contraception and sterilization Flashcards
what is the method failure rate vs the typical failure rate surrounding contraceptives
- method failure- the rate that the method is going to fail when used correctly
- typical failure - the rate the method is going to fail when it is used by the patient
what ar the two general mechanisms of contraception?
inhibit formation and release of the egg
create a berrier between the sperm and the egg
what goes into choosing a birth control
efficacy
safety
availability
cost
accebtility
_ contraceptives provide the most reversible contraception
hormonal
oral contraceptives: the combination pill- what is the role of estrogen and progesterone
estrogen: improves cycle control by stabilizing the endometrium and decreases breakthrough bleeding
progesterone: the major player in suppressing LH (which stops ovulation and increases cervical mucuous thickening) which inhbitis sperm migration nad creates an unfavorable atropic endometrium for implantation
suppresses FH and LSH
oral contraceptive: combination pill are phasic formulas meaning they can ?
monophasic or triphasic (mimic the natural cycle)
class combinatino pills is _ days of active hormones and _ days of placebo
21 days
7 days
oral contraceptives: progestin only (mini pill) MOA
makes cervical mucus thick and impermeable
ovulation continues in 40% of users
the mini pill is mainly used in _ women who have contraindication to _
breastfeeding
estrogen
because of the mini pill ow does they must?
be taken at the same time every day
what are some benefits of oral contraceptives
mestrual cycle regularity
stop painful periods
decrease risk of anemia
lowe incidence of endometrial/ ovarian cancers/benign breast/ovarian diseases
what are some side effects of oral contraceptives
breakthrough bleeding, amenorrhea, bloating, breast tenderness, fatigue.
what are some SERIOUS side effects of oral contraceptives?
venous thrombosis
pulmonary embolism
cholestasis anf gall bladder disease
hepatic tumors
stroke/MI
the transdermal patch has _ and _
estrogen and progesterone
how does the transdermal patch work
apply one patch weekly for 3 weeks at a time to dry skin (just not on breast)
is it cautioned in people greater than 198 pounds
transdermal patch has the same side effects as oral contraceptives expect they are at a greater risk for?
thrombosis
brand names for transdermal patches
twirla
ortho evra
the vaginal ring is a combination of _ and _
estrogen and progesterone
the vaginal ring is associated with greater _ becuase of its once a month use- insert into the vagina for up to 3 weeks
compliance
the vaginal ring can be removed for up to _ hours without affecting efficay
3
better tolerated because there is not first pass through the liver
what is the annovera vaginal ring
it is a newer vaginal ring that is has a prescription for 13 months
you use the same ring, place in vagina for 21 days, take out for 7, wash and put back inside
combination product
who cant use combination contraceptives?
women over 35 who smoke cigarettes
people with a history of thromboembolic event/DVT/PE
migranine with auras, uncontrolled hypertension, CAD
liver disease or liver tumors
what is the depot medoxyprogesterone acetate (DEPO Provera)
this is a progesterone only intramusclar shot that is given every 11-13 weeks
depo prevera shot maintains contraceptive level of progestin for about _ weeks
14
what is the MOA of depo provera
thickens cervical mucus, decidualization of the endometrium and blacks LH surge/ovulation
depo provera efficacy is roughly equivalent to that of _ steralization and is not altered by _
sterilization
weight
what is the concern behind bone density and depo provera
it alters bone metabolism because of decreased estrogen
this is concerning in adolescents who are still growing
if you discontinue depot provera the bone symptoms will improve
BBW that you should use for only 2 years
side effects of Depo provera
irregular bleeding (can become amenorrheic after 2 years)
- this can improve if you have estrogen addback
menses will take up to a year to regulate after discontinuation of the medication
weight gain- progesterone makes you hungry
depression exacerbation
what are some reasons why people get on depo provera
contraception
method with good compliance
breastfeeding
when estrogen is contraindicateed
seizures, sickle sell anemia, endometriosis, decrease risk of endometrial hyperplasia
when should you not use depo provera
if there is suspected/known pregnancy
unevaluated vaginal bleeding (dont want to mask the effects of something else)
breast malignancy
current rhomboembolic/cerbral vascular disease
liver dysfunction
what are the long acting reversible contraceptives (LARCs)
implants and IUDs
what is nexplanon
a progesterone only radiopaque injectable implant that is used for contraception
it can be used for 3 yeats then needs to be taken out and a new one in
MOA of nexplanon
progesterone only so it inhibits ovulation and thickens cervical mucus
side effects of implant/nexplanon
irregular bleeding
headache
weight increase
vaginitis
acne
tender breasts
indications for implant - nexplanon
convient and effective
can be used in breast feeding
contraindications of the implant
BREAST CANCER (absolute contraindication)
current/history of thrombosis
liver tumors
undiagnosed uterine bleeding
complications with insertion of an implant
infection
bruising
migration
deep insertion
persistant pain/tingling at insertion site
what IUD is nonhormonal
what IUDs are progesterone releasing
nonhormonal- paragaurd
levonorgesterl releasing- mirena/sklya
insertion of IUD is done in _
office
risks of IUD
increased risk of infection in the first 20 days post insertion
increased risk of ectopic pregnancy if pregnancy did occur
uterine perforation at time of insetoin
risk of malposition
if someone becomes pregnant with an IUD in they should be offered removal if the strings are visible this decreases the risk of
spontaneous abortion
malposition of IUD necessitates _ for removal
hysteroscopy
contranindications to IUDs
breast cancer- progesterone containing ones
puerperal sepsis/chorioamnionitis
recent septic abortion
cervical infection
wilsons disease (in paragaurd)
uterine malformations like septums, fobroids etc- cant get food placement
the levonogesterl IUDS are mirena/kyleena, liletta, skyla what are the differences
skyla- is smalled and is used for 3 years in nulliparous women
liletta- used for 7 years
mirea- used for 7.5 years
all are highly effective
what are the benefits of levonogesterel IUDS
decrease mentrual blood loss, less painful periods, protection of endometrial lining from unapposed estrogen
convient and longterm
Copper T/Paragaurd IUD is used for 10 years, what is the MOA
copper will interefere with sperm transport or fertilization and prevention of implantation
barrier methods have a _ failure rate
high
they are inexpensive, no medical consultation
_ provide the only method with protection against sexually tramitted infections
condoms
_ _ condoms may decrease condom breakage
resivoir tip
female condoms are a vaginal liner and recommend to be left in _ hours after intercourse
6 hours
what are diaphragms
latex covered dome shaped devices that must be used with a spermicide
must be inserted 6 hours before inercours and left in for 6 hours aftr intercourse: they must be fitted by health care professional and fit may change
women who use diaphragms are more likely to get?
urinary tract infections due to urinary stasis from repssure on the urethra
+ spermicides alter the vaginal flora
what is a cervical cap
a smaller version of a diapraghm that is applied to the cervic
use it with a spermicide and has high risk of TSS and displacement
leave in for 6 hours after intercourse
what is a sponge
a pillow chaped sponge that contains spermicide that fits of the cervix with a hoop on the other side to make removal easier
must be left in 6 hours after intercourse, increase risk of TSS
what is phexxi
a hormone free gel that raises the pH of the vagina and lowers sperm motility it is available by prescription
lasts 4 hours
contains lactic acid/citic acid/and postattium bitartrate
side effects of phexxi
vaginal burning, itching , infections, bV, UTI, vaginal burning in male partner
what is the calendar method
this is calculation of fertile period and avoiding sex during that time (cycle beads)
what is the basal body temperature method
checking temperature daily in the monring and noting a change in temperature at the time of ovulation, avoiding sex during this time
avoid for 3 days
what is the cervical mucus method
examining cervical mucus and notes changes around ovulation and avoid sec for 4 days after peak
what is the symptothermal method
combinding cervical mucus and basal body temperature with awareness of any other symptom of ovulation
what are the symptoms of ovulation
cramping, breast tenderness, change in position/firmness of cervix
emergency contraception acts by preventing _ and _
ovulation and fertilization
are there medical contraindications for emergency contraception
no
plan B is _ only and works in women older than 17, it should be used within 72 hours of unprotected sex
progestin
ella is an emergency contraception that is _ acetate and postpones _
ulipristil
postpones follicular rupture / delay ovulation
what is most frequently used contraception method in the united states
sterilization
steralization methods prevent?
the sperm and the egg from meeting ***permanent
how do you decide if someone should consider sterilization?
tell them its permenant
explore other options like LARCS
what is their reasoning
procedure risks/benefits
screen for REGRET (in young patient)
possibility of failure and ectopic risk
condoms for STD prevention
what is male sterilization
a vasectomy that is occlusion of the vas deferens
- not immediately effective
what is female steralization
permenant steralization that is low cost and can be done by laparoscopy, mini-laparotomy at the time of c-section
what is laparoscopy sterilization
samll incusions to occlude the fallopian tube
how can you occlude the fallopian tube
electrocautery- greatest risk for ecctopic pregnancy
clips (hulka - most reversible) and filshie
bands
salpingectomy- removal of whole tube (decreases ovarian cancer risk)
what is a mini laparotomy for sterilizaition
infra umbilica incision postpartum to take a portion or all of the fallopian tube
what is hysteroscopy sterilization
transcervical approach to tubal ligation (enssure system )
