Contraception and Family Planning Flashcards
Unintended Pregnancies
Contraception Options: groups & how to chose
over 50% of US pregnancies are unintended ; not using contraception or using incorrectly
higher in
- adolescents
- minorities
- women in lower SES or lower edu levels
Risk of
- poor fetal and materal outcomes
Options of Contraception
- Family Planning
- barriers/spermicides
- hormonal contraception (pills, shot)
- surgical sterilization
- long acting reversible contraception (LARCS) - iud
how to choose depends on
- efficaicy
- cost
- safety/medical elligibity
- pt. perference
history
- what have you used
- address side effects
Natural Family Planning
what is it
methods
Cycle Awareness (days)
What is it
- least effective means, should not be used if the desire to not be preganant is high
- no chemical or barriers
Methods
- cotius inturruptus: the pull out method
- periodic abstence: fertility awareness
- ovulation assessments: basal body temp, ovulation kit, cycle tracking, cervical mucus tracking
- lactational amenorrhea: for a few months BF no periods
Cycle Awareness
- track first day of cycle: day of perod = day 1
- avoid intercourse or use barrier form 7 days before ovulation and 3 days after (ovulation around day 14)
Natural Family Planning
Basal Body temp
cervical mucous testing
lactational amenorrhea
Basal Body Temp
- relies on predictable rise in body temp
- rise is 0.4 degrees indicates ovulation: need special thermometer
Cervical Mucous Testing
- reliers on predictable thickness changes in the mucous that occurs with ovulation cycling
period happens
3-4 days after: no secretions
then: scant, cloudy sicky secretions 3-5 days
abundant, clear, wet secretions for the next 3-4 days: this is the period leading and including ovulation
then no secretions for 11-14 days: then period
Lactaional Amenorrhea
- resotration of ovulation delayed during breast feeding: prolactin inhibits GnRH release from the hypothalmus : stops period
- happens for about 6montsh
- but ovulation will occur before thefirst mentrual cycle
Barrier Contraception/Spermacides
male condome
female condome
Spermacide
- topical agents that disrupt the cell membrane of spermatoxa
- act as a mechanical barrier in the cervical canal
- best used in combo with a barrier
- nonoxynyl 9 and ocotxynyl 9
Barriers
Male Condom
- latex sheath over erect penis: prevent ejaculations from enter vaginal canal
- + = prevents STIs and cheap!
- - = decreased sensitivity for male
Female condom
- polyurethane (not latex) with inner and outer ring
- + = STI protection
- - = decreased sensation, bulkiness and difficult to insert
Barrier Contraception/Spermacides
diaphgram
cap
Female Diaphgram
- dome shaped film stretching over rim; placed in vaginal over cervix: remains in place for 6-8 hours
- requires the use of spermacide to make a seal
- requires fitting by professional, TSS likely & needs to be refitted/replaced every 2 years
Cervical Cap
- silicone cap that sits on the cervix: must be used with spermicide too
- dislodgement is common reason for failure
- can be left in longer than the diaphgram can
- needs to be fitted, and refitted after pregnancy
- no preotection against STIs
Hormonal Contraceptives
CDC criteria: what is it
initiation a contraceptive
CDC Medical Elligiility Criteria
- determines safety of use for a type of contraceptive given pt. medical history/conditions
Initiation
ensure female is not pregnant :
- < 7 days before last menses
- no sexual intercourse since last menses
- has correct/reliably been using contraception
- < 7 days since abortion
- breastfeeeding
- often sunday start is doneor first day of period
Hormonal Contraceptives: Combinations Products
COCPS
- waht are they and how do they work
Combinations
- use estrogen + progesterone
- can be pills (watch intestinal absorbtion issues), injection/patch or intravaginal
COCPS: combination oral contractive pills
how they work: create a “pseudopreg. state” so that they inhibit the released of LH and FSH (because high levels of estrgoen/progesterone) neg. feeback situation
results in…
- decreased follicle growth
- recruitment decreased
- ovulation decreased
additionally
- thickens cervical mucus
- thins endometrium
- thus decreases ability for sperm to implant and make it
COCPS
monophasic v bi/triphasic
Monophasic
- 30= choices: decide based on side effects what to give to your pt.
- have placebo sugar pills to let period happen
- can skip the sugar pills: for those with endometriosis, PCOS, menorrhagia, cysts so they’re given consistntly
Bi/Triphasic pills
- extednded OCPS: 84 days of hormones, then 1 week without = period every 3 months
- contiuous OCP: no sugar pills = no period
- good for women with significant menses symptoms (PMS, dysmenorrhea)
when on these meds, no medical reason to have a bleed! can just stay on these
COCPs
effectiveness
postives/non contraceptive benefits
Effectives
- 92% if taken properly! : missed pills = an issue
Postives
- cheap and avalible
- easy to use
- noncontraceptive benifits (acne!)
Noncontraceptive Benefits
decreased risk of
- ovarian cancer
- endometrial cancer
- ectopic preg.
- sever anemia
- PID
- salpigitis
Imprvement
- IDA
- dysmenorrhea
- function ovarian cysts (occur with cycle)
- benign breast disease (fibroitc changes with cycle)
- OP
- RA
Treat
- DUB
- control bleedon
- acne/hirsutism
- PMS
- Dysmheorrhia/endometrisisis
COCPS
negatives
major complications
ACHES
Complications (Major)
increased risk of…
- DVT/PE
- MI
- Stroke
- HTN
- cholithiasis& cystis
- because increased clotting and increased lipids
- benign liver adenomas: rare but fatal
- cerivacl adenocarcinoma
Side Effects
A: abd. pain (ectopic, cholithiasis/cystitis, liver tumor hemorrhage)
C: chest pain (MI, PE)
H: HA (migrine, stroke)
E: Eyes (migraine,stroke, retinal vessel disease)
S: sudden pain/swelling (DVT)
COCPS
CONTRAINDICATIONS
relative Contraindications
CONTRAINDICATIONS
-DVT/PE (ever)
- CAD
- Stroke
- smoker over 35
- breast cancer, endometrial cancer
- unexplained vaginal bleeding (need to work it up)
- abnormal liver function
- pregnancy
- less than 21 days post partum (DVT risk)
- severe hyerlipidemia/TG
- SLE with antiphospholipid
- migraine with aura
relative CI
- uterin fibroids
- lactation
- DM
- sickle cell
- Hepatic disease
- HTN
- 40 + high risk vascualr disease
- migraine disorder
- seizure disorder
- elective surgery
COCPS
interacations with meds
Interactions
meds that reduce efficacy of the OCP
- barbituabtes
- carbamazepime
- pheytonin
- rifamin
- topiramtate
- st. johns wort
meds that OCP reduceds the efficacy of the other med
- diazepam
- hypoglycmies
- methlydopa
- phenothiazine
- theophylline
- TCAs
Contraceptive Patch
what is it & how it works
What is it
- a combined estrogen/progesterone patch
- so works the same as the pill
how it works
- wear the patch for 3 weeks, off for 1 week to allow bleed
side effects
- higher concentration of estrogen released, so increased risk of DVT/PE
- all other side effects of OCPs apply
reduced effiacy in those > 198 pounds
Vaginal Ring
what is it
advantages
disadvantages
vaginal ring: cobined estrgen/progesterone contraceptive
how it works
- placed in vagina for 3 weeks, left out for 1 week to allow blled
advantages
- no fitting required
- lower hormone exposure than others
- does not need to be removed for sex
disadvantage
- cost
- remember to cahnge
- discomfort!
same CI and side effects as COCPS
Progesterone Only Contraceptives
types
how they work
Types of POCs
POP: progestrone only pill
depo-provera shot (injection)
implants (arm)
IUD
Progesterone
- thickens cervical mucuse: making sperm unable to penitrate
- induces endometrial atrophy (at this high of dose)
- suppress ovulation (in some)
