Can add extra estrogen or switch to more estrogenic progestin
How should we treat amenorrhea with HC?
try preparation w/ more estrogen
Risks with E-P Contraception
1. CVD? 3
- HTN? 2
- CVD:
- Thrombotic, not atherosclerotic
- > 35YO who smoke or have HTN
- Women who have taken OCPs are not at increased risk for CVD later in life - HTN
- OCPs can cause mild elevation of BP
- Overt HTN can occur and is associated with increased risk of MI & stroke (Nurses’ Health Study)
Risks with E-P contraception
1. Stroke?
- Carbohydrate and Lipid Metabolism?
- Estrogen affects levels how? 3
- Progestin affects levels how? 2
- Stroke:
- Ischemic: possible extremely low increased risk.
- Estrogen dose dependent. Other risk factors: smoking, older age, HTN, migraine with aura, obesity, prothrombotic mutations - Metabolism:
- -OCPs can cause mild insulin resistance; probable progestin effect
-Estrogen: serum triglycerides (Oral) and HDL increase;
LDL decreases
-Progestin: decrease HDL; increase LDL cholesterol
Risks of E-P contraception
VTE Disease 4
GI risks? 1
- Dose-dependent risk with estrogen
- Risk varies with type of progestin
- Older and obese women at greater risk
- **Important to take careful personal & family hx of DVT or PE
- Increased risk of cholithiasis
Risks with E-P Contraception
- Breast cancer?
- Cervical cancer? 3
(who can it affect and who does it usually not?)
- Breast Cancer: (data is conflicting)
Large studies have not shown an association
-May increase breast cancer risk in carriers of BRCA1 mutations & possibly BRCA2 - Cervical cancer:
- Low increased risk, increasing with duration of use
- Most indicate HPV negative OCP users do not have an increased risk
- In HPV positive women, a metabolite of estradiol can act as a cofactor with oncogenic HPV
Hormonal contraceptive-Drug Interactions
1. Metabolized where?
- Drugs that ________ liver microsomal enzyme activity accelerate ___________ and may decrease efficacy?
- _____________ can increase hormonal contraceptive metabolism by inducing the cytochrome P450 system?
- Liver
- increase, OCs metabolism
- St. John’s Wort
Hormonal Contraceptive Drug Interactions
1. _________ is the only proven antimicrobial shown to decrease the efficacy of OCs. (Similar effect expected with rifabutin.)
- Rifampicin
Hormonal contraceptive-Drug Interactions
1. What antifungal may decrease metabolism of estrogen resulting in a higher level than expected?
- What food?
- OCs reported to decrease plasma concentrations of the anticonvulsant __________ in one study?
- Antiretroviral therapy, esp ritonavir-boosted protease inhibitors affect OC how? 2
- Fluconazole and may decrease metabolism of estrogen resulting in a higher than expected serum EE level. (Significance unclear)
- possibly grapefruit juice
3 lamotrigine
- lower progestin levels with POP and implants ;
- some meds in this category increase and others decrease contraceptive steroids
OTHER PROGESTIN ONLY METHODS
3
- Depo medroxyprogesteron acetate (DMPA or DepoProvera) injection
- Progestin implant (Nexplanon; previously Implanon)
- Progestin IUD (Mirena, Skyla)
Progestin Only Methods: Mechanism of Action
5
- Inhibition of gonadotropin secretion
- With resultant inhibition of follicular maturation and ovulation
- Thickens cervical mucus
- Creates thin, atrophic endometrium
- Ovum transport may be slowed by reduced ciliary action in tubes
Progestin Only or Not Hormonal Contraception
When to use?
10
- Breast feeding (at least until breast milk well established)
- Hepatic disease: acute viral hepatitis, hepatocellular adenoma, liver cancer, severe cirrhosis, symptomatic gallbladder disease, cholestasis related to COC
- Postpartum- first 6 weeks
- Age over 35 and smoker or HTN
- Hx of DVT/PE/retinal artery occlusion
- Anticipated major surgery
- Takes at least 6 weeks for procoagulant effects of estrogen to reverse - Migraine HA—with aura, any age; without aura > 35 or
Progestin Only Methods: Advantages
7
- Compared to estrogen: fewer contraindications and fewer drug interactions
- Injection, implant, and progestin IUD are all long acting
Noncontraceptive benefits: (also apply to estrogen)
- Scanty or no menses (decreased anemia)
- Decreased menstrual cramps
- Decreased risk of endometrial cancer, PID
- Decrease of endometriosis pain
- Low risk of ectopic pregnancy
Progestin Only Methods: Disadvantages
1. Menstrual cycle disturbances? 2
- Possible weight gain:
- How? 2
- Greatest with what? - Psych changes? 2
- Menstrual cycle disturbances:
- Early on irregular bleeding and spotting
- Eventually most women become amenorrheic - Possible weight gain:
- Altered carbohydrate metabolism -anabolic effect with increased appetite
- Greatest with DMPA (Depo-medroxyprogesterone acetate) - Possible moodiness
- aggravation of depression
Progestin Only Methods
Disadvantages
1. Bone density decrease? 3
- Increased risk of type 2 diabetes in some high risk populations: Specifically who? 2
- Bone density decrease:
- Usually reversible
- Black Box Warning to limit use to 2 years if possible, although no proven increased fracture risk.
- NO INDICATION for DXA - Increased risk of type 2 diabetes in some high risk populations
- Latino women on progestin only pill
- Navajo women on DMPA
Depot Medroxyprogesterone
Acetate (DMPA)(Depo Provera)
1. Two formulations: What are they?
- Dosing schedule?
- DMPA—two formulations
- 150 mg/ 1mL for IM injections
- 104 mg/0.65 mL for SQ injections: slower and more sustained absorption - Administer q 3 months (13 weeks with 1-2 week grace period)
First 7 days of menses: no need for pregnancy test or back-up
Quick start: day of visit with negative pregnancy test; use back-up for 7 days; consider EC if unprotected IC in prior 120 hour
DMPA
- Safe to use when?
- After stopping DMPA return to fertility may be delayed up to___________ after the last injection
- What is this delay related to ?
- SE? 6
- Safe to use immediately post delivery
- 18 months
- increased BMI, not duration of use
- usually stop or decrease within several months:
- weight gain,
- dizziness,
- headache,
- nervousness,
- libido decreased,
- menstrual irregularities (unpredictable bleeding or amenorrhea (up to 75%))
Clinical Advantages of DMPA
2
- Sickle cell anemia: decrease in painful crises
2. Has intrinsic anticonvulsant effect. May be a good choice for woman with seizures
Progesterone Implants
2
- Implanon/Nexplanon:
2. Jadelle
Implanon/Nexplanon
- Administration?
- Lasts how long?
- Inserted where?
- Primary reason of discontinuation?
Jadelle
Not marketed in the US
Implanon/Nexplanon:
1. Single rod with slow release of 68mg etonogestrel
- Lasts for 3 years
- Inserted in the upper arm subdermally in the office
- Irregular bleeding was the primary reason of discontinuation
IUD/IUC
Intrauterine Device/Contraception
1. MOA?
- May protect against what?
- Mechanism of action: not precisely known but primary effect appears to be prevention of fertilization *
- Foreign body reaction creates sterile inflammatory changes toxic to sperm and ova and inhibits ovulation - Endometrial cancer
Progestin IUD/IUC
- Drug?
- Lasts how long? 2
Local progestin effect:
3. creates _________ at 24 months in 50%;
- _________ menstrual flow even with anticoagulant use;
- may decrease risk of PID due to what?
- SE? (main one) 4
- Levonorgestrel
- LNG20 Mirena approved for 5 yrs, LNG14 Skyla approved for 3 yrs.
- amenorrhea
- decreased
- thickened cervical mucus
- irregular bleeding***
- breast tenderness,
- mood changes,
- acne
- NON-hormonal IUC: What drug?
- MOA?
- __________ monofilament string at end
- Frame contains _______ for detection by x-ray
- ___ okay
- Approved to remain in place for ___ years
- Advantages? 2
- SE? 2
- Tcu380A (copper) Paragard: T-shaped with 380 mm2 exposed surface w/ copper
- releases copper continuously into the uterine cavity; this interferes with sperm transport and prevents fertilization of ova.
- Polyethylene
- barium
- MRI
- 10
- Advantage to women who cannot use hormonal methods;
- can be used for emergency contraception
- heavy menses,
- dysmenorrhea,
IUC Ideal Candidates
4
- Not planning a pregnancy for at least 1 year
- Want to use a reversible form of contraception
- Want or need to avoid estrogen
- Want “minimal user effort” and/or privacy
- IUC Complications
2. Sites of this complication? 3
- Uterine perforation, embedding, cervical perforation
- Perforation of 1 of 3 sites
- Uterine fundus
- Body of uterus
- Cervical wall
IUCs Disadvantages & Cautions
4
- PID: 1% incidence in first 3 weeks only
- Menstrual problems
- Expulsion: 2-10% in first year
- Pregnancy complication if conception occurs
EXPULSION of IUD
Top reasons? 3
- Nulliparity,
- heavy menses,
- severe dysmenorrhea are risk factors
Clues of Possible Expulsion of the IUC/IUD
6
- Unusual vaginal discharge
- Cramping or pain
- Intermenstrual or postcoital spotting
- Dyspareunia: for male or female
- Absence or lengthening of the IUD string
- Presence of the IUD at the cervical os or in the vagina
IUC Contraindications
6
- Severe uterine distortion
- Acute pelvic infection
- Known or suspected pregnancy
- Wilson’s disease or copper allergy
- Unexplained abnormal uterine bleeding
- Current breast cancer (Mirena or Skyla)
Barriers
- Good for who?
- Indications? 2
- Good choice for women who only need intermittent contraception
- STI protection
- Decreased cervical neoplasia risk
Barriers: Disadvantages & Cautions
5
- Allergy to spermicide, rubber, latex or polyurethane
- Abnormalities in vaginal anatomy
- Inability to learn correct technique
- History of toxic shock syndrome
- Repeated UTIs (diaphragm)
Characteristics associated with higher risk of failure of barriers
5
- Frequent intercourse (>3 x a week)
- Age less than 30 years
- Personal style or sexual patterns that make consistent use difficult
- Previous contraceptive failure
- Ambivalent feelings about pregnancy
Failure of Barrier Methods
How does it happen?
4
- Lack of trained personnel to fit the device and/
- or lack of clinical time to provide instruction in use
- Full-term delivery within past 6 weeks,
- recent SAB or EAB or vaginal bleeding from any cause including menstrual flow (cap, sponge)
Diaphragm
- What is it?
- Administration?
- Must be left in the vagina for how long after intercourse?
- A dome-shaped cup made of latex or silicone
- Partially filled w/ spermicidal cream/jelly and then inserted deep into the vagina to cover the cervix
- Must be left in the vagina for 6 to 8 hrs after intercourse, then needs to be removed.
Women who are not good candidates for the diaphragm?
7
- Allergic to latex/silicone or spermicides
- Significant organ prolapse
- Frequent UTIs
- HIV infection or at high risk
- Difficulty with insertion
- Adolescents
- Contraindicated with hx of toxic shock syndrome
Advantages of the diaphragm
6
- Safe/reusable
- Inexpensive ($ 70 + $10.00 spermicide)
- May offer some protection against GC and chlamydia (NOT HIV)
- Immediately effective and reversible
- No hormonal SE
- Can be used by women who are breastfeeding
Disadvantages of diaphragms
6
- Must be willing to insert before each episode of coitus and left in place for 6 hours after IC
- Requires some skill to insert
- Both the diaphragm & spermicide must be within reach within a few hours of coitus
- May increase frequency of UTIs
- Refitting recommended after childbirth
- Not available at all pharmacies *
Fitting a Diaphragm
Sizing must be done when? 2
Sizing must be done>6 wks postpartum or 2 wks post abortion
Cervical Cap
- What is it?
- Whats the only one available in the US?
- SE? 3
- Reusable, deep rubber cup that fits over the cervix, must be used with a spermicide has to remain in for 6-8 hrs can be left in place for up to 48 hours
- FemCap is only one available in the US
- SE:
- UTIs,
- vaginal infections
- TSS**
Contraceptive Sponge
- What is it?
- Preparation for insertion?
- Contraceptive benefit for up to how long?
- Increased risk of what?
- Today sponge is a 2 in. wide circular disk, ¾ in. thick that contains 1000 mg of nonoxynol-9 and has attached loop for removal
- It is moistened w/ tap water before insertion
- Contraceptive benefit for up to 24 hours regardless of number of episodes of IC. Must be left in place for 6 hours after intercourse
- Increased risk of TSS
Female Condom
- What is it?
- Which one is available in the US?
- Issues? 3
- Lines the vagina and shields introitus providing physical barrier during intercourse
- “Reality” female condom only one available in US
- More problems with
- breakage,
- slippage and
- incorrect penetration
Male Condoms Advantages
8
- Accessible and portable
- Inexpensive
- Male participation
- Erection enhancement
- Hygienic
- Prevention of sperm allergy
- Proof of protection
- Decreased risk of STIs
Male Condoms: Disadvantages
7
- Reduced sensitivity
- Interference with erection
- Interruption of coitus
- Latex allergy
- Embarrassment
- Breakage/slippage
- Failure rate: 18% typical use; 2% correct use
Spermicides: Advantages & Indications
7
- Can be purchased OTC
- Can be used without partner involvement
- Immediate protection
- Back-up option
- Midcycle use to augment other methods
- Emergency measure if condom breaks
- Provides lubrication
Spermicides: Disadvantages & Cautions
4
- Irritation
- Vaginitis
- Can irritate vaginal lining and enhance spread of viruses such as HIV if used 2 times or more a day
- Failure rate:
typical use 28%
Correct use 18%
Withdrawl technique
- What is it called?
- Failure occurs when? 2
- Failure rates? 2
- Coitus interruptus
Requires men to withdraw before ejaculation - Failure occurs if withdrawal is not timed correctly or preejaculatory fluid contains sperm
- Failure rates:
correct use 4 %
Typical use 22 %
- Why is lactation a form of BC?
2. Associated with subfertility, but can only be relied upon to prevent pregnancy when? 3
- Breastfeeding delays ovulation
1. The woman is
Fertility Awareness-based Methods: Factors contributing to low utilization?
4
- Readily available information is limited
- Provider bias against or lack of education about these methods
- Complicated, user dependent with cooperative partner
- High failure rate
Fertility Awareness
Not recommended when menses less predicatable such as?
5
Also not recommended for women with? 3
- Recent menarche
- Recent childbirth
- Approaching menopause
- Recent discontinuation of hormonal contraceptives
- Currently breastfeeding
- Women with cycles shorter then 26 days or longer than 32 days
- Women who are unable to interpret their fertility signs correctly
- Women with persistent vaginal infections that affect the signs of their fertility
Fertility Awareness
Methods
4
- Ovulation method: predicting fertile time based upon recent history of cycle length. If cycles 26-32 days, days 8-19 are most fertile.*
- Symptothermal:basal body temperature and cervical mucus as well as other symptoms of ovulation
- Cervical mucus: increases in amount and is thin and slippery in several days before and at ovulation
- BBT alone: Basal body temperature increases 0.5-1 degree F at time of ovulation but 2-3 days before ovulation is most fertile time
Surgical Sterilization of Women
1. At time of C/sec?
- Early postpartum?
- Interval sterilization? 4
- Hysteroscopic (also interval sterilization) as office procedure (Essure)
Requires what?
- Pomeroy technique
- minilaparotomy with general/regional/local anesthesia
- Laparoscopic (usually with general surgery)
- Bipolar electrocautery (highest ectopic rate)
- Mechanical devices (clips, bands)
- Tubal excision
- HSG after 3 months to confirm occlusion
Tubal Ligation
1. Laparoscopic tubal decreases risk of what?
- If failure occurs, 33% of pregnancies are ______
Compared to 20% with IUD failure
- ovarian cancer even in women with BRCA 1 and 2
2. ectopic
Female sterilization:
Factors associated with regret afterwards?
4
- Young age (30 or younger: 20% vs 5.9% over age 30)
- Change in relationship
- Low parity
- Not aware of availability of long-acting reversible methods before having had tubal
Reversal usually not covered by insurance
Male Sterilization
Vasectomy
-Safer, less expensive and lower failure rate than tubal ligation
- Unlike a tubal, if conception occurs, there is not an increased chance of an ectopic pregnancy
No increased risk of? 4
- impotence
- testicular or prostate cancer
- atherosclerotic disease
- Immunologic disease