Contraception and Sterilization (Wootton) Flashcards
What are the two general contraceptive mechanisms?
- inhibit the formation and release of the egg
- imposing a mechanical, chemical or temporal barrier between the sperm and the egg
typical failure rate
rate when the method is actually used by the patient
What are 5 things to consider when choosing a birth control?
- efficacy
- safety
- availability
- cost
- acceptability
What are the 6 hormonal contraceptive options?
- oral contraceptive pills
- injectables
- implantable
- hormone containing IUD
- contraceptive patches
The two types of oral contraceptives pills (OCPs)
- combination: estrogen and progesterone
- progestin only - mainly used in breastfeeding women and pts w contraindication to estrogen
What is the role of progesterone in OCPs
major player in suppressing LH and therefore ovulation as well thickening the cervical mucous inhibiting sperm migration
benefits to OCPs
cycle regularity; improve painful periods; decrease iron deficiency (shorter and less heavy cycles) and low incidence of cancers
Serious Side effects of OCPs
venous thrombosis; PE; stroke and MI; hepatic tumors
The patch
estrogen and progesterone; one patch every 3 weeks; only women under 198 lbs; greater risk for thrombosis
The patch carries which greater risk compared to OCPs?
greater risk for thrombosis
vaginal ring
combination of estrogen and progesterone; insert in vagina for 3 weeks; better tolerated; less breakthrough bleeding
Annovera vaginal ring
newer ring; segesterone acetate; 13 months in one reusable ring; BMI and weight not assessed (unlike the patch)
Contraindications to combined contraceptives
women over 35 who smoke cigarettes
hx of thromboembolic event-DVT/PE
liver disease or liver tumors
Injectable hormonal contraceptives
Depo provera; progestin ONLY
Depo provera
injectable progestin; every 14 weeks; given first 5 days of menses; not altered by weight (unlike the patch); alterations in bone metabolism (concern for adolescents); not supposed to be used for more than 2 yrs
Sides effects of depo provera
irregular bleeding (why most pts discontinue)
weight gain (makes you hungry)
exacerbation of depression (watch for hx)
MOA of depo provera
thickening cervical mucous; decidualization of the endometrium; blocks LH surge and ovulation
Contraindications of depo provera
active/current thromboembolic event (not a hx of); known or suspected breast malignancy; vaginal bleeding; liver disease; pregnancy
Long acting reversible contraceptives (LARCs)
Nexplanon - implantable rod; 3 yrs
IUDs (5): Copper T, Mirena, Liletta, Skyla, Kyleena
Major side effects of nexplanon
irregularly irregular vaginal bleeding (most common irritation); headaches; weight gain; breast pain; acne
Indication for nexplanon
breastfeeding patients; also pts who want a convenient effective method
What is the only absolute contraindication to the nexplanon?
known or suspected breast cancer
Complications to the nexplanon
infection; bruising; deep insertion; migration and persistent pain at insertion site
What is the only non-hormonal IUD
Copper T (Paragard); used for 10 yrs; MOA - copper interferes with sperm transport or fertilization and prevention of implantation
What are 3 major risks with IUDs?
- infection first 20 days post insertion
- increased risk for ectopic pregnancy
- risk of uterine perforation at time of insertion
Contraindications to IUDs
breast cancer (does not include copper T)
recent sepsis or septic abortion
active cervical infection
Wilson’s disease (copper T only)
uterine malformations
Mirena/Kyleena
IUDs, used for 7 yrs and 5 yrs
Liletta
IUD; use for 7 yrs
Skyla
IUD; used for 3 yrs; designed for nulliparous women (smaller in diameter)
What is the only method of contraception that has protection against STIs?
barrier methods (condoms)
Diaphragms
non-hormonal option; dome-shaped device inserted into vagina 6 hrs before intercourse; must be left for 6 to 8 hrs; must be used with spermicide; more likely to get a UTI
Women who use diaphragms are more at risk for what?
urinary tract infections (UTIs)
Women who use cervical cap (FemCap) are more at risk for what?
Toxic shock syndrome
Cervical cap (FemCap)
small diaphragm; placed in cervic; increase risk for toxic shock syndrome; used with spermicide
Phexxi
non-hormonal option; vaginal gel inserted into the vagina that raises pH which lowers sperm mobility; increase of vaginal infections
Basal body temperature method
check daily temp; 0.5 to 1 degree change, avoid sex for 3 days after
Emergency contraceptions
no medical contraindications
1. Plan B - progestin only; 120 hours after unprotected intercourse
2. Ella - ulipristal acetate; 5 days after unprotected intercourse
Vasectomy
occlusion of vas deferens; not immediate - takes 10 weeks; safer more easily performed, less expensive and easier to reverse
