Contraception Flashcards
Distorted uterine cavity
no IUD
Breast Cancer
Can use Copper IUD
Cirrhosis
mild -any
severe - Copper IUD
DVT
Anything but combined methods
DM
Nephropathy/Retinopathy/neuropathy- no OCP’s or Injection
Diabetes with vascular disease- no combined or injections
Diabetes >20 years- no combined or injections
Endometrial or GTN
Think before using IUD
Headaches
consider non-combined method
Malabsorptive bariatric procedures
no pills in general
AIDS
Don’t place a IUD
Hypertension
Consider non-estrogen containing. If uncontrolled or vascular disease no injection/no estrogen
H/O MI
Copper IUD is preferred
Liver tumors
focal nodualar hyperplasia- any method
Adenoma or malignancy- copper IUD
Multiple risk factors for arterial cardiovascular disease
no estrogen or injection
Peripartum Cardiomyopathy
No estrogen
Infected uterus or cervix
No IUD
Smoking
less than 35 estrogen is ok
Stroke
IUD
APLS
IUD
HIV with Ritonavir booster protease inhibitor
No Pills
Anticonvulsants
No pills
Rifampicin
no pills
Benefits of OCP’s
bone density, endometriosis, benign breast disease, ovarian cysts, acne, hirsutism
Quick Start
backup contraception for 1 week
How does progesterone work
thickens cervical mucus, thins the lining and slows tubal motility
missing a pill
if missing 2 pills in the 3rd week or 3 in any other week start a new pack and use back-up
Emergency options
Plan B- levonorgesterol .75 q 12
Plan B one step - 1.5 mg
Ella (Ulipristal) 30 mg x1
Yuzpe Regimen
Patch
change weekly
150 ug norelgestromin and 20 ug EE
increased risk for VTE
Nuvaring
wear for 3 weeks
15 ug EE and 120 ug etonorgesterol
lowest estrogen
Medroxyprogestrone acetate
relative contra: cerebro or cardiac vascular disease, SBP>160, DBP >90, Liver tumors, diabetic vascular diease, SLE with APLS
70% irregular bleeding in the 1st year
80% amenorrhea after 5 years
Implanon
30-50 mcg of etonogesterel
Levonorgesterol IUD
30-50% amenorrhea
vasovagal response with insertion - atropine
IUD expulsion in 3-10%
unable to see string- endocervical brush
Contraindication to copper IUD
infection, irregular cavity and wilson’s diease
STD screening and IUD placement
Not necessary in low risk and can be done at the same time as placement in high risk
must have negative pregnancy test
Pregnancy with IUD in place
If pregnancy continued, increased risks of
spontaneous abortion, infection, and preterm
delivery; removal of IUD reduces but does not
eliminate these risks
What is the most effective emergency contraception?
Copper IUD
HIV on HAART
Efavirenz, protease interact with hormonal contraception making both less effective. Consider Mirena IUD
Seizures
phenytoin, carbamazepine, and phenobarbital decrease effectiveness of birth control
- IUD or Depo
On antibiotic that decreases OCP effectiveness?
rifampin
