Contraception and Sterilization Flashcards
What are the 2 general contraceptive mechanisms?
- inhibit the formation and release of the egg
- impose a mechanical, chemical, or temporal barrier between the sperm and the egg
What is the difference between method failure rate and typical failure rate?
- method: when it’s used correctly
- typical: when it’s actually used by the patient
What kind of contraception do hormonal contraceptives provide?
-the reversible kind
What is the major player in COC’s?
- progesterone
- suppresses LH and therefore ovulation
- thickenc cervical mucous
- creates an unfavorable atrophic endometrium for implantation
What does the estrogen component of COC do?
-mainly improves cycle control by stabilizing the endometrium and allows less breakthrough bleeding
What are the less androgenic agents?
- desogestrel
- norgestimate
- drospirenone
When is the progestin only pill usually used?
- in breastfeeding women and women who have a contraindication to estrogen
- these are the ones that must be taken at the same time every day starting on the first day of menses
What are the benefits of hormonal oral contraceptives?
- menstrual cycle regularity
- improve dysmenorrhea (painful)
- decrease risk of iron deficiency anemia (shorter and less intense periods)
- lower incidence of endometrial and ovarian cancers (cysts)
What are some side effects of oral contraceptives?
- breakthrough bleeding
- amenorrhea
- other mild ones like bloating and stuff
What are the 2 big serious side effects of oral contraceptives?
- Venous thrombosis
- Pulmonary embolism
What does the transdermal patch have in it?
- E and P
- one patch weekly for three weeks
- caution in women >198 pounds
What is one of the cool things about the vaginal ring?
- better tolerated since not going through GI tract
- less breakthrough bleeding
What women CANNOT use oral contraceptives?
- women over 35 who smoke
- thromboembolic event
- hx of CAD, or other heart things, uncontrolled htn
- women with moderate to severe liver disease or liver tumors
How often do we have to give the depot medroxyprogesterone acetate shot?
- every 11-13 weeks
- maintains conraceptive level of progestin for about 14 weeks
- preffered to be given within first 5 days of menses and if not use a back up method for 2 weeks
Is the efficacy of depo shot altered by wiehgt?
no
What can happen with depo ppl that we are concerned about especially in adolescents?
- alterations of bone metabolism
- bone loss!
- it’s reversible after discontinuation
What are some side effects of depo?
- irregular bleeding
- menses can take up to a year to regulate after discontinuation
- weight gain
- exacerbation of depression*
What are some indications for use of depo?
- contraception (duh)
- breastfeeding
- seizure disorders
- Sickle cell
- Decrease risk of endometrial hyperplasia (makes sens)
Contraindications of Depo
- know or suspected preggo
- unevaluated vaginal bleeding
- breast malignancy
- thrombophlebitis
- liver dysfunction
What is Nexplanon?
- that rod thing that has etonogestrel in it
- lasts for 3 years
- thickens cervical mucous
- inhibits ovulation
side effects of the implant rod?
- headache
- weight gain
- breast pain
- acne
Indications for implant rod?
- desires a convenient effective method of contraception
- may be used in breastfeeding patients
contraindications for implant rod?
- kind the same for depo
- preggo
- liver tumors
- AUB
- breast cancer
What are some risks for IUDs?
- increased risk of infection withing the first 20 days post insertion
- ectopic preggo if preggo would occur
- uterine perforation
Contraindications for IUDs?
- breast cancer
- recent puerperal sepsis
- recent septic abortion
- cervical infection
- Wilsons disease (copper T only)
What are the 3 kinds of IUDs?
- Copper T (Paragard)
- Levonorgestrel releasing: Mirena/Liletta, Skyla
How long does Mirena last?
- 5 years
- Liletta is 3 years
Which IUD is the small one that is designed originally for nulliparous women?
-Skyla
How effective are Levonogestrel IUDs?
- super effective
- preggo rate= 0.2%
Benefits of IUD?
- -decrease in menstrual blood loss
- less dymenorrhea
- protection of the endometrial lining from unopposed estrogen
- convenient and long term
How long does the copper T (Paragard) last?
- 10 years
- the copper interferes with sperm transport or fertilization and prevention of implantation
What will happen to women when they ovulate that will make them able to “naturally” family plan?
- basal body temp will rise .5 -1 degree
- avoid sex for 3 days after
What is Plan B?
- progestin only (levonorgestrel)
- 2 pills taken 12 hours apart
- must be used within 120 hours after unprotected intercourse
What is Ella?
- ulipristal acetate
- indicated for up to 5 days after unprotected intercourse
- postpones follicular rupture/inhibits or delay ovulation
What are some postoperative complications of a vasectomy?
- bleeding
- hematomas
- acute/chronic pain
- local skin infections
- not immediately effective- complete azoospermia usually obtained within 10 weeks
What is the most reversible clips to put on the fallopian tubes when “tying” them?
- the hulka
- because there is little tissue damage
- the filshie have lower failure rate because of larger diameter
What method of female sterilization has been increasing because of the decrease in ovarian cancer risk?
-salpingectomy: removal of the entire fallopian tube
What is a mini laparaotomy?
- most common approach for female sterilization
- infra umbilical incision in postpartum period or suprapubic incision as an interval procedure
What is the Essure system?
- hysteroscopy
- 3.6 cm stainless steel inner coil placed into tube with aide of hysteroscope
- must use backup method for 3 months
- then have hysterosalpingogram (HSG) to document complete occlusion
- good for obese patients that might not be good candidates for other methods
