Contraception And Family Planning Flashcards
Wha are the mechanisms of action for contraceptions?
-Inhibiting the development and release of the egg
-Imposing a mechanical, chemical, or temporal barrier between sperm and egg
What is the def of secondary mechanism for contraception?
Alter the ability of the fertilized egg to implant and grow
*emergency
Can antibiotics decrease the efficacy of contraception?
NO
What is the pearl index?
The measure of unintended pregnancies from 100 women during 1 year of contraceptive use
*lower the score the lower the amount of unintended pregnancy
What is the def of typical (actual) failure rate
Failure rate seen with the method when it is actually used by the patients
*takes into account mistakes or noncompliance
What is the def of method failure rate?
Patient is using the method perfectly
*but the method is failing
When taking estrogen what does that increase the risk of?
Blood clots
What is the purpose of contraceptions?
They inhibit ovulation
When will the lining of the uterus shed?
When progesterone levels drop
When does ovulation occur?
When luteinizing hormone is at its peak
*LH recruits a follicle
What are combination pills made with?
Estrogen ad progestin
What is in the estrogen component of a combination pill
Ethinyl estradiol or newer estradiol valerate
What is in the progestin component of a combination pill
One of the 19-nortestosterone or spironolactone derivative
What is the MOA of a combination pill?
Suppresses the pituitary production of FSH and LH
What is the MOA of progesterone?
-Provides the major contraceptive effect
-suppresses secretion of LH and in turn ovulation
*thickens cervical mucus
What is the MOA of Estrogen?
Suppresses secretion of FSH
Prevents maturation of a follicle
What is breakthrough bleeding?
Spotting
*Bleeding that occurs outside the normal menstrual cycle
What is antithrombin III (ATIII)
-A potent inhibitor of the coagulation cascade
*can cause clotting
What are the effects of progestin/
Increase sebum
Stimulate the growth of facial hair and body hair
Induce smooth muscle relaxation
What are the “Phasic” regimens of (OCP)
Monophasic
*same dose in each pill each day
*21 days, 7 days placebo
Biphasic
*Same amount of estrogen each day
*Progestin dose is increased halfway
Triphasic
*three varying doses of hormones
What are continuous regimens of OCP?
Extends the cycle to every 3 months
*shorter and less frequent menses
What is the 365 day pill?
Amethyst
*28 active pills
*no placebo pills
*no menstrual cycle for the year
What is the progestin only pill?
Mini-pill
*camila, Errin, jolivette, Heather, and micronor
*Makes cervical mucus thick
When should progestin only pills be used?
Lactating women
*If not exclusively breastfeeding may become pregnant while on the pill
Women over age 40
What group of women are contraindicated to estrogen?
At risk CVD
Smokers
What are some disadvantages of POP
-Must be taken at the same time each day
*>3 hours late when taking the pill, the backup method should be used
What are some OCP advantages
Reduces the risk of iron-deficiency anemia
Lower incidence of endometrial and ovarian cancer
What are OCP disadvantages
Venous thrombosis
*clotting
Hepatic tumors
Cholestasis and gallbladder disease
When does breakthrough bleeding occur?
MC reason when discontinuing OCP
*MC during first 3 months of use
*counsel to expect irregularities
What is the only proven antibiotic that can reduce the efficacy of OCP
Rifampin
What is a first day start?
If you start bleeding take the pill
*provides the maximum contraceptive effect
What is a Sunday start?
Start first Sunday after menses onset
*use secondary form for first 7 days
What is a quick start?
Start on the day it is prescribed
*back-up form for 7 days
*confirm the patient is not pregnant
What are some contraindications of OCP?
Women over 35 years who smoke
Migraine
What does the transdermal patch contain?
Estrogen and progestin
How long is the patch effective for?
The entire week
*start patch during the first 5 days
*replace weekly for 3 weeks
*4th week is patch-free
Where should the patch be placed?
Butt
Upper outer arm
Lower abdomen
NOT the breast
What is the weight limit for the patch?
90kg
*caution when prescribing above
*decreased efficacy with obesity
CI
*BMI>30kg/m2
What does the nuvaring contain?
Releases estrogen and progestin daily
*left in place for 3 week at the start of menses
*remove for 1 week
How long can the ring be taken out without altering the efficacy?
3 hours
What does the Depo shot contain?
150mg of progestin
*given IM or SC every 3 months
*given within the first 5 days of current menstrual period
What can the Depo shot correlate with when on for long periods of time?
Bone concerns
*osteoporosis
What is the MOA of DMPA? Depot medroxyprogesterone acetate
Thickens the cervical mucus
*Progestin is high enough to block the LH surge
Wha are some side effects of DMPA
Weight gain
Irregular menstrual pattern
Delayed return to fertility
*14-24 months
Who should DMPA be given to?
Younger patients
Older patients
What are some indication for taking DMPA?
Only have progestin
-breastfeeding
-women with seizure disorders
-sickle cell anemia
What does nexplanon contain?
Daily dose of progestin
*MOA thickening the cervical mucus
*irregular bleeding can continues
How long is Nexplanon good for?
3 years
What is the only reliable and non permanent method of contraception available to men?
Condoms
What type of condoms protect against HIV?
Latex
How can condoms be damaged?
By oil-based lubricants
If there is breakage of a condom when should emergency contraceptions be used?
Within 120 hours
What is the physical barrier- Diaphragm
Must be applied with spermicide
*into the vagina, over the cervix, and behind the public symphysis
When should the diaphragm be inserted?
Up to 6 hours before intercourse
*left in place 6-8 hours after
*max 24 hours
What is the common size of a diaphragm
75mm
*must be fitted by a HCP
What is a cervical cap?
Smaller version of a diaphragm
How long can a cervical cap be left in place for?
6 hours after, max 48 hours
Does spermicide need to be apply for repeat intercourse?
No
What is a contraceptive sponge?
A small, pillow-shaped sponge containing spermicide
*fits over the cervix
How long can a contraceptive sponge be left in place for?
6 hours after intercourse
Up to 30 hours
What are spermicides?
MC active ingredient: nonoxynol-9
Put into vagina against cervix
*10-30 minutes before each act of intercourse
What is the max effectiveness for spermicides?
No more than 1 hour
*douching should be avoided for at least 8 hours
What is one of the MC used and safe methods of interval contraception worldwide?
Intrauterine devices (IUD)
What do some IUD contain?
Levonorgestrel
Copper
What is the MOA of levonorgestrel-containing IUD
Thickens the cervical mucus and creates an unfavorable uterine environment
What are the common IUD name containing levonorgestrel and their lifespan
Mirena: 8 years
Liletta: 6 years
Kyleena: 5 years
Skyla: 3 years
What do copper IUD contain?
Copper
*non-hormonal
*acts like spermicide
What is the lifespan of a copper IUD?
10 years
Which has more risks copper IUD or levonorgestrel
Copper
What are some IUD risks?
Bacterial infection
Risk of expulsion (2-10%)
*greatest during first few months
When will an IUD be inserted?
Anytime during the cycle as long as pregnancy can be excluded
When can a post-partum woman be re-inserted with an IUD
6 weeks after
*may be used by breastfeeding women
What are the different methods of family planning
Calendar
Basal body temperature
Cervical mucus
Symptothermal
Lactational amenorrhea
Describe the calendar method
-A patient needs to chart cycles over the course of 6 months
First day of fertility
*subtract 18 from the length of the shorten cycle
Last day of fertility
*subtract 11 days from the length of the longest cycle
Describe the basal body temperature method
Based temperature changes that occur around ovulation
*must be checked upon awakening
What does a risk of 0.5-1.0 degrees indicate?
Ovulation
Describe the cervical mucus method?
When the mucus appears thin and stretchy
*called spinnbarkeit
Fertile period is
*first signs of mucus and continues until 4 days after the peak day
Describe the symptothermal method
Combines cervical mucus and basal body temperature methods
Fertile period is from
*sing of ovulation until 3 days after temperature rise or 4 days after peak mucus
What is lactational amenorrhea?
Using exclusively breastfeeding as a contraceptive method
*suckling is associated with elevated prolactin levels, amenorrhea *suppresses GRH from hypothalamus
What is the Yuzpe method (emergency contraception)
A combination of estradiol 100mcg plus levonorgestrel r-McGee regimen
Multiple OCP from a cyclic pack
What is plan B
Progestin only
*levonorgestrel alone is more effective
What is Plan B (the morning after pill)
Contain two 0.75 mg tablets to be taken 12 hours apart
*taken ASAP but within 72 hours of coitus
What is plan b (one step)
Contains one pill
*1.5mg levonorgestrel
*available over the counter without age restriction as of 2011
Describe the antiprogestins
Ella- Ulipristal acetate 30mg
*Rx only
*can be taken up to 5 days after unprotected sex
Can a copper IUD be used as an emergency form of contraception
Yes (off-label use of ECP)
*very effective
*pregnancy test is required
*needs to be inserted 5 days after unprotected sex
What are the different types of sterilizations called?
Male:
*Vasectomy
Female
*tubal ligation
*Essure (not used)
Is a vasectomy immediate sterilization?
No
*multiple ejacultion are required
*azoospermia is confirmed by semen analysis
*checked at 8-10 weeks
What is a laparoscopy?
Blockage of the Fallopian tubes
*clips, excision, electrocautery
What is a minilaparotomy
Blockage by excision of all or part of the Fallopian tubes
*usually done after pregnancy
*clips, rings,cautery
*immediate sterilization
What is a hysteroscopy?
Trans cervical approach to sterility
*essure
Titanium spring is inserted into the tubal Ostia bilaterally
When have elective abortions been legalized?
Since 1973
