Contraception Flashcards
Age to discuss reproductive health
15-55 YO;
“what are your plans for pregnancy in the next year?”
Emergency Contraceptives (EC)
2 doses of contraceptive pills w/i 72 hours of unprotected sex
- Yuzpe “old school” - estrogen 200 mg
- Plan B or Preven - no estrogen
IUD insert w/i 5 days
- Paraguard (copper IUD)
Ulipristal Acetate (Ella)- SPRM effective up to 120 hrs (5 days); hormonal up to 72 hours (3 days)
Short acting BC
oral contraceptive pills
nuva ring
orthoEvra Patch
Depo Provera
*efficacy irreversibly proportionate to frequency
Best candidate for short acting BC
- women who have short interval prior to wanting pregnancy (excludes depo provera)
- not looking for long term prevention
- using for non-contraceptive benefits
- financial concerns/uninsured
OCP MOA
suppress ovulation, thicken cervical mucous, thinning of endometrial lining
Progestin only pill (POP) or “mini pill”
contain only progestin
less likely to consistently suppress ovulation (focus on thickening mucous and thinning lining)
usually used when estrogen contraindicated
Combination oral contraceptives (COCs)
estrogen + progestin
progestin type differs – important for SE profile
Estrogen helps w/ cycle regulation
major progestin only SE
irregular, unpredictable bleeding
Types of combo pills
monophasic
triphasic
continuous pills
Monophasic pills
single dose of estrogen + prosterone for 21-24 days; + placebo pills for 4-7
Triphasic pills
not really used anymore
differing dose of estrogen/progesterone throughout course of pack; 7 placebos; lower total dose of estrogen
Continuous pills
ex. Seasonique
Monophasic; 84 active, 7 placebo
withdrawal bleeding every 3 months
Continuous pills good for
dysmenorrhea
anemia
Caution to COCs
well controlled DM, HTN
smoking <35 YO
common migraine h/a
liver disease
Contra to COCs
uncontrolled HTN CAD uncontrolled DM complex migraine h/a (auras) hx of thromboembolism hormone sensitive cancers smoking >35 YO
Eligibility criteria for BC
1- no restriction w/ a condition
2- advantages > risks
3- risk > advantages; only used when other methods aren’t available/acceptable
4- unacceptable health risk
POP
mini pill
breastfeeding, post-partum moms
estrogen contra
more likely to fail if not taken properly (inadequate ovulation suppression due to non-therapeutic levels)
SE of POP
break through bleeding (lack of estrogen)
Progestin-only option
Minipill
Depo Provera Shot
Nexplanon implant
Progestin IUD (mirena, skyla, liletta, kyleena)
Pros/cons of minipill
pro: pregnant right after stoping
con: spotting; depression, hair/skin changes, change in sex drive
Pros/cons of shot
pro: works for 12 mo; decreases periods, no daly pill
cons: spotting, no period, weight gain, depression, hair/skin changes, change in sex drive; delay in getting pregnant after you stop; SE last up to 6 mo after stopping
Pro/cons of implant
pro: long lasting (up to 4 years); no daily pill; pregnant after removed
cons: irregular bleeding; no period at all after 1 year
Progestin only IUD pro/con
Pro: works 3-7 years; no daily pill; improve cramps/bleeding; prego after removed
Cons: lighter periods, spotting or no period at all
Contra to estrogen
immediate postpartum (increased risk of VTE) early lactation can be suppressed hx of thrombophelias hx of CVD smokers >35 classic migraines liver dysfunction
Non-contraceptive benefits of OCPs
cycle regulation
tx of heavy menses (progesterone thins lining)
tx of acne (suppresses ovarian production of testosterone) - SE vaginal dryness and dysmenorrhea
tx of dysmenorrhea (no prostaglandins)
prevent functional ovarian cysts
prevent ovarian, colon and endometrial CA
CA prevention of BC
endometrial > ovarian > colon
Excluding pregnancy when starting a new method
- no intercourse since last menstrual
- consistent/correctly on reliable method of contraception
- w/i first 7 days after normal menses
- she is w/i 4 weeks postpartum (non nonlactating)
- 1st 7 days postabortion or miscarriage
- fully/nearly fully breastfeeding, amenorrhoeic, and less than 6 mo postpartum
back up/additional contraception not needed
copper-containing IUD
> 7 days after menses, use back up BC for 7 days
Progesterone-IUD
injectable
> 5 days after start of menses, use back up BC for 7 days
Implant
COCs
> 5 days after menses started, back up for 2 days
POP
bimanual exam and cervical inspection needed before BC
copper IUD
progesterone IUD
BP needed before BC
COCs
No exam needed BC
implant
shot
POP
Depo Provera
medroxyprogesterone acetate (progesterone only) Failure: low Contra: none -- caution with DM, HTN, CVD
SE: irregular cycle, amenorrhea, bone mineral density loss (reversible) – don’t use for more than 2 years due to bone loss
back up if >7 days after menses, use for 7 days
Transdermal options
nuva ring
ortho Evra Patch
failure: low
Estrogen + progesterone
Contra: same as COCs
Barrier methods
block fertilization
condom, diaphragm, cervical cap/sponge
failure: high
contra: sensitivity to material
non-contraceptive benefit: lower risk of STD
LARCs types
implants
intrauterine devices
sub-dermal implant
hormonal suppression of ovulation
Types: implanon/nexplanon, both contain progestin only
Failure: very low
Contra: allergy to material
IU devices
MOA: unknown
formulation: progestin containing vs. copper (worse dysmenorrhea)
Failure: very low
Contra: active infection, sensitivity to copper, uterine anomaly, untreated cervical disease
SE of IUD
follicular cytsts more common
dysmenorrhea w/ copper
Types of progestin IUD
mirena (FDA approve for menorrhagia)
skyla
liletta
Non-progestin IUD
Paraguard (copper)
Non-contraceptive benefits of IUDs
treat menorrhagia (Mirena)
reduce average menstrual blood flow (not FDA approved)
LARC benefits
eliminate user input hormone levels consistent further decreasing ovulation eliminate frequent doc visit one less thing for mom to remember plan pregnancies better
Most common sterilization
laparscopic
types of sterilization
laparoscopic
postpartum via mini-laparotomy
transcervical (essue) - removed from market
Contraindications to sterilization
surgical restrictions
incomplete childbearing
Non contraceptive benefit of sterilization
Ovarian CA?
Laparoscopic sterilization aka
“interval” sterilization
Laparoscopic procedure
requires ventilation and therefore done under general anesthesia
requires hospital/surgery center
outpatient surgery
effective IMMEDIATELY
