Contraception Flashcards
List the women more likely to experience unintended births
- Black Women
- Women w/ low education or income
- Unmarried Women
What is the Standard Days Method? Who is the most appropriate for?
- Women who have regular menstrual cycles: 26-32 days
- Must abstain from sex between days of 8-19 of cycle
*Highly motivated couples
What is the Calendar Method?
- 1st day of fertile period= subtract 18 days from total length of shortest menstrual cycle
- Last day of fertile period= subtract 11 days from total length of longest cycle
- Avoid sex during this time
*Must track menses x6 months before you can utilize
Define Cervical Mucus method
Abstinence with any cervical secretion until 4 days after last day of wet, car, slippery mucous
Define 2 day method
If no mucus secretions on 2 consecutive days, ok to have intercourse
Define Basal Body Temperature method
Abstain from sex from end of menstrual period until 3 days after rise in temperature (0.5-1 degrees)
What is the Symptothermal Method?
Cervical Mucus + Basal Body Temp Method
Fertile period:
First sign of ovulation until 3 days after temperature OR
4 days after peak mucus
What are the advantages of women controlled barrier methods?
- Immediately active: Spermicides requires 15 minutes for activation
- No effect on menses/hormones
What are the disadvantages of women controlled barrier methods?
- UTI risk: Diaphragm
- No HIV protection
- NOT for HIV+ and/or high risk for HIV
- Failure rate fairly high
Who is transdermal patches less effective in?
Obese women: >198 lbs
What are the advantages to prescribing CHC’s?
- Can be initiated at any time
2. No back up needed if started in first 5 days of bleed
What is the only thing you need to monitor PRIOR to starting a women on CHC’s?
BP
What is the MAIN MOA in CHC’s?
Suppress Ovulation=90-95%
CI to CHC’s
- Current breast CA
- Severe HTN or vascular dz (PE/DVT)
- Heart dz
- Complicated DM (or DM >20 yrs)
- Smoke > or equal to 15 cigs/day
- Migraine w/ aura
- Certain liver dz’s (cirrhosis) or GB dz
- Seizure disorders
What happens if you miss 1 pill?
Take missed pill ASAP and take next pill as usual
What happens if you miss 2 or more missed pills?
- Take most recent missed pill asap
- Remaining pills should be continued at usual time
- Backup contraception for 7 days
- Consider EC
What is the MAIN MOA of Progestin Only pills?
Thickens cervical mucus to prevent sperm entry to upper reproduction tract
What is one of the main advantages of Progestin Only pills?
May be used by women with CI or ADE’s to Estrogen
Progestin Only pills SE’s
- Increased spotting/bleeding
2. Intermittent amenorrhea
What is considered a “missed pill” in Progestin Only pills? Recommendations?
> 3 hrs late dose taking pill
- Take another pill
- Use back up x2 days
- Consider EC
IUD CI/Limitations
- Cervical CA
- Purulent cervicitis
- Current chlamydia or gonorrhea
- High individual likelihood of STI exposure (partner w/ infix)
- Increased risk of spontaneous AB and preterm delivery if become pregnant
With failure of the Mirena or Paragard IUD, what are women @ an increased risk for?
Ectopic pregnancy
Levonorgestrel IUD MOA
Causes Cervical mucus to become thicker
Copper IUD MOA
- Copper ions inhibit sperm motility
2. Inflammatory reaction in the endometrium phagocytes the sperm
What is one of the main advantages of the Etonogestrel Implant?
Good for women with estrogen CI
List the EC pills options
- Ulipristal acetate: More effective than levonorgestrel between days 3-5
- Levonorgestrel (Plan B)
- Combined Estrogen and Progestin: 2 doses-less effective and more SE’s
How long do you need to use back up for with the use of LNG and combined estrogen/progestin EC?
x7 days
Hysteroscopic sterilization MOA? How long do you need to use back up for?
Tubal occlusion
Backup x3 months until you have confirmed sterility
List the risk of regret in women who are sterilized (Hysteroscopic or tubal ligation)?
- Age <30
- Low parity
- Sterilization @ time of C-section
- Changes in marital status
- Poverty
- Minority status
- Minisinformation about permanence
- Hurried decision
How long do you need to use alternative contraception with a vasectomy?
Until 2 consecutive sperm samples who no motile sperm
