contraception Flashcards
Groups with the largest increase in unintended pregnancies are
Low education
Low income
Cohabiting women (not married)
(black women also more likely to have unintended births)
Barriers to contraception are
unnecessary screening exams and tests
Inability to receive contraceptive on same day as visit
Difficulty obtaining continued contraceptive supplies
teens: understanding confidentiality laws
Routine pregnancy screening is NOT necessary if
<7 days after start of normal menses
no sexual intercourse since start of last normal menses
Correct and compliant use of contraception
<7 days after spontaneous or induced abortion
w/in 4 weeks postpartum
fully or near fully breastfeeding, amenorrheic, and <6 months postpartum
If you dont meet reasonable certainty, when can you start contraception regardless (except IUD)
If benefits>risks;
start contraception and have patient get a pregnancy test in 2-4 weeks
(not IUD bc they have a higher risk of complications- spontaneous, preterm, septic aboriton)
Key medical history before starting contraceptives are
PMHx: hormonal cancer, obesity, liver dz, gallbladder dz, migraines w/ aura, HTN, VTE, Sz, DM
Med use
SHx: smoking, sexual (high risk for STI)
FHx: cancer, DVT/VTE
The 3 MOA of contraceptives take
- Inhibit ovulation
- Prevent sperm from reaching egg
- Inhibit implantation
What are the types of contraception
Natural family planning Barrier/ Spermicidal Combined Hormonal Contraception Progestin only contraception Long Acting Reversible Contraception Emergency Contraception Sterilization
Rate types of contraception by effectiveness
Worst: NFP, spermicide
Eh: condoms, withdrawal
Better: Depo, pill, patch, ring, diaphragm
Best: Implant, sterilization, IUD
What is the standard days method
For women w/ cycles 26-32 days long, NO SEX days 8-19
What is the calendar method
Monitor cycles for 6 months, then abstain form sex when fertile
Fertility starts: length of shortest cycle-18 days
Fertility ends: length of longest cycle-11 days
What is the cervical mucus/2 day method
check cervical mucus daily
“Peak” day is last day of stretchy, clear mucus
Fertility starts with first signs of clear mucus-4 days after peak day
If no mucus for 2 days, you can have sex
What is the basal body temp method
Check basal temp when you wake up every morning before getting out of bed
Rise in temp of 0.5-1.0 degree= ovulation occurred
don’t have sex from end of period-3 days after temp increase
What is the symptothermal method
combo of cervical mucus assessment and basal body temp
also monitor for signs of ovulation (cramping, spotting, tender breasts); fertility is from first sign of ovulation-3 days after temp rise of 4 days after peak mucus
What are the types of male condoms
Latex
Polyurethane: more likely to slip and break
Natural (lamb cecum): lower level of STI protection
*Avoid petroleum or oil based vaginal products with latex condoms!
How do female barrier methods work
mechanical barrier to sperm entering cervical canal
Spermicide attacks flagella and body= reduced motility
How long does spermicide require to activate
15 minutes
What is in the transdermal patch
150 Norelgestromin/ 20 ethinyl estradiol
What is in the vaginal ring
120 etonorgestrel/ 15 ethinyl estradiol
When can you start CHC
any time!
No backup needed if you start in the first 5 days of a bleed
**Prescribe 1 year supply at initiation and follow up!
What do you need to monitor prior to initiating CHC
Blood Pressure
No routine follow up needed
How do CHC work
Suppress ovulation**
thicken cervical mucus
thin endometrium= hard for implantation
slow tubal motility
Limitations to using CHC include
current breast cancer severe HTN or vascular disease complicated DM (or DM >20 years) heart disease migraine with aura seizure disorder liver/gallbladder disease smoke 15+ cigarettes per day
What happens if you miss 1 CHC pill
Take it ASAP and take the next pill as usual
What happens if you miss 2 CHC pills
Take the most recently missed one ASAP
Continue as usual the next day (you will have an extra pill in your pack)
Use backup for 7 days or EC if needed
What if you miss 2 pills from the last hormonal week
dont take the placebo week pills, start a new pack the next day
When can you start POPs
any time!
No backup needed if you start in the first 5 days of bleed
Prescribe 1 year supply at a time
NO monitoring necessary
How do POP work
Thicken cervical mucus
thin endometrium
Suppress ovulation 50% of the time
slow sperm motility
ADE of POP include
Increased spotting/bleeding
intermittent amenorrhea