contraception Flashcards
which women are more likely to experience unintended births?
black or hispanic, low education or income, unmarried women
consequences in unintended pregnancies
delays in prenatal care, maternal depression, increased risk of physical violence during pregnancy, birth defects and low birth wt., baby will have lower educational attainment and behavioral issues
barriers to contraception?
unnecessary screening exams/tests, inability to receive contraceptive on same day as visit, difficulty obtaining continued contraceptive supplies, adolescents understanding confidentiality laws
parameters for rx’ing contraceptives
routine pregnancy testing NOT necessary
HISTORY!!
<7d after start of normal menses, no sexual intercourse since start of last normal menses, using contraception reliably, w/in 4 wks postpartum, fully/nearly breastfeeding, amenorrheic….???????
if no criteria for contraception met
consider EC, Urine preg test/qualitative HCG
only contraception that you cannot use if a pt happened to be pregnant?
IUD
contraception and pt communication
ask about future fertility, impact on sexual activity, and recognize personal, physical, religious or cultural values
PMHx questions
hormonally based CA, obesity, migraine, HTN, venous thromboembolism, seizure disorders, complicated DM, liver/gallbladder dz
FHx questions
CA’s and thromboembolic disorders
what are some contraindications to contraceptive use?
using hormonally based contraceptives w/breast CA’s, IUD’s w/cervical or endometrial CA’s, CHC w/clotting conditions
MOAs for contraception
inhibit ovulation, prevent sperm from reaching egg, inhibit implantation
which forms of contraception are most effective?
implants, vasectomy, female sterilization, IUD’s
which forms of contraception are least effective?
fertility-awareness based, spermicide, male condoms, female condoms
standard days method of natural family planning may be utilized by women w/menstrual cycles that are how many days long?
26-32
on what days of the menstrual cycle must sexual intercourse be avoided w/the SDM?
8-19
how does the calendar method work?
monitor cycles x6mo’s
1st day of fertile period = length of shortest menstrual cycle minus 18 days
last day of fertile period = length of longest menstrual cycle minus 11 days
avoid sex during fertile period
cervical mucus method?
check daily
“peak” day = last day of stretchy, clear mucus
fertile period = 1st signs of mucus and continues until 4 days after peak
basal body temp?
check every am before getting out of bed
rise in temp of 0.5-1degF = ovulation
from end of menstrual period until 3 days after temp increase
what types of products must be avoided w/use of latex condoms (d/t decreasing effectiveness)?
oil based
which type of male condom is more likely to break of slip?
polyurethane compared to latex (2.6-5% more likely)
what is the minimum amount of time a cervical cap, diaphragm, or sponge must be left in place after sexual intercourse?
6hrs
when does spermicide (alone) become active and how long does it last?
takes 15 mins and lasts 1 hr
spermicide is assoc. w/increased transmission of what condition? why?
HIV, create irritation vaginally
there is an increased risk of ___ w/use of female diaphragm?
UTI
are any of the CHC’s effected by obesity?
patch
under 108lbs
what are some contraindications using CHC’s?
breast CA, heart dz, smoker >15cigs/day, vascular dz, migraine w/aura, seizure disorder
what screening or monitoring should be completed w/CHC use?
BP at initiation, no routine f/u needed
what is the primary MOA for CHC’s?
prevents ovulation
proper prescribing for CHC?
no back up needed if start in first 5 days of bleed, can be initiated at any time, should Rx yearly
if miss 1 CHC pill?
take pill ASAP and take next pill as usual
take most recent missed pill asap, backup for 7d, consider emergency contraception
what is the primary MOA for progestin only contraception?
thicken cervical mucus
thin, atrophic endometrium inhibits implantation
ovulation suppression, slows sperm motility
how long does it take to achieve maximum efficacy of POP’s? (progestin only pill)
2 days or 48hrs
when is a POP considered ‘missed’?
3hrs
if V or severe D occur w/in 3hrs after taking POP
who would be an ideal candidate for POP?
someone who can’t take estrogen
limitations for progestin only pills?
limited window (3hr delay= missed) current breast ca, liver dz's, meds that incr hepatic clearance (st. john's wort, anticonvulsants, etc)
what is the continuation rate for Depot Provera?
56%
what are common side effects of depot provera?
delayed to returned fertility after stopping, amenorrhea, irregular bleeding, decreased BMD
LARC (long acting reversible contraception) options?
copper IUD (Cu-IUD) levonorgestrel (LNG-IUD)
what physical exam must be completed prior to IUD insertion?
pelvic exam
Contraindications to LNG-IUD use?
anatomically abnl uterus
what are risks assoc. w/IUD failure? (if pregnant on IUD)
ectopic pregnancy
what bleeding patterns are expected w/use of a LNG-IUD?
amenorrheic after several months
proper prescribing for IUD
if NOT pregnant, no backup with Cu-IUD, no backup if inserted w/in 7days of insertion for LNG-IUD
what is the primary MOA for the LNG-IUD?
causes cervical mucus to become thicker, changes in uterotubal fluid also impairs sperm and ovum migration, alteration of endometrium prevents implantation of fertilized ovum
what is the primary MOA for copper-IUD?
inhibits sperm motility so sperm rarely reach the fallopian tubes, creates inflammatory response in vagina
what is an AE of the copper IUD?
heavy bleeding
what is the MOA of the etonogestrel implant?
thickened cervical mucus and inhibit tubal motility, also inhibit follicular maturation and ovulation
what is a common side effect of etonogestrel implant?
irregular bleeding
what is the MOA of EC when taken prior to ovulation?
prevent ovulation (block LH surge)
what is the effect of EC on an implanted pregnancy?
no effect
how long after unprotected sexual intercourse is EC effect?
72hrs to 5 days
which IUD can be used as an EC?
copper IUD w/in 1 month
how many days do you need backup if you use Post-UPA?
14 days or until next menses
name some factors assoc. w/a higher risk of regret about sterilization??
young age < 30y/o, low parity, sterilization at time of C-section, poverty, minority status, hurried decision, misinformation about permanence or risks
if hysteroscopic occlusion is performed for sterilization, what f/u is required?
hysterosalpingogram
what is the 1st line recommendation for contraception in an adolescent patients?
LARC
what age should contraception use be discontinued?
ACOG–> 50-55y/o or until menopause
>45y/o caution w/comorbidities
in women over age 45, which contraceptives have a preferred safety profile?
Cu or progestin only
