Contraception and Sterilization Flashcards
What is the failure rate for withdrawal method?
27%
How does lactational amenorrhea work?
Prolactin-induced inhibition of pulsatile GnRH and suppression of ovulation
What is the caveat to lactational amenorrhea?
Ovulation returns before the return of menstruation
50% of mothers ovulate between 6-12 months postpartum even while breastfeeding
Can only be used for a maximum of 6 months
What is the actual efficacy of condoms?
85%
What are commonly used spermicides?
Nonoxynol-9 and octoxynol-9 which disrupt the cell membranes of the spermatozoa
What are the downsides to spermicides?
Can cause vaginal irritation and lead to increased susceptibility to STIs
What is the most commonly used method of reversible contraception in the world?
IUD
How do IUDs work?
Spermicidal and prevention of fertilizatoin = sterile inflammatory response
mirena also has progesterone that thickens cervical mucus and atrophies the endometrium
copper hampers sperm motility and capitation
What is the effectiveness of IUDs?
- 8% for paragard
0. 1% for mirena
What are contraindications for IUD placement?
Known or suspected pregnancy Undiagnosed abnormal bleeding infection copper allergy (paragard) recurrent breast cancer (mirena)
How do OCPs work?
Interfere with pulsatile release of FSH and LH = suppresss ovulation
Bleeding is due to withdrawal bleeding and not menstrual period
What is the failure rate of OCPs?
8%
What medications can interfere with OCPs?
Rifampin
Barbiturates
Carbamezepine
Phenytoin
What are the consequences of OCPs?
Coagulability (DVT, PE)
increased incidence of gall bladder disease, and benign hepatic tumors
Who are OCPs contraindicated in?
>35 yo smokers of 15 or more cigs a day CAD, CVA, breast/endometrial cancer abnormal liver function pregnancy severe hypercholesterolemia severe hypertriglyceridemia
OCPs can decrease the risks of what disease?
Ovarian cancer
Endometrial cancer
PID
The transdermal patch is less effective in which people?
Markedly overweight women (>198 lbs, 90kg)
What is the function of progestin only contraceptive methods?
thickens cervical mucus and causes endometrial atrophy
What are the options for progestin only contraception?
Progestin-only pills
Depo-Provera injection (3 mon)
Nexplanon (3 years)
What is the most effective reversible form of contraception?
Nexplanon - 0.5%
What are the options for emergency contraception?
Morning-after pill (plan B, next choice) - levonorgestrel
-must be taken within 72 hours of unprotected intercourse
Paragard IUD, within 5 days, which induces inflammation
Ella (ulipristal) = selective progesterone receptor modulator = delays ovulation
How does Essure sterilization work?
Insertion of spring coils into the fallopian tubes that cause growth of tissue to occlude the tubes = takes 12 weeks
What is a side effect of Depo-provera?
reversible bone demineralization
delay in return of fertility
