Contraception And Sterilazation Dr. Wootton Flashcards
Hormonal Contraception : Oral Contraceptives
- Combination : E and P
= suppress GnRF which decreases LH and FSH
= Progesterone : suppress LH, suppressing ovulation, thickening cervical mucous
= Estrogen : cycle control stabilizing endometrium an less breakthrough bleeding
Oral Contraceptives pills work how
- 21 days active hormones and 7 days placebo (some are 24 days H and 4 days placebo , shorter bleeding)
- Also continuous were you never bleed
Progesterone only oral contraceptives work how
- How it works
- Ovulation ?
- Who
- How to take it
- Make cervical mucous thick and impermeable
- 40% still have ovulation
- Usually for women who have contraindications to E, or breastfeeding women
- Must be taken same time every day (not more then 3 hours late)
Benefits to Oral Contraception
- Regular menstrual cycle
- Improved painful bleeding = prevents arachodonic production —> PGE
- Lower risk of anemia
- Lower Endometrial and ovarian cancer, benign breast and ovarian cysts (PCOS)
Side Effects of Oral Contraceptions
- Breakthrough bleeding (first 3 mo)
- Amenorrhea (1%)
- MILD : bloating, Weight gain (perceived), breast tenderness, N,F, HA
- SERIOUS : DVT, PE, Cholestasis, Gallbladder dz, MI, Hepatic Tumors
The Patch
- Is what
- How do you apply
- Who
- Side effects
- E + P
- Every 3 weeks to dry clean skin on buttocks, upper outer arm or lower abd
- Not over 198lb
- Greater risk of DVT, and same other side effects as oral
Vaginal Rings
- Are what
- Associated with
- Toleration
- E and P
- Higher compliance because its 1 time a month (insert to vagina for 3weeks) , can be removed for 3hr
- Tolerated since not going through GI and less spotting (not pass through liver)
Annovera Vaginal Ring
- Is what
- Used how
- Side effects
- Newer thicker ring, Segesterone acetate + E
- Leave in for 21 days take out 7 days (13 months use)
- Same as other combination contraceptives
Who can you not use Combination Oral Contraceptives in
- Women over 35 who smoke
- DVT/PE history
- HTN, DM, SLE
- Liver tumors or severe liver disease
- Migraine with aura (youn ps usually)*
Injectable Hormonal Contraceptives
- Also called
- What is it + how good
- How to use it
- MOA
- Depo-Provera ( Depo medroxyprogesterone acetate) = Progesterone only
- P , very good , not altered by weight
- Inject every 11-13 weeks (P level stays for 14 weeks), first 5 days of menses is when you should inject
- Thickens cervical mucosa, decidualization of endometrium, blocks LH surge and ovulation
Depo PRovera injections side effects 5
- Bone metabolism (due to low E from no ovulation)
- Black box for use over 2 years
- Real Weight gain
- Irregularly bleeding *
- Exacerbate depression
Depro PRovera decrease risk of what + others who use it
- Endometrial hyperplasia + Sickle Cell crisis
2. Women that cant take E, breastfeeding, effective contraception, endometriosis
When to NOT give Depo Prevera
- Suspected Pregnancy
- Unevaluated Vaginal bleeding
- Breast malignancy
- DVT current
- Liver dysfunction
Long Acting Reversible Contraceptives (LARCS) 2 types
- Implants
2. IUDs
Nexplanon
- Is what
- Used how
- MOA
- Single radiopaque rod implant 68mg E(4cm long 2mm diameter) = Progesterone*
- For 3 years (within 5 days of menses preferred to implant)
- Cervical thickness, Inhibit ovulation
Nexplanon side effects
- Irregular Vaginal bleeding *
- Vaginitis
- Acne
- Breast pain
- HA
- Weight gain
Nexplanon who
- Very effective
2. Breast feeding
Contraindications of Nexplanon
- Suspected pregnancy
- Current DVT
- Liver tumor one active liver dz
- Abnormal bleeding not dx
- Suspected breast cancer
What can happen at Nexplanon site of implantation
- Infection (if you don’t take bandage off)
- Bruising
- Deep insertion, migration
- Persistent pain
IUD 5 available
- Paragard (Cooper T)
- Mirena / Liletta
- Skyla / Kyleena
= insertion in office
Risks of IUD
- Infection in forest 20 days
- Ectopic Pregnancy
- Uterine perforation at time of insertion (laparoscopic removal needed)
- Malposition (hysteroscopy for removal)
Contraindications for IUD
- Breast cancer (you CANT use Levonorgestrel)
- Sepsis or chorioamnionitis recent
- Cervical inf
- Septic abortion
- Wilsons Dz (Cooper T)
- Uterine malformations like fibroids or uterine septums
Mirena
Kyleena, Liletta, Skyla how long you use it , what hormone they have
- Mirena : 7 years
- Kyleena : 5 years
- Liletta : 7 years
- Skyla : 3 years (smallest size)
= highly effective
= ONLY Progesterone (Levonorgestrel) **
Benefits of Levonorgestrel IUDs
- Decrease bleeding (50%)
- Lower painful periods
- Protection of endometrial lining from unopposed E
- Long term
Copper T is used how long, MOA, side effects
- 10 years -12 years
- Copper kills spree transport or fertilization
- Same as other IUDs, except NO breast cancer issues
Only thing that protects against STIs
Condoms
Good condoms have what
Reservoir tip
Diaphragms are used how , used how, side effect
Latex + spermicide dome shaped up in vagina 6-8 hours before and after intercourse (not more then 24hours)
= have to be fitted by health care provider
= higher UTI infections (compression of urethra) + vaginitis from spermicide
Single size fit all Diaphragm
Chaya ( you can put in out yourself and no health care provider needs to fit you)
Cervical Cap (FemCap)
Smaller then diaphragm and put on cervix no more then 48hr, high risk of displacement, use with spermicide
Sponge
Pillow shapes containing spermicide, dimple fitting over cervix, left for 6 hours only not more then 30hrs, more effective in nullparous woman (toxic shock syndrome high risk)
Phexxi
Hormone free, raising pH of vagina, lactic acid + citric acid + Potassium bitartate gel, prescription only, 84% effective, 4 hours lasting
= risk of UTI, vaginitis, burning, itching , infections
Basal body temperature method
0.5 to 1.0 degree increase at ovulation avoid sex 3 days after (check in morning)
Cervical mucous method
Cervical mucous changes around ovulation avoid sex 4 days after (Spinnbarkeit)
Symptothermal method
Combing basal temp method and cervical mucus
Emergency Contraception
Women who had unprotected sex, prevent ovulation and fertilization, no contraindications, within 72hours of unprotected sex (Yuzpe method)
Plan B
P only 2 pills taken 12 hours apart
17yo and older
Within 120 hours of sex
1.1% failure rate (worse after 72 hours)
Ella
Ulipristal acetate 30mg , up to 5 days after sex, postpones follicular rupture + inhibit ovulation
Sterilization
Most frequent in US 1/3 married couples,prevent sperm and egg from meeting
= permanent
= discuss LARKS
= regret at young age
= increased ectopic pregnancy, STI can still spread
Male sterilization
- What
- Reasons to do it
- Side effects
- How to use
- Vasectomy = occlusion of vas deferents
- safer, more easy, easier to reverse, not as expensive
- Post op bleeding, hematoma, chronic pain, skin infections
- Takes 10 weeks and then to confirm there is no sperm
Female sterilization
- Done how
- Reason to do it
- Laparoscopy, mini-laparotomy, at time of C-section (occlude Fallopian tubes)
- Relatively safe, low cost, easy, permanent
Laparoscopy of female sterilization
4 types and how they are done, failure rate and rate of being reversed
Small incisions, low complications,
- Electrocautery (thermal injury, low reversibility, higher ectopic preg risk)
- Clips ( hulka - more reversible + higher failure, Filshie - lower failure + lower reversibily)
- Bands (falope rings = intermediate reversible and failure, post op pain + increases bleeding risk)
- Salpingectomy = remove Fallopian tubes, decrease ovarian cancer risk
Mini Laparotomy
MOST COMMON
- Small infra umbilical incision postpartum or suprapubic (interval procedure)
- Transect part of the Fallopian tube or all of wanted
When is the P only pill reliable
When breastfeeding
