contraception

Question 1

NATURAL FAMILY PLANNING

Answer 1

Several methods to identify the fertile phase of cycle
 Risk of pregnancy increases starting 5 days prior to the day of ovulation, peaks on the
day of ovulation, and then rapidly decreases to zero the day after ovulation
Regular menses is necessary
 Failure rate with perfect use – 1-9%
 Failure rate with typical use – 20-40%

Question 2

BARRIER METHODS

Answer 2

Male condom – 4-12% failure rate
 Diaphragm – 4-20% failure rate
 Cervical cap – 10-20% failure rate
 Spermicides – 3-21%
 Benefits:
 Reduce bacterial and viral STIs
 Contraindications:
 Latex allergy
 History of dysplasia for cervical cap

Question 3

IMPLANTS AND INJECTIONS

Answer 3

IUD (Intrauterine Device)

 Paraguard – 0.6% failure rate, 10 years
 Mirena & Skyla (progesterone) – 0.15% failure rate, 5 years and 3 years
respectively
 All women are candidates – not just for multiparous or monogamous
 Side effects
 Mirena/Skyla: irregular light bleeding, amenorrhea
 Paraguard: irregular heavy bleeding and dysmenorrhea
 Contraindications: current infection, pregnancy, uterine anomaly

Subdermal Implants (Nexplanon)
 Single, thin, flexible plastic rod
 Releases progestin
 Failure rate: 0.05%
 Side effects and risks similar to other progestin only methods
 Advantages:
 Lasts 3 years
 Fertility returns quickly
 Disadvantages:
 Inserted by health care provider
 Expensive

Depo-Provera (Medroxyprogesterone Acetate)
 IM/SC injection q 3 months
 Failure rate – 6% typical failure rate
 Side effects:
 Weight gain
 Menstrual irregularity
 Depression

Women’s Health Review CME Resources Inc, 2016-2017 15
 Effects on bone density
 Fertility delayed possibly by up to 18 mos after discontinuation
 Contraindications:
 Same as all progesterone only products
 Black box-lowered bone density

Question 4

MNI PILL- PROGESTERONE ONLY

Answer 4

 Failure rate – 7%
 Choice for breastfeeding women
 High incidence of abnormal bleeding
 Contraindications:
 DVT
 Liver disease
 Breast cancer

Question 5

OCP

Answer 5

Pill, patch, vaginal ring
 Failure rate – 9% with typical use; < 1-3% with perfect use
 Advantages:
 Reduce risk of endometrial and ovarian cancer
 Decrease dysmenorrhea
 Improves acne
 Disadvantages:
 Pills taken daily
 No protection from STIs
 Cardiovascular disease (venous thromboembolism, stroke, MI)
 Contraindications:
 DVT/PE, CVA, CAD, Afib
 Thrombogenic mutations
 Severe hypertension or vascular disease/heart disease
 Migraine with aura
 35 years or older and a smoker > 15 cigs per day
 Breast cancer
 Complicated diabetes
 Competes with seizure meds
 Liver disease, gallbladder disease
 Lower efficacy in obsess pts

Question 6

STERILIZATION FOR FEMALE

Answer 6

Failure rate – 0.4-1.8% - not a reversible method
 Non-surgical - Essure

 Small metallic implant placed into the fallopian tubes
 Induces scar tissue to form over implant, blocking the tubes
 Can be done in the office without incision or general anesthesia

 Surgical - Bilateral Tubal Ligation:

 Outpatient surgery done under local or general anesthesia
 Effective immediately
 Risk of anesthesia/bowel or other organ perforation
 Both carry a high incidence of ectopic pregnancies if they become pregnant

Question 7

EMERGENCY CONTRACEPTION

Answer 7

Used to prevent pregnancy after:
 known or suspected failure of contraception
 unprotected intercourse
 Methods:
 Progestin-only method
 Plan B with 72-120 hrs of intercourse
 Ulipristal acetate (Ella) up to 120 hrs post-coital
 Insertion of Copper IUD – within 5 days after intercourse
 Efficacy: Reduce number of pregnancies by at least 75%
 Side Effects: nausea and vomiting; no teratogenic effects