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)
Progesterone only pills
how theyre taken
side effects
advantages/disadvantages
POPS
- only progesterone
How to take
- must be taken within the same 3 hour window daily
- taken continuously: no pill free week
Side effects
- breakthrough bleeding
- increased risk of follicular phase cysts
- acne
- breast tenderness
- irriatbility
Advantages
- ideal for nursing moms
- fewer clot risks: but still some
- can be used for irregualr bleeds after evaluated
disadvantages
- irregular menses
- strict schedule : 3 hour window
Injectable Progesterone ( depo-prevara)
how it works
side effects
+ and -
Injectable
how it works
- thickesn cervical mucus
- atrophies endometrium
- reduces tubal motility
ovulation: supressed for 14 weeks after injection
Side effects
- irregular bleeding common
- amenorrhea
- reversible: but a decreased in bone mineral density with prolonged use
- returns to baseline within 6mo.-2years
Advantages
- amenorrhea
- highly effective
- good for the following conditions… because suppressing endometrial growth
- menorrahiga
- dysmenhorrhea
- endometriosis
- menstrual realted anemia
- endometrail hyperplasia
Disadvantages
- irregaulr bleeding
- delayed return to ovulation
- mental heatl: caution in PMDD
- weight gain due to increased appetite
Long acting Reversible Contracetives (LARC)
Implantabel progesterone
how it works
Implantable Progesterone
- Jadelle (5 yrs.) or Nexplanon (3 years)
- small, subdermally placed matchstick size
side effects
- same as oral progesterones
- irregular bleeding mostly
LARC: IUD
two types
MOA
IUD: implatable uterine devices
Copper IUD (Paragaurd) or Levnorgesterl (mirena, kleena, etc.) (progesterone only)
MOA
- spermicidial: prevents fertilization/implantation
- reducted tubal motility
- progesterone in the preogesteron IUDs thicken mucus and atrophy endometrium
IUD
Contracindications
Contraindications
- pregannt
- undiagnsoed uterine bleed
- acute cervical, uterine or tube infection
- copper allergy/wilsons dx. (for the copper ISU)
- current breast cander (copper is ok)
realtive contraindications
- prior ectopic pregnany
- history of STI in past 3 months (risk of infection)
- uterine anomoly
- current meonrrhagia or dysmenhorrea (copper: because increased risk of bleeding with this)
IUD
Advantages
disadvantages
Advantages
- easy to insert by clinican
- readily avalible
- copper : 10 yrs
- otehrs: 5 years
- liletta: 3 yrs.
- can be inserted immediately post partum OR after 6 weeks of birth
- safe with breastfeeding
- cheap in comparison
- fewer SE
- lighter periods with the LGN-IUDs
Disadvantages
- small infection risk: PID
- small ectopic pregnancy risk
- high risk of abortion if pregnancy occurs
return to fertility for each contraceptive use
COCPs: realtively quick, = days
LARCS: usually within 30 days
preogesterone injection: can take months
when to d/c contraception in older women
For women under 50
- nonhormonal methods: can stop 2 yeras after last period
- progesterone only: can continue until 55
- estrogen containing options: continue until 50+ as long as no CVD risk (rare)
for women over 50
- nonhormonal: can stop 1 year after last period
- progestrone only: can continue until 55 then stop, or swapt to nonhormonal
- estrogen containing option: can continue until 55 if no CVD ris, or swap to nonhormonal method
Emergency Contraceptive Methods
what can be done
how do they work
What can be done
high dose progestrone pills/estrogen pills
OR
Inserting a copper IUD within 72 hours of the event
MOA: depends on time within the cycle
- inhibits ovulation
- interferes with fetrilization/transport
- prevents implantation
- regression of corpus lutem (less likely to support the preg)
avalible without rx. in the US for 17+
Leveonorgesterl methods = preferred agents
- Plan B
- Next choice
Emergency Contraceptive Methods
when to use
seide effects
contraindications
When to use
- closer to the time of the event: better chnace of working
Side Effects (less likely with progestin only methods)
- N/V
Contraindications
- pregnancy
- thormobotic events not really a concern with the ECP
cost: 40-50 in store or planned parenthood at little/no cost
can take extra COCPS (that you have) - but higher estreong = higher vomiting risk
if inplanting copper IUD: done with 5 days: produces an infalmmaotyr reaction and makes it unsuitable for implantation to occur
Surgical Sterilization methods for contraception
generally : not reversible
Surgery risk
- bleeding
- infection
- anesthseia
tubal ligation
vasectomy
remove part of the tubes
Termination of Pregnancy
elevetice procedure can be due to
- finaical reasons
- interfere with work/school
- dont want to be single parent
safe procedure!!
risks include
- hemorrhage
- infection
- VTE
- anesthesai issues
- incomplete abortion
Options: First term
- suction curettage :surgical
- manual vaccum aspiration:surgical
- methotrexate: medication
- mifeprostone: medication
Options: second trimester
- surgical evauation of uterus
- medical induction of labor
