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Fall 2020 Sexual and Reproductive Health > Contraception > Flashcards

Contraception Flashcards

1
Q

Contraception

61 million women in US of reproductive age, 43 million are sexually active and need or want to prevent pregnancy

What is the Average # of years ppl at risk for pregnancy spend trying to prevent pregnancy?

A

30 years!

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2
Q

Learning Objectives

A
  1. Utilize the PATH questions for shared decision making in contraceptive counseling
  2. Discuss the efficacy, MOA, advantage/disadvantages, and key patient education points for hormonal contraceptive options currently available in the US, including emergency contraception
  3. Utilize the CDC US Medical Eligibility Criteria fro Contraceptive Use and Selected Practice Recomendations for evidence based contraceptive care
  4. Accurately communicate risks and Benefits associated with contraceptive use
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3
Q

Women’s Contraceptive Choices and Options are Changing

List variety of options

A

Pills

Sterilization

Condoms

IUD

Implant

Contraceptive Ring or Patch

Injectiable

Withdrawal

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4
Q

Shared Decision Making

“…clinicians provide patients with information about ___ the (relevant) _____ and help them to identify their _____ in the context of their _____”

A

all, options, preferences, values

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5
Q

Shared Decision Making

  • Patient Contribution
    • Their v____, p_____, g____, and ____ experiences
  • Clinician Contribution
    • Assist in ______ patients goals and preferences
    • Provide _____/medical information that is: r_____, assimilated/int_____ by the patient
A
  • Patient Contribution
    • Values, Preferences, Goals, Past
  • Clinician Contribution
    • clarifying
    • scientific, relevant, integrated
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6
Q

PATH Questions

PA:

T:

H:

A

Parenting/Pregnancy Attitudes: Do you think you might like to have (more) children at some point?

Timing: When do you think that might be?

How Important: How important is it to you to prevent pregnancy (until then)?

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7
Q

Follow up to PATH Questions

Do you have a sense of what is important to you about your?

A

Birth control method?

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8
Q

How Well Does Birth Control Work?

  • ​Really Really Well (3)
    • <__/100 pregnancies
  • Okay (4)
    • ​__-__/100 pregnancies
  • Not so Well (4)
    • ​__-__/100 pregnancies
A
  • The Implant, IUD, Sterilization (men and women)
    • <1
  • The Pill, Patch, Ring, The Shot (Depo-Provera)
    • 6-9
  • Withdarawal, Diaphragm, Fertility Awareness, Condoms
    • 12-24
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9
Q

Birth Control Effectiveness

_____ in 10,000 women in 1 year for No method?

A

8,500

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10
Q

US Medical Eligibility Criteria: Categories

1 =

2 =

3 =

4 =

A

No restriction

Advantages outweigh the risks

RIsks outweigh the advantage - or no other methods available

Unacceptable

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11
Q

Summary Chart of US Medical Eligibility Criteria

Overall, very few __ - the point is?

Some 4’s include

i vs. C (Initiating vs. Continuing)

A

4’s Mass Majority of women can use mass variety of BCM

Distorted uterine cavity, Breast/Endometrial CA, <21 days postpartum, Cirrhosis, GI disease, DVT/PE

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12
Q

US Selected Practice Recommendations for Contraceptive Use, 2016 (SPR)

  • When to _____/_____ methods
  • _____ pills
  • B______ problems
  • E___ and tests
  • F____ -up
  • How to be reasonably certain that a woman is?
A
  • initiate/changing
  • Missed
  • Bleeding
  • Exams
  • Follow-up
  • Not pregnant
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13
Q

How to Be Reasobly Certain That a Woman is Not Pregnant

Once you are reasonably certain that a client is not pregnant?: YOU CAN?

  • Is < 7 days after the ___ of menses
  • Has not had sexual intercourse since?
  • Has been c_____ and c____ using a reliable method of contraception
  • Is < 7 days after spontaneous or induced ______
  • Is within __ weeks postpartum
  • Is fully or nearly fully _______ , A____orrheic, and <6 months postpartum
A

QUICK START ANY METHOD

  • start
  • since start of normal menses
  • correctly and consisting
  • abortion
  • 4
  • breastfeeding, amenhorrheic
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14
Q

When to Start Using Specific Contraceptive Methods

The only thing that really requires an exam is?

A

IUD

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15
Q

How long until protection from pregnancy after initiation?

Immediately =

If >___d since 1st day of cycle

1 week = (4)

A

Copper-T IUD

5 day

LNG IUS, Implant, Pills/Patch/Ring, Injectable

Pretty much Copper IUD’s work immediately, everything else >5 days

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16
Q

Hormonal Methods

COMBINED HORMONAL METHODS​

  • Combined _____ (Ethinyl ____ + 1 of several _____)
  • ______ (Ethinyl ____ + et_____)
  • _____ (Ethinyl ____ + nor_____)

PROGESTIN ONLY METHODS

  • Progestin only _____ (norethindrone)
  • In_____ (DMPA)
  • Im_____ (etonorgestrel)
  • LNG _ _ _ (levonorgestrel)
A
  • Pills (estradiol, progestins)
  • Ring (estradiol + etonogestrel)
  • Patch (estradiol + norelgestromin)
  • pills
  • Injection
  • Implant
  • IUS

Etonogestrel, Norelgestromin is progesterone

Situations that you would want progestin only (clots, don’t want estrogen)

First line is combined hormonal methods

17
Q

Combined Hormonal Contraception (first line)

(3)

How frequently?

MOA:

A

XULANE Patch - Weekly

Pill - Daily

Ring - Monthly

Ovulation suppression, progestational effects

On the inactive week, there is light bleeding but is not true period bc theres no ovulation

18
Q

Pill, Patch, Ring MOA

The pill, patch, and ring all have hormones that prevent _____ from releasing ____

The hormones also _____ cervical mucus, _____ sperm from getting to the egg

A

ovaries from releasing egg

thicken mucus, block sperm

19
Q

Variety of Pills

  • Good Starter Pill =
  • Monophasic; __d pill free interval
  • __phasic
  • ___phasic
  • ______- Cycle
  • __ pill free interval
A
  • Monophasic 7d pill free interval
  • Monophasic 4d
  • Biphasic
  • Triphasic
  • Extended
  • No

20mcg monophasic - less change of spotting and regularity

20
Q

CHC: Contraindications

  1. Current/Past Hx ______ CA
  2. Severe C______, viral ____ (acute or flare)
  3. S_______ > 15/day and age >35
  4. Known th________ mutations (Factor V Ledien, Protein S deficiency)
  5. <____d Post partum (breast feeding or not)
  6. Hx of _ _ _, major _____ w prolonged imm______
  7. D_____ w/ vascular disease
  8. G________ disease (medically treated)
  9. M______ w aura
  10. Hx of ______ procedures (malabsorptive)
  11. H _ _, S_____
  12. _______ Heart Disease, complicaed v_____ heart disease
  13. Multiple risk factors of ______ disease (older, age, DM, low HDL)
  14. Some meds: anti_______, ARV, anti______, R______)
A
  1. Breast
  2. Cirrhosis, Hep
  3. Smoking
  4. Thrombogenic
  5. <42 postpartum
  6. DVT, surgery w immobilization
  7. Diabetes
  8. Gallbladder
  9. Migraine
  10. Bariatric
  11. HTN/Stroke
  12. Ischemic, Valvular
  13. Cardiovascular
  14. anticonvulsants, antiparasitics, Rifampin
21
Q

Assessing for Migraine with Aura

Key Questions: Do the ______ symptoms start before the ___, last up to an ____, and resolve before the HA begins? Yes to ALL = positive for aura

  • Most auras are ______ -(99%); duration? followed by HA
  • At least one of the following:
    • Visual symptoms: flickering _____, sp____, l____, or ____ of vision in ______ of visual field
      • (NOT generalized spots, blurry vision, or light sensitivity)
    • Sensory symptoms: “____ and _____” or n______
    • D______ speech disturbance
A

Visual before HA, 1 hour

  • Visual
    • lights, spots, lines, loss MIDDLE
    • pins and needles, numbness
    • Dysphagic
22
Q

Patient Education for CHC

ACHES: Danger Signs

A

A: Abdominal cramping (severe)

C: Chest pain (severe)

H: Headache (new onset, severe)

E: Eyes (visual disturbances)

S: Severe leg pain, severe mood change

23
Q

Hormonal Contraception: Communicating Risk

  • ____/____/____
    • ​E and P: ______ levesl of procoagulant factors and f______; _____ anticoagulant levels
    • Incidence is ____ in reproductive age women, with or without OC use
    • _______ > OC use at all ages
    • Post ______ > pregnancy > COC user
  • ______ Cancer
    • ​No link: ____ dose pills
    • Possible link: ____ dose (50mcg), triphasic, some progestins (ethynodiol diacetate)
A
  • VTE/STROKE/MI
    • ​increase, fibrinogen, decrease
    • low
    • Smoking
    • Post partum
  • Breast CA
    • ​low
    • high
24
Q

Progestin-Only Oral Contraceptives (POPs)

MOA:

  • No ______ week
  • Disadvantages (2)
  • Advantage (1)
A

60% of women - ovulation suppression, progestational effects

  • No placebo week
  • Timing must be within 1hr qd, Bleeding irregularities
  • Can be used when estrogen is contraindicated (ie PP and breastfeeding)
25
Q

Possible SE of CHC

  1. Progestin Related:
  2. Estrogen Related:
  3. E or P:
A
  1. Increased appetite, breast tenderness, mood/depression, decreased libido, fatigue, hair growth/acne
  2. N/V, elevated BP, Chloasma
  3. HA, Bleeding irregularities
26
Q

CHC Non-Contraceptive Benefits/Advantages

  • Decreased Cancer Risk (C_____, O_____, E______)
  • Decreased
    • ​Endo_____, Aden_____
    • P _ _
    • E______ Pregnancy
    • Benign ______ Disease
    • A____, H_______
    • O______ Cysts
    • ________ Symptoms or _______ Symptoms
A
  • Colon, Ovarian, Endometrial
    • Endometriosis, Adenomyisis
    • PID
    • Ectopic
    • Breast
    • Acne, Hirsuitism
    • Ovarian
    • Menstrual, Perimenopausal
27
Q

DEPO Injection

  • Generic Name:
  • Brand Name:
  • Route:
  • Frequency:
  • MOA: ______ suppression 2/2 inhibition of _______ secretion and ______ effects
    • ___ Folliculogenesis or FSH/LH surge
    • ______ Cervical mucus, ______ of endometrium, _____ tubul motility
A
  • Depot Medroxyprogesterone Acetate (DMPA, “DEPO”)
  • Depo Provera
  • IM or SQ
  • Every 3 months
    • Ovulation, gonadotropin, progestational
      • NO
      • Thickens, Thining, Slows
28
Q

DEPO Provera

Advantages

  • Non_____
  • Use when ______ is CI
  • Non-contraceptive _____: _____ disorders; _____ Cell
  • Can use post-_____, b______

DisAdvantages/SE

  • _____ gain
  • Menstrual _______
  • Delayed return of _____ (1-2 yrs)
  • Requires office ______
  • _____ density
A
  • Nondaily
  • estrogen
  • benefits, seizure, sickle
  • partum, breastfeeding
  • Weight
  • irregularities
  • fertility
  • visit
  • Bone
29
Q

Key Points About DMPA

  • Structured _______ increases _______ rates
  • What returns to baseline after cessation?
    • ​What to encourage in the meantime?
  • ACOG and WHO support ____ term use
  • Weight _____: Diet/Exercise
  • ______ irregularities can be medically managed
A
  • counseling, continuation
  • Bone mineral density
    • Calcium, Exercise
  • long
  • Gain
  • Bleeding
30
Q

Progestrone Only Injection: Managing Bleeding Irregularities

  • Irregularities could be?
  • Frequent/Heavy Bleeding Management:
    • R/O _______, In_____, Neo_____, An_____
    • _______ (Ibuprofen, mefanamic acid)
    • Add _____ 1-2 mos
A
  • Amenorrhea, Infrequent, Frequent, Heavy
  • Management
    • Pregnancy, Infection, Neoplasia, Anemia
    • NSAIDS
    • CHC’s
31
Q

Lactational Amenorrhea (LAM)

MOA: Increased _______ ______ the HPO Axis

  • 3 conditions MUST be met
    • ​Exclusive _______
    • A_______
    • < ___ mos post partum
  • Advantages: No ___, No ____, No ___ resource poor areas
  • Disadvantages: Limited use per _____ for use and ____ 6 mos _____
A

Prolactin inhibits HPO Axis

  • 3 conditions
    • ​Breastfeeding
    • Amenorrhea
    • <6 mos
  • Cis, Cost, SES
  • conditions limit use, max 6m
32
Q

Barrier Methods

(5)

  • Pt Counseling
    • _____ for use
    • Opportunity to practice in _____
    • ***______ _______***
A

Condoms/Insertive Condoms

Diaphragm (requires filling)

Contraceptive Gel

Sponge

Cervicle Cap (3 sizes)

  • Counseling
    • Instructions
    • Office
    • EMERGENCY CONTRACEPTION

If only using barrier methods, we want pts to have emergency contraception on hand

33
Q

Fertility Awareness Methods: APPs Available

  • OPTIONS
    • ​_______ (Rhythm) method
    • Cervical ______ Monitoring
    • Basal Body ________
    • S____-Th_____
  • ADVANTAGES/DISADVANTAGES
    • _​_In______, no pro_____, supp____
    • No ____ effects, No ____indications
    • Acceptable for those who prefer no _____; adherence to ______ ideologies
    • Cumber____, in_____
    • Comm_____
    • Have to use other method during _____ days or ab_____
A
  • OPTIONS
    • ​Calendar: predicts ovulation based on when occurred in past cycles
    • Mucous: fertile mucous: wet, slippery/2day method: secretions today or yesterday? yes to either = fertile
    • Temperature: daily T, rise indicates ovulation occurred
    • Sympto-Thermal: combines mucous, T, and other sx
  • ADVANTAGES/DISADVANTAGES
    • _​_Inexpensive, procedure, supplies
    • SE, CI
    • hormones, religious
    • Cumbersome, inaccurate
    • Committment
    • fertile, abstain
34
Q

Spermicide

MOA: ______ and ______ sperm ______

  • Advantages:
    • ​L______, ____ to use
  • Disadvantages: ​
    • ​Films and suppositories require ___ min for activation
    • M____
    • Potential _____
  • Pt ED:
    • ​Place close to ___/___
    • Follow package ______
    • Use with _____ method
    • _____ ______!*
A

Barrier and Slows sperm motility

  • Advantages:
    • Lubricant, easy
  • Disadvantages
    • 15
    • Messy
    • Irritant
  • Pt ed
    • cervix/os
    • instructions
    • barrier
    • Emergency Contraceptions!* on hand
35
Q

Emergency Contraception

A

Primarily progesterone -> when brain gets this message -> ovulation is not going to occur bc brain thinks it already did

36
Q

Key Points: Contraceptive Counseling is Primary Care

Dual Protection =

A

CONDOMS are the only thing that protect from STDs -> so whatever they are using for contraception also need condom!

Fall 2020 Sexual and Reproductive Health (10 decks)

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