Contraception Flashcards
1
Q
Shared decision making
A
- Decide jointly on a contraceptive method
- Consider barriers and benefits
- Individualized
- Patient should be active participant
- Consider when she wants to conceive, what is important to her, what concerns her
2
Q
Considerations impacting choice of contraception
A
- HER PREFERENCES
- Motivation
- Cost
- Cultural/religious considerations
- Convenience
- Effectiveness (most important)
- Side effects
- Safety
- STI protection
3
Q
Address prior knowledge
A
- Past contraceptive use
- Myths and misconceptions
4
Q
Triangle for helping patients decide
A
- Begin with what is most important to her
- Explain contraindications
- Support her choice
- Offer other choices if necessary
5
Q
Nurse’s role with contraceptives
A
- Make sure patients know about available methods
- Educate them about use
- Ensure they have follow-up care
6
Q
Effectiveness of methods
A
- Most effective = implant, vasectomy, female sterilization, IUD
- Middle = injectable, pills, patch, ring, diaphragm
- Least = male condoms, female condoms, sponge, withdrawal, spermicides, fertility awareness
7
Q
Failure rate
A
- Number out of every 100 women who experienced an unintended pregnancy within the first year of typical use
8
Q
Two types of BC
A
Hormonal and non-hormonal
9
Q
Hormonal BC
A
- Pills
- Injection
- Patch
- Ring
- IUD: mirena, skyla
- Implant
10
Q
Non-Hormonal BC
A
- Paragard IUD
- Condoms
- Diaphragm/sponge
- Natural family planning
- Withdrawal
11
Q
Birth control pills
A
- Long lasting but not permanent
- Alter hormones: estrogen and progestin or progestin only used to inhibit ovulation
- Also alter cervical mucus to inhibit sperm penetration
- No STI protection
- 9% failure with typical use and 0.3% with perfect use
- Antibiotics can render ineffective
12
Q
Contraindications for combined BC pills
A
- Over 35 and smoker
- HTN
- DVT
- Migraines with aura
- Breast cancer
- Complicated diabetes
- Certain anticonvulsants
- Lupus
- Cardiac risk factors
13
Q
Progestin only pills
A
Use for:
- Breastfeeding moms
- Women over 35 who smoke
14
Q
Depo-Provera Injection
A
- Progesterone-only contraceptive
- Q12 weeks
- Potential for bone loss
- May give in mother baby
- Can cause problems with breastfeeding
- 6% failure with typical use and 0.3% failure wtih perfect use
- MOA: suppress ovulation and production of hormones, thickens cervical mucus, causes endometrial atrophy
15
Q
Ring
A
- Flexible, soft ring inserted into vagina for 3 weeks then take out for one week (period)
- Insert as far back as possible
- Estrogen and progestin
- Reduced side effects because absorbed directly into blood stream
- 9% failure with typical use and 0.3% failure with perfect
- MOA: Inhibit ovulation, change cervical mucus and endometrium
16
Q
Patch
A
- Matchbox size placed anywhere but breasts
- 3 weeks on then patch-free week (period)
- Side effects reduced because absorbed directly into bloodstream
- Risk of DVT and PE
- Hormones: estrogen and progestin
- 9% failure with typical and 0.3% failure with perfect
- MOA: prevent ovulation, also change cervical mucus
17
Q
Implant
A
- Steady dose of progestin: prevents ovulation and thickens mucus
- 3 years of protection
- Rod: Minor surgery to insert and remove
- Side effects: irregular bleeding, headache, weight gain, breast tenderness, depression
- 0.05% failure with typical use
18
Q
Contraindications for nexplanon implant
A
- Pregnancy
- Active DVT
- Severe hepatic disease
- Personal hx of breast cancer
- Undiagnosed vag bleeding
- Inability to tolerate irregular period
19
Q
Long acting reversible contraceptives
A
IUD: mirena, skyla, paragard
Impants: nexplanon
20
Q
ParaGard
A
- Copper IUD
- Use up to 10 years or as emergency contraception
- No hormones
- MOA: impairs viability of sperm and interferes with sperm movement
21
Q
Skyla
A
- Hormonal IUD
- Smaller than Mierna
- Approved for up to 3 years
- Good for nulliparas
22
Q
Mirena
A
- Hormonal IUD
- Approved for up to 5 years
- Amenorrhea in 20% of users by 1 year
23
Q
MOA of hormonal IUD
A
- Progestin only
- Creates inflammatory response = fatal to sperm
- Thicken cervical mucus
- Ovulation NOT INHIBITED
- Thin endometrial lining
24
Q
IUD contraindications
A
- Pregnancy
- Cervical malignancy
- Breast/endometrial cancer
- Distorted uterine cavity
- Current PID
- Current purulent discharge
- Wilson’s disease (just for copper IUD)
25
Q
Barrier method
A
- Physically prevent sperm from reaching ovum
- Many contain latex
- Diaphragm, cervical cap, condom, sponge
26
Q
Diaphragm
A
- Soft latex dome surrounded by metal ring
- Use with spermacide jelly
- Insert up to 4 hours before sex and leave in 6 hours after
- Rx and professionally fitted
- 12% failure with typical and 6% with perfect
27
Q
Spermacide
A
- Substance that is toxic to sperm
- Frequent use can breakdown vag tissue and increase HIV susceptibility
- Most effective when used with barrier method
- 28% failure with typical and 18% perfect
28
Q
Sterilization
A
- Popular in developed nations
- More women than men have it (18% women and 7% men)
- Permanent but reversal is possible
29
Q
Tubal ligation
A
- Can happen during c/s, PP, after abortion or procedure unrelated to pregnancy
- Laparoscope near umbilicus
- Seal, cut, tie fallopian tubes
- 0.5% failure with typical and 0.1% perfect
30
Q
Essure
A
- Transcervical sterilization
- Visualize fallopian tubes through cervix so don’t need anesthesia or surgery
- Introduce coil into tube which blocks tube within 3 months
31
Q
Vasectomy
A
- Outpatient w local anethesia
- Cut vas deferens
- Still have semen but no sperm (have semen specimen)
- 0.15% failure with typical and 0.1% with perfect
32
Q
Fertility awareness methods
A
- Cervical mucus ovulation method: clear, slippery, smooth, stretchy = fertile
- Basal body temp: temp rises postovulation and stay until menses
- Symptothermal method: identify s/s and monitor temp
- Standard days and 2 days: avoid intercourse on days 8-19 of cycle
- 24% failure with typical
33
Q
Important tips with fertility awareness
A
- Women must know their bodies and be comfortable touching themselves
- Less convenient and spontaneous
- Must communicate openly with partner
34
Q
Lactational amenorrhea method
A
- Continuous breastfeeding can postpone ovulation because stimulated prolactin and inhibits gonadotropin (needed for ovulation)
- Good for 6 months PP but only with no period, BF 6x/day, on demand, no supplements, nighttime feeds Q6 hours
- 1-2% failure
35
Q
Withdrawal
A
- Pull and pray
- Least effective
- Pre-ejaculate may contain sperm, requires lots of control and trust
- 22% failure with typical and 4% with perfect
36
Q
Emergency Contraception
A
- Use within 72 hours unprotected sex
- The sooner the better
- Reduces pregnancy risk by 80%
- Plan B, copper IUD
- Side effects: N/V
- Do not use as regular contraception
- MOA: delays ovulation, thickens mucus
