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N825 > Contraception > Flashcards

Contraception Flashcards

1
Q

Extremely Effective Contraception (>99%)

A
  • Sterilization
  • IUD/IUS
  • Implants
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2
Q

Very Effective Contraception (>92%)

A
  • Pills
  • Injectables
  • Patch
  • Ring
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3
Q

Moderately Effective Contraception (~80%)

A
  • Condom
  • Withdrawal
  • Sponge
  • Diaphragm
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4
Q

Effective Contraception (Up to 75%)

A
  • Fertility awareness
  • Cervical cap
  • Spermicide
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5
Q

Contraception chosen most often by women 35+ yo

A

Female Sterilization

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6
Q

Male Sterilization

A
  • No scalpel vasectomy is standard of care
  • Low rate of failure
  • Cheaper, safer, and more effective than female sterilization
  • Must have 2 negative sperm counts after procedure for confirmation of success
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7
Q

Female Sterilization (Surgical)

A
  • Surgical procedure by laparoscopy

- Ligate, clip, cauterize tubes

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8
Q

Female Sterilization (Non-Surgical)

A
  • Essure:
  • Micro-inserts expand and occlude fallopian tubes
  • No reported failures to date
  • Adiana:
  • Low-level radio frequency delivered to fallopian tubes
  • Micro-inserts placed into fallopian tubes
  • 98% effective after 3 years
  • Must use back-up method for 3mo
  • Permanent
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9
Q

Levonorgestrel IUS (Mirena)

A
  • Approved for 5 years (effective for 7)
  • 20mcg/day
  • Progestin only IUD
  • Amenorrhea in 20-30% by 1yr
  • CANNOT be used for EC
  • Trim strings to about 2-3cm
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10
Q

Copper IUD (ParaGard)

A
  • Copper ions
  • Approved for 10 years (effective for 12)
  • CAN be used for EC (98% if within 5d)
  • Main MOA = Prevents fertilization; reduce motility and viability of egg
  • Decreased risk for endometrial CA
  • DOES NOT reduce menstrual bleeding (can increase); can increase cramping
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11
Q

Indications for IUD

A
  • Desire for long-term contraception
  • Don’t want to use OC’s
  • Desire quickly reversible method
  • CI: Fibroids, sepsis, bleeding, PID, STI, TB, etc.
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12
Q

Characteristics of IUDs

A
  • One of highest pt satisfaction
  • rapid return of fertility
  • Safe; starts protecting immediately
  • Long-term protection
  • Highly effective
  • May be inserted after delivery or abortion
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13
Q

Copper vs. LNG IUD

A
  • Copper:
  • Wants regular menses
  • Does not want to use hormones
  • No history of dysmenorrhea/menorrhagia
  • LNG IUD
  • Amenorrhea acceptable
  • Irregular bleeding tolerable
  • Hx of dysmenorrhea/menorrhagia
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14
Q

Dispelling myths about IUD

A
  • Can be used with multiple partners
  • Women with Hx of STD or PID (risk only increased in 1mo after insertion)
  • Nulliparous women
  • Teens
  • Immediately post-partum/post-abortion
  • Hx w/Hx of ectopic pregnancy
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15
Q

Contraindications for IUDs

A
  • Current purulent cervicitis, gonorrhea, or chlamydia
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16
Q

Implanon

A
  • Subdermal implant
  • Contains etonogestrel (progestin-type hormone)
  • Effective for 3 years
  • Effectiveness in morbidly obese not yet determined
  • Rapidly reversible (ovulation within 3wk-3mo)
  • Can be used during breast feeding after 6wk
  • Can improve dysmenorrhea and acne
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17
Q

Contraindications for implanon

A
  • Pregnancy
  • Hx of blood clots, liver Dz
  • Abnormal genital bleeding
  • Known or suspected breast Ca or Hx of
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18
Q

Disadvantages of implanon

A
  • Infrequent bleeding
  • Prolonged bleeding
  • Weight gain (~5lbs)
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19
Q

Timing of placing IUD or Implanon

A
  • Anytime during menstrual cycle when pregnancy can be excluded
  • Confirmed by negative pregnancy test and no unprotected sex in last 2wk
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20
Q

Combined Oral Contraceptives (COCs)

A
  • 20-35mcg ethinyl estradiol + 1 of 8 available progestins (21 pills, 7 placebos)
  • By 3rd month, typical users miss 3+ days/cycle
  • Progestin is main ingredient; suppresses gonadotropins, leutenizing hormone (Pituitary)
  • Estrogen inhibits FSH secretion
  • Both work synergistically to affect uterine lining and mucus
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21
Q

Who can use COC’s

A
  • Menstrual cramps
  • Desire to regulate periods
  • High compliance
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22
Q

Advantages COC

A
  • Reduce risk of ovarian cancer (15-20yr after use)
  • regulate menses
  • Protects against endometrial cancer
  • Protects against ectopic pregnancy, acne, benign breast disease, IDA, bone density, and PID
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23
Q

Contraindications COCs

A
  • Risk factors for CV disease (Smoking, DM, HTN)
  • Known thrombogenic mutations
  • Hx of heart Dz, Stroke, PE, Valve Dz, PVD
  • BP >160/100
  • Age >35 and smoker (>15cigs/day)
  • Migraine WITH aura
  • Current Breast Ca
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24
Q

Obesity and COCs

A
  • Obesity decreases effectiveness of COC’s
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25
Q

Bleeding and COCs

A
  • May experience irregular bleeding, N/V, breast tenderness for first 3mo
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26
Q

Progestin-Only Contraceptives (POPs)

A
  • “Mini-pill”
  • 2 Formulations: norethindrone (Micro-Nor) & Norgestrel (Norvrette)
  • Consistent timing is IMPERATIVE
  • Being late by 4hr can cause ovulation breakthrough
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27
Q

MOA POPs

A
  • Suppress ovulation
  • Suppress midcycle LH, gonadotropin peaks
  • Alter cervical mucus (thickens)***
  • Alter endometrium and fallopian tubes
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28
Q

Who to use POPs

A
  • Want immediately reversible contraception, but estrogen is contraindicated
  • Breastfeeding, cardiovascular Dz, Migraines
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29
Q

Advantages POPs

A
  • Used to correct dysfunctional uterine bleeding
  • No estrogen related side effects
  • Protect against cancer of breasts and ovaries, PID, & benign breast Dz
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30
Q

Contraindications of POPs

A
  • Current Breast Ca
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31
Q

Disadvantages POPs

A
  • Need backup if not taken on time or EC
  • Backup for 48hrs after late dose
  • Do not suppress ovulation as well as COCs
32
Q

Side effects of POPs

A
  • Irregular bleeding and Spotting
  • Usually clears up after 3-6mo
  • Amenorrhea
33
Q

Extended Hormonal Contraceptions

A
  • Continuous use of COC’s, transdermal patch, or vaginal ring
  • For pills, 63 on pills, 7 off pill (vs. 21on and 7off)
  • Delays or eliminates menstruation
  • Menstrual and non-menstrual benefits
  • Do NOT need bleeding week as previously thought
34
Q

Extended Hormonal Contraception Methods

A
  • Continuous use of COC’s
  • Transdermal patch
  • Vaginal ring
  • Seasonale, Seasonique, and Lybrel
35
Q

EHC Benefits

A
  • Remove menstrual related complaints

- Treats heavy menstrual bleeding, dysmenorrhea, endometriosis, chronic pelvic pain, & anemia

36
Q

EHC Disadvantages

A
  • Increase in breakthrough bleeding in first few cycles after start of pill
37
Q

Transdermal Patch/Ring Application

A
  • Quick start: apply first patch on day prescribed
  • If the patch is applied within 24hr after start of menstrual cycle -> No back-up needed
  • If it is not begun within 1st 24hrs or not quick start method, need backup for 1wk
  • Sunday Start Method: good to help remembering when period weeks begin
38
Q

Transdermal Patch

A
  • “Ortho-Evra”
  • Applied to ABD, buttock, upper outer arm, or torso
  • Patch applied 1x/wk (3wk on, 1wk off)
  • May deliver med for 10d
  • 150mcg norelgestromin/20mcg ethinyl estradiol
39
Q

Ortho-Evra Advantages

A
  • weekly

- Rapidly reversible

40
Q

Ortho-Evra Disadvantages

A
  • similar to oral COC’s
  • More breast discomfort, dysmenorrhea, and N/V
  • Avoid placing it on the breast
  • Do NOT place under high friction areas to prevent excess release of medicine
41
Q

Ortho-Evra Side Effects

A
  • Breast tenderness (fades)
  • Decreased effectiveness in >198lbs.
  • 2x risk for Thromboembolism as compared to COC’s (risk for VTE is still greater in pregnancy)
42
Q

NuvaRing Facts

A
  • One size fits most
  • Etenorgestrol/Ethinyl Estradiol
  • Contraception achieved in ~1wk
  • Insert on or before day 5 of cycle. Backup for 7d
  • If switching from COC, do not need to use backup.
43
Q

NuvaRing Advantages

A
  • Helps to regulate periods
  • 3 week cycle
  • Improves vaginal flora (decrease in BV)
  • Privacy
44
Q

NuvaRing Disadvantages

A
  • Doesn’t work w/significant vaginal relaxation
  • Fibroids decrease
  • increased leukorrhea
  • HA, Nausea
  • Risk of expulsion (rinse off and replace if within 3 hours, if >3hr new ring)
45
Q

Rationale for Ring

A
  • Easily inserted by pt.
  • Monthly, NOT daily
  • Continuous release w/constant serum hormones
  • Lowest EE dose
  • Avoids GI interference w/absorption
  • Avoids hepatic 1st pass metabolism
46
Q

What to do if ring is not replaced on time

A
  • Consider EC
  • R/O pregnancy
  • Insert new ring
  • Backup for 1wk
  • NuvaTimer
47
Q

Health Benefits: COC’s

A
  • Decreased dysmenorrhea, menstrual loss, anemia
  • May reduce PMS symptoms
  • Decreased risk of ectopic pregnancy, endometrial/ovarian Ca, benign breast Dz, & PID
48
Q

Side effects hormonal contraception: Progestin

A
  • Bloating, anxiety, irritability, depression, menstrual irreg.
49
Q

Side Effects hormonal contraception: Estrogens

A
  • Breast tenderness
  • N/V
  • HA
  • HTN (rare)
50
Q

Contraindications: COC’s

A
  • Clotting disorders
  • Hx of DVT or PE
  • Migraine w/aura or focal neurologic deficit
  • Uncontrolled HTN
  • <21d post-partum, gallbladder Dz, breast feeing,
51
Q

Quick Start Method

A
  • Start contraceptive in presence of clinician or on the day of visit
  • Time during the menstrual cycle not a factor
  • Back-up for 7d
52
Q

Missed or late hormonal contraception: COC’s

A
  • Take missed pill ASAP and next pill at regular time

- Use back-up method for 1wk if missed 1-2 pills at the start of pack or 3+ pills in the first 3wk

53
Q

Missed or late hormonal contraception: POP’s

A
  • Take missed pill ASAP and next pill at regular time

- Use back-up method if pill is taken more than 3hr past regular time

54
Q

Transdermal patch

A
  • Use back up method for 1wk if patch has been on more than 9d, off more than 7d, or falls off and is not reaffixed w/in 24hr
55
Q
  • Vaginal Ring
A
  • Use back-up method for 1wk if ring has been in more than 5wk, out more than 7d, or falls out and is not reinserted within 3hr
56
Q

Dose Regimens

A
  • 21/7: Based on large doses of progestin in 1960’s
  • 24/4: Also produces menses
  • Extended use: Prevents menses
  • Ring: Can be used 365d in a row (must change ring q3wk); about 80% estrogen as oral dose
  • Patch not studied for extended use; 3 in a row only
57
Q

Starting Pills

A
  • Quick Start: (25% who do not start pill at office got pregnant)
  • Can use any time in cycle
  • If she has had unprotected sex and it is on day 17+, give Plan B and 7d of backup
58
Q

Depot Medroxyprogesterone Acetate (DMPA)

A
  • Depo-Provera
  • IM or SQ injection q3mo
  • Not Immediately reversible
  • 1cc, 150mg
  • Progestin only; prevents ovulation and prevents ovarian production of estradiol
  • Can be used immediately post-partum
59
Q

Contraindications for Estrogen

A
  • Complicated migraine
  • Complicated DM
  • Smokers >35yo
  • Immediately post-partum
60
Q

Advantages of Depo-Provera

A
  • may improve menorrhagia, dysmenorrhea, and IDA due to amenorrhea
  • Amenorrhea develops within 12mo
  • May improve dysfunctional bleeding in obese women
  • Decreasing risk of endometrial Ca, PID, uterine fibroids, and sickle cell crisis
61
Q

Disadvantages of Depo-Provera

A
  • CI in Breast CA
  • Weight gain (~5lb/yr)
  • Menstrual irregularities for first 3mo
  • Median time to pregnancy after last injection is 10mo
62
Q

Protection from pregnancy

A
  • Immediately: Copper IUD

- After 7d: LNG IUS, Implant, pills, patch, ring, or injection

63
Q

Male Condoms

A
  • Protects against STD’s

- Perfect use 98%; typical use 83%

64
Q

Withdrawal

A
  • Almost effect as condom
  • Perfect use 96%; typical 82%
  • Does not protect against STD
65
Q

Female Condom

A
  • Coated with silicone based lubricant
  • Made from nitrile material, quieter (2nd gen); polyurethane, louder (1st gen)
  • Can be inserted up to 8hr prior to intercourse
  • Should not be used w/male condom
  • Perfect use 95%; Typical use 80%
  • Protects against STDs
66
Q

Sponge

A
  • Contains 1g minoxyl 9
  • Barrier protection
  • Can be left in for 24hr
  • May cause yeast infection if left in place too long
67
Q

Diaphragm

A
  • Used with spermicide
  • Barrier method
  • Requires prescription
  • Must be fitted (and refitted if have pregnancy or gain 10lbs)
  • May be placed 20min-6hr prior to intercourse, but MUST be left in place for 6-8 hours after intercourse
  • If intercourse within 6hr after the 1st act, then add more spermicide (do NOT remove)
68
Q

Fertility Awareness

A
  • Uses physical S/S and data to determine when ovulation occurs
  • “Cycle-Beads”
  • Avoid unprotected intercourse b/n days 8-19
  • 1st day of cycle is red bead; brown beads are infertile days; white days are fertile days
  • Can add or remove beads
  • If cycle is not in 26-32d, then this is not appropriate method
69
Q

Cervical Cap

A
  • “FemCap”
  • More effective for nulliparous women
  • reusable; conforms to anatomy
  • Comes in 3 sizes (Small for nullips; medium for women with no vaginal deliveries; large for women with vaginal deliveries
70
Q

Leah’s Shield

A
  • Can be purchased online, get from planned parenthood, from provider, or from YAMA
  • Reusable
  • One-size
  • Not held in place by cervix
  • Can be used by highly motivated women, breast feeding women, or as back-up method
71
Q

Spermicide (Nonoxynol-9)

A
  • Damages vaginal flora, may increase risk for HIV transmission
  • Can protect against STI’s
72
Q

Lubricants: Safe w/condoms

A
  • Astroglide, Water/Saliva, Glycerin, I-D lubes, Aloe 9, H-R lube jelly, KY jelly, Prepair, Probe, Aqualube, ForPlay, Gynol, Wet, Cornhuskers lotion, silicone lube, deLube, Spermicide
73
Q

Lubricants: Not safe w/condoms

A
  • Aldara cream, baby oils, cold creams, Eddie oils (olive, Peanut, corn, Sunflower), Massage oils, Mineral oils, head and body lotions, petroleum jelly
74
Q

Emergency Contraception

A
  • Prevents pregnancy after sex
  • Not an abortifacient (not same as abortion pill {RU-486/mifepristone})
  • No effect on future fertility
75
Q

Emergency Contraception: Methods

A
  • Brand: Plan B One-Step - behind counter >16yo; Rx for 16yo; Rx s (Ella is most efficient oral EC)
  • Copper IUD
76
Q

EC: Plan B and Next Choice

A
  • Most effective when taken sooner
  • Can be taken up to 5d after unprotected intercourse or contraceptive failure
  • Works with progesterone to change chemistry in cervical mucous to prevent fertilization
77
Q

EC: Copper IUD

A
  • Blocks or prevents implantation (Does not prevent fertilization)
  • Creates hostile environment in uterus

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