Contraception Flashcards
What are Goals of contraception
Prevent pregnancy
Prevention of STDs (with condoms)
Improvements in menstrual cycle regularity (with hormonal contraceptives)
Improvements in certain health conditions (with oral contraceptives [OCs])
Management of perimenopause
What do spermicides do?
contain nonoxynol-9, are chemical surfactants that destroy sperm cell walls and act as barriers that prevent sperm from entering the cervical os
What are contraceptives use Barrier Techniques
Condoms
Diaphragms
cervical caps
Sponges
What is the method behind Spermicides-implanted barrier technique
vaginal contraceptive sponge contains 1 g of the spermicide nonoxynol-9
When it comes to Male condoms what is potential downside they contain
Mineral oil-based vaginal drug formulations (eg, Cleocin, Premarin, and Monistat), lotions, or lubricants can decrease the barrier strength of latex, thus making water-soluble lubricants (eg, Astroglide and K-Y Jelly) preferable.
Why are condoms with spermicides no longer recommended?
They provide no additional protection against pregnancy or STDs and may increase vulnerability to HIV
Contrainditions for Male and Female condoms
Male: Allergy to latex or rubber
Female: Allergy to polyrethane
Or hx of TSS
What instructions must be followed when using a Diaphgragm with spermicides?
*May be inserted up to 6 hours before intercourse and must be left in place for at least 6 hours afterward
What does prolonged diaphragm placement cause
Placement for more than 24 hr can cause Toxic Shock syndrome
What are instructions when using Cervical cap?
What is the benefit behind using these
Can be inserted 6 hours prior to intercourse and should not be removed for at least 6 hours after intercourse.
It can remain in place for multiple episodes of intercourse without adding more spermicide but should not be worn for
more than 48 hours at a time to reduce the risk of TSS.
What are special instructions for using Sponges and the benefit behind it
Sponge is moistened with water and inserted into the vagina up to 6 hours before intercourse. Provides protection for 24 hours, regardless of the frequency of intercourse during this time.
After intercourse, the sponge must be left in place for at least 6 hours before removal and should not be left in place for more than 24 to 30 hours to reduce the risk of TSS. Sponges should not be reused
Which pharacologic device seems to have the least amount of unintended pregnancy
Progestin-only implant
IUD
What are symptoms associated in the early menstrual cycle
Irritability Anxiety Depression Lower abd. pain Back and leg pain Headache Diarrhea Inc. or Dec. libido Infection Nose bleeds
Signs and symptoms associated in the late menstrual cycle
Pregnancy symptoms
Weight gain Bloating Ankle swelling Breast fullness/tenderness Pain Constipation Depression Headache Acne Discharge
What enzyme is key in making estrogen hormones
Aromatase
which then makes testosterone –> Estradiol
What hormones do hormonal contraceptives contain a combination of
Estrogen and progestin
OR progestin alone
What is the MOA of combined Hormonal contraceptives (CHCs)
Starting with progestins
Progestins provide most of the contraceptive effect
By thickening cervical mucus to prevent sperm penetration
Slowing tubal motility and delaying sperm transport
inducing endometrial atrophy
Progestins block the LH surge, therefore inhibiting ovulation
What is the MOA of Estrogens in combined Hormonal contraceptives
Estrogens
suppress FSH release from the pituitary, which may contribute to blocking the LH surge and preventing
ovulation
primary role of estrogen in hormonal contraceptives is to stabilize the endometrial lining and provide cycle control
helps thicken cervical mucus
What are the 3 Synthetic estrogens found in hormonal contraceptives in U.S.
Ethinyl estradiol (EE)
Mestranol–> must be converted by the liver to EE before it is pharmacologically active and is 50% less potent than EE
Estradiol valerate
What are the 1st Generation of Progestins?
Norethinidrone
well tolerated, but lower doses have more breakthrough bleeding
What are 2nd Generation Progestins?
What are its side effects
Levonorgestrel
Worse for hisutism
Which Progestins have the longest half life?
2nd Generation
long half life (in implant/IUD), more androgenic activity- better for libido, worse for hirsutism/acne/lipids
What are 3rd generation Progestins?
Desogestrel
What are 4th generation Progestisn?
Drospirenone
Which progestin is closely related to Spirinolactone?
Drospirenone
What special instructions are given with Progestin only contraceptives
Must be taken at the same time every day
3 hour window
If taken more than 3 hours late, patients should use a backup method of contraception for 48 hours
Progestin only contraceptives put women at higher risks for what?
Ectopic pregnancies
Why is Progestin only contraceptives best used for post partum?
Because estrogen containing pills cause thrombosis
What are contraindications of Progestin only pills?
Gastric bypass
ischemic heart disease
Rifampin therapy
Which generation of progestins are common in IUDs
Levonorgestrel
When using CHC what should you stress patients also use to prevent STDs
Condoms
Slides 24,25
Look up contraceptive recomendations for smokers
slide 24,25
What amount of contraceptives are recommended in women with no coexisting medical condition?
OC containing 35 mcg or less of EE and less than 0.5 mg of norethindrone or an equivalent is recommended
slide 29
slide 29
Upon initiation what type is the preferred contraceptive that is recommended to start with?
Monophasic OC
Who might extended cycle regimens be beneficial for? (no placebo pills)
Women with:
dysmenorrhea, severe premenstrual syndrome, or menstrual migraines
What benefit do Extended-cycle OCs provide
eliminate or reduce # of menstrual cycles
leading to less
premenstrual symptoms,
dysmenorrhea and menstrual migraines
What are complications from oral birth controls that you must discontinue
A.C.H.E.S.
Abdominal pain Chest pain (SOB) Headaches Eye problems Severe Leg pain
If a patient is experiencing ADEs such as Breakthrough bleeding/spotting what is recommended?
Consider changing to a higher estrogenic dose
To minimize nausea, breast tenderness or vascular headaches what should you advise for you patient
Select a product with lower dose of estrogen
What is the MC adverse effect when taking OC
What should you tell patients who first experience these
Irregular bleeding
improve spontaneously by the third cycle of use after adjusting to the altered hormone levels
If a patient wants to start OC today (Quick Start) what must be instructed to the patient
Instruct to use a second method of contraception (typically recommend condoms) for at least 7 days after initiation for maximum effectiveness
What is recommended not to use in the first 21 days postpartum?
estrogen-containing hormonal contraceptives should be avoided (when the risk of thrombosis is higher),
What is the concern of taking CHC postpartum?
Mothers hyper coagulability and the effects on lactation
What type of oral contraceptives are acceptible post partum
Progestin only contraceptives
What are Unacceptable health risks that you should not used contraceptives with
Anatomic abnormalities History of breast, cervical or endometrial cancer (initiation vs continuation) PID Post abortion Postpartum Pregnancy Pelvic TB STDs Unexplained vaginal bleeding
What type of contraceptives are first line for sexually active adolescents
LARC
Long Acting Reversible Contraceptives
What benefits does Mirena provide
Approved for 5 years (?good for 7)
Reduces bleeding
May also shrink fibroids and reduce endometriosis
99% effective, effective 7 days after insertion
Which IUD can be used as a Emergency Contraception?
ParaGard (Copper T)
What are contraindications for ParaGard (Copper T)
SLE (thrombocytopenia)
Wilson’s Disease
Contraindications for using the IUD Nexplanon/Implanon
Cirrhosis
Ischemic Heart Disease
What is ADE of taking Depo-Provera?
Weight gain
Irregular menses even after stopping shot
Who are Transdermal patches contraindicated in?
High risk pt for VTE
Skin conditions
Obesity
Do Emergency Contraceptions disrupt or harm an embryo if a women is pregnant?
No
What is a common adverse effect if a women takes Emergency Contraceptions?
NV
Irregular bleeding
Menstrual period will occur again 1 week later
What is the recommended choice for Emergency Contraceptions?
Levonorgestrel containing EC
What is the time frame you have in order to take EC?
within 72 hours
MOA of Progestin-only EC
Inhibits or delays ovulation
Which EC can be taken up to 120 hours (5 days) after intercourse
Ulipristal (Ella)
28 year old G1P0 female is pregnant and being counseled for postpartum family planning. She is not planning on breastfeeding. What options are available to her postpartum?
Progestin-only methods (pills, injectables, Implant)
A 30 year old female has a history of migraine headaches with light sensitivity. She does not experience any visual warning signs for a coming headache. She is interested in starting contraception. What methods are safe for her to consider?
Combined hormonal methods (pill, patch, ring)
