contraception Flashcards
anesthetic used for TL + vasectomy
tubal = GA
vasectomy = local
failure rates for TL + Vasecotomy
TL = 0.2-0.5% Vasectomy = 0.1-0.2%
limit for abortion in Canada (weeks)
24 weeks (viability)
efficacy (typical use) of: OCP IUDs Plan B Condoms Rhythm Method Nothing (failure per 100 women in 1 year of use)
OCP 3-8% (progestin only slightly more) injection - 0.3% Mirena - 0.1-0.5% Copper IUD - 1-2% Plan B - 75-95% Condoms - 14% Rhythm Method - 20% Nothing - 85%
Progestin mechanism
thins endometrium (poor implant)
thicken cervical mucus (stop sperm)
prevent LH surge - no ovulation
alter tubal transport
Estrogen mechanism
FSH suppression - suppress follicle dev
endometrial proliferation
progestin side effects
spotting
PMS - bloating, moods, breast tenderness
weight gain - appetite, mostly /w high doses in injectable
estrogen side effects
spotting nausea breast tenderness clots (VTE, CAD) headache - migraines liver metabolism - active liver disease
note: lowers ovarian + endo cancer rates
What is in combined hormonal contraception
ethinyl estradiol 20-35ug
+
a progestin (variety)
non-contraceptive benefits of CHC
menorrhagia, anemia cycle regulation dysmennorrhea + endo fibroids ectopic risk PID - progestins effect on mucus acne/hirsuitism - higher SHBG due to estrogen ovary + endo Ca decreased benign ovarian cysts benign breast disease
Absolute C/I to CHC (estrogen mostly)
active liver disease/Ca uncontrolled HTN migraines /w neuro symptoms DM /w vascular damage pregnancy undx vag bleeding hx or strong fam hx of VTE estrogen-dep malignancy smoker over 35
relative CI to CHC
controlled HTN (must be stable + checked)
migraines /w out neuro symptoms (increase or new onset symptoms - stop)
BFing (milk supply)
anti-epileptics - risk of failure due to metabolism faster
hyperlipidemia - more pancreatitis
gallbladder disease - symptoms worse
IBD - risk of relapse small, absorption
SLE - can use if no nephritis or APA
other schedules/routes for CHC
patch - weekly
vaginal - monthly
extended use - 84 days (or 365 if use back-to-back)
shorter placebo - 4 or 5 days, decreases ovulation more, symptoms
small amount of estradiol in pill free week = minimize estrogen /wdrawal symptoms (headache, hot flash)
Depo Provera Dose
150mg depo medroxyprogesterone acetate (DMPA) IM q12 weeks
Depo side effects
high rates:
spotting
mood
weight gain
up to 1 year delay in return to fertility
bone density: controversial, decreased after long use, may return when stop – avoid in teens and perimenopause (building + breakdown)
depo benefits
high rate of amenorrhea/oligomenorrhea
progestin only pill (micronor)
pros and cons
takes daily (no placebo)
high rates of spotting, less ammenorrhea
high failure if not really good compliance
good for BFing, or >35 smokers
IUD mechanisms
inflammatory (poor implantation)
copper - toxic to sperm
progestin - endo thin, cerv mucous, tubal transport (still ovulate)
copper IUD - pros + cons
can be used as effective EC if inserted /w in 7 days
dysmenorrhea worse
failure: 1-2%
ectopic risk if preg: 15%
hormonal IUD pros + cons
good for menorrhagia, menopause
failure low
ectopic risk if preg: 6%
cost $300
pain management for IUD insertion
doesn’t help insertion: pretreat /w miso, paracerv block and pain meds
helps pain after: pre-treat /w NSAID
What is in Plan B + when can you take it?
progestin - thins lining + prevents ovulation/LH surge
take 2 doses 12 hrs apart or at once
/w in 72 hrs (some efficacy up to 5 days)
natural family planning pitfalls
sperm live 48-72hrs
egg lives 12-24 hrs
cycles irreg - esp perimenopause
withdrawal - high failure, pre-ejaculate
