Contraception Flashcards
2 general contraceptive mech’s
- inhibit formation and release of egg
- mechanical, chemical, or temporal barrier b/w sperm and eggq
Hormonal contaceptives
- pills
- injectable
- implantable
- IUD
- contraceptive patches
- contraceptive rings
Injectable
-depo medroxyprogesterone acetate (DepoProvera)
Implantable
-etonogestrel rod implant (Nexplanon)
IUD
- levonorgestrel (Mirena
- Skyla
- Liletta
Contraceptive patches
-OrthoEvra
Contraceptive rings
NuvaRing
Oral Contraceptives- combo- moa
- suppress GnRH- suppression of FSH and LH
- progesterone- major player- suppress LH and ovulation, thicken cervical mucus, creates an unfavorable atrophic endometrium for implantation
- estrogen- improves cycle control- stabilize endometrium, allows less breakthru bleeding
Progesterone- consider what?
androgenic effect!!
Progestin-only oral contraceptives (mini-pill)- moa
- make cervical mucous thick and impermeable
- ovulation continues in 40%
- used in breastfeeding women and women how have a contraindication to estrogen!!
Oral contraceptives- benefits
- menstrual cycle regularity
- improve dysmenorrhea
- dec risk of iron def anemia
- lower incidence of endometrial and ovarian cancers
oral contraceptives- SE’s
- breakthru bleeding- in 1st 3 months
- amenorrhea
- mild SEs- bloating, breast tenderness, nausea, fatigue, HA
oral contraceptives- serous SE’s
- venous thrombosis!!
- PE!!
- cholestasis and gallbladder dz
- stroke and MI
- hepatic tumors
Transdermal patch
(estrogen and progesterone)
- for 3 wks
- greater risk of thrombosis
vaginal ring
(estrogen and progesterone)
-for 3 wks
who CANT use oral contraceptives?
- > 35 yo and smoke cigarettes
- hx of thromboembolic event
- CAD, cerebral vascular dz, CHF, migraine with aura, uncontrolled HTN
- liver dz/tumors
Depot Medroxyprogesterone Acetate (Depo Provera)
- IM injection every 11-13 wks
- maintains contraceptive level of progestin for 14 wks
- thickens cervical mucus, decidualization of endometrium, blocks LH surge and ovulation
Depot Medroxyprogesterone Acetate (Depo Provera)- bone effects?
- alterations of bone metabolism (dec estrogen levels)
- reversible after discontinuation
Depot Medroxyprogesterone Acetate (Depo Provera)- SEs
- irregular bleeding!- menses can take up to a yr to regulate after discontinuation
- weight gain (hungry)
- exacerbation of depression!!!
Depot Medroxyprogesterone Acetate (Depo Provera)- contraindications
- pregnancy
- vaginal bleeding
- malignancy of breast
- thromboembolic events
- liver dz
LARCs
-implants and IUDs
Implant
etonogestrel- Nexplanon
Nexplanon
- radiopaque, implant- etonogestrel
- used for 3 yrs
- moa- thickens cervical mucus, inhibits ovulation
Nexplanon- SEs
- irregular vaginal bleeding
- HA
- weight inc
- breast pain
Nexplanon- contraindications
- pregnancy
- liver tumors/ active liver dz
- breast cancer- only absolute contraindication!!
Nexplanon- complications with insertion
- infection
- deep insertion
- persistent pain or paraesthesia at insertion site
IUD- 3 available in US
- copper T (paragard)
- levonorgestrel releasing- Mirena/Liletta and Skyla
- expulsion rate- 1-5%
risks with IUDs
- infection within 1st 20 days
- ectopic pregnancy
- uterine perforation
- malposition
IUDs- contraindications
- breast cancer
- puerperal sepsis
- septic abortion
- cervical infection
- wilsons dz (copper T)
- uterine malformations
Levonorgestrel IUDs
- Mirena- 5 yrs
- Liletta- 3 yrs
- Skyla- 3 yrs
IUDs- benefits
- dec in menstrual blood loss
- less dysmenorrhea
- protection of endometrial lining from unopposed estrogen
- convenient, long-term
Copper T (paragard)
- 10 yrs
- copper interferes with sperm transport or fertilization and prevention of implantation
barrier contraceptives
- condoms
- diaphragm
- cervical cap
- sponge
- spermicides
diaphragms
- must be used with a spermicide
- must be left for 6-8 hrs after intercourse
- more likely to get UTIs
fertility awareness methods
- calendar methods (cycle beads)
- basal body T method (0.5 to 1 degree change at time of ovulation- avoid sex for 3 days after)
- cervical mucus method
- symptothermal method (cervical mucus and basal body T)
Emergency contraception
- prevent ovulation and fertilization
- plan B- progestin only (levonorgestrel)- 2 pills, use within 120 hrs!!!
- Ella- ulipristal acetate- up to 5 days- postpones follicular rupture/inhibit or delay ovulation
Sterilization decision- counsel pts
- permanent
- address all other options- LARCs
- reasons for choosing sterilization
- risks/benefits
- screen for regret (esp at young age)
- possibility of failure and inc risk of ectopic pregnancy
male sterilization
Vasectomy
-occlusion of vas deferens
Female sterilization
-laparoscopy, mini-laparotomy, hysteroscopy
