Contraception Flashcards
What are goals of contraception?
- Prevent pregnancy
- Prevent STDs (condoms)
- Improve menstrual cycle
- Improve health conditions
- Manage perimenopause
What are methods of contraception?
- Periodic abstinence
- Barrier techniques
- Spermicides
- Spermicides-implanted barrier
- Hormonal
What are 2 contraindications for female condoms?
- Allergy to polyurethane
- Hx of TSS
What are contraindications of using a diaphragm w/ spermicide?
- Allergy to latex, rubber, or spermicide
- Recurrent UTIs
- Hx of TSS
- Abnormal anatomy
What are contraindications of using a cervical cap?
- Allergy to spermicide
- Hx of TSS
- Abnormal anatomy
- Abnormal pap
- Menses
How do you use a cervical cap?
Insert 6 hrs prior to intercourse
Do not remove for at least 6 hrs after intercourse
Can a cervical cap remain in place for multiple episodes of intercourse?
Yes, but not for longer than 48hrs at a time
What are contraindications to using a sponge?
- Allergy to spermicide
- Recurrent UTIs
- Hx of TSS
- Abnormal anatomy
- Menses
What form of contraception can increase the transmission of HIV?
Spermicides
How do you use a sponge?
Moisten w/ water & insert up to 6hrs prior to intercourse
Do not remove for at least 6hrs after intercourse
Do not leave in for longer than 24-36hrs
Describe the hierarchy of contraception methods.
Implant > LNG > Copper T > injectable > pill, patch, ring > diaphragm, sponge (nullparous) > male condom > female condom > withdrawal > sponge (parous), fertility awareness > spermicide
What s/s are seen EARLY in the menstrual cycle?
Irritability, anxiety, depression Bleeding Lower abd, back, & leg pain HA, dizziness N/D Changes in libido Infection
What s/s are seen LATE in the menstrual cycle?
Anxiety, depression Wt gain, bloating, constipation Swollen eyes, ankles Breast fullness, tenderness HA Nausea Acne Spotting, discharge
In combined hormonal contraceptives (CHCs), what provides the majority of the contraceptive effect?
Progestin
What is the MOA of progestins?
Thicken mucus
Slow motility & delay sperm transport
Induce endometrial atrophy
Block LH surge –> inhibits ovulation
What is the MOA of estrogens?
Suppress FSH release –> prevents ovulation
Stabilize endometrial lining & control cycle
Thicken mucus
What are the 3 synthetic estrogens?
Ethinyl estradiol (EE)
Mestranol (liver converts to EE)
Estradiol valerate
Progestins differ w/ respect to….
inherent estrogenic, antiestrogenic, & androgenic effects
What 2 variables are androgenic effects dependent upon?
presence of sex hormone binding globulin
androgen:progesterone activity ratio
What happens if SHBG decreases?
Free testosterone increases
Androgenic side effects become more prominent
Describe 1st gen progestins. Give an example of one.
Well tolerated, but lower doses have breakthrough bleeding
Norethindrone
Describe 2nd gen progestins. Give an example of one.
long half life (in implant/IUD), more androgenic activity- better for libido, worse for hirsutism/acne/lipids
Levonorgestrel
Describe 3rd gen progestins. Give an example of one.
Same progestational activity w/ decreased androgenic activity
Desogestrel
Describe 4th gen progestins. Give an example of one.
Anti-androgenic
Drospirenone
What are special considerations of oral contraceptives?
Women > 35 Smoking HTN HLD DM Migraines Breast CA Thromboembolism Obesity SLE
What are the risks associated with Minipills (progestin only)?
40% of women continue to ovulate
Increased risk of ectopic pregnancy
What are contraindications of progestin only?
Gastric bypass
Ischemic heart disease
Rifampin
What are ADEs of CHCs?
N/V Breast tenderness Wt gain Acne, oily skin Depression, fatigue Breakthrough bleeding/spotting Site reaction Vaginal irritation
What s/s warrant discontinuation of CHCs?
“ACHES”
- Abd pain
- Chest pain, SOB
- HAs
- Eye problems
- Severe leg pain
Women breastfeeding w/ RFs of VTE should avoid CHCs for how long? What about those w/out RFs?
42 days postpartum
If no RFs –> avoid CHCs for 30 days postpartum
What type of contraception should be offered if trying to minimize androgen effects or avoid HLD?
3rd gen progestin, low dose
What is 1st line for contraception in adolescents?
LARC
- Nexplanon
- Mirena, Kyleena, Skyla
- Copper ParaGard
What are contraindications to IUDs?
Unexplained vaginal bleeding STDs PID Hx of breast CA or endometrial CA Post abortion Pregnancy Pelvic TB Anatomic abnormalities
Describe the mirena
Lasts 5 years
Reduces bleeding
Shrinks fibroids, reduces endometriosis
Effective 7 days after insertion
Describe the ParaGard
Lasts 10 years
Can be used for emergency conception
May cause more menstrual bleeding
What are contraindications of ParaGard?
Wilsons disease
SLE
Describe Nexplanon
Lasts 3 years
Irregular bleeding
What are contraindications for Nexplanon?
Cirrhosis
Ischemic heart disease
What are ADEs of levonorgestrel & copper IUDs?
Menstrual irregularities
Expulsion
Insertion complications
PID
What are ADEs of progestin only implants?
Menstrual irregularities
Insertion site reactions
Describe ADEs of Depo Provera (DMPA)
Wt gain Irregular menses Bone loss Acne, hirsutism Depression
Who is the Depo Provera shot good for?
Sickle cell anemia
Older smokers
Seizures
What is a contraindication of Depo Provera?
Breast CA
What are considerations of Depo Provera?
Cirrhosis DM w/ microvascular disease CVD Uncontrolled HTN SLE Unexplained vaginal bleeding Women close to menopause (risk of osteoporosis)
What are contraindications for the transdermal patch (OrthoEvra)
Higher risk of VTE
Skin conditions
Obesity
If switching pill to patch, what should be the overlap?
1 day
If switching pill to shot or pill to hormone IUD, what should be the overlap?
1 wk
If switching pill to implant, what should be the overlap?
4 days
If switching pill to copper IUD, how long do you have to wait?
5 days after stopping pill
