Contraception and STIs Flashcards
How is Contraceptive Failure measured?
% of women who experience an unintended
pregnancy within one year of us
What are the two failure rates used to measure contraceptive failure?
Perfect use rate
Typical use rate
What are the most efficient contraceptives?
Prescribed: Birth control shot (4%), Birth control pills, patch and ring (7%)
Practiced by OB/GYN: Hormonal IUD (0.1%), Birth control implant (0.1%)
percentage in perfect use
Worst: Contraceptive sponge
What are the reproductive consequences associated with STIs?
-Pelvic Inflammatory Disease (PID)
-chronic pelvic pain
-ectopic pregnancy (pregnancy outside of uterus - not viable)
-malignancies, and infertility
Which STIs are Noncureable/Vaccine-preventable?
-Genital warts (HBV)
-Hepatitis B
Noncurable + No vaccine: HIV, Herpes simples (HSV)
What is the best contraceptive method (also to prevent STIs)?
-Latex condom
-2nd: Polyurethane condom
Which contraceptive method (also to prevent STIs) is not recommended?
Natural membrane condom -> not recommended bc to porous: can prevent the passage of bacteria and parasites but NOT passage of viruses
Which male condom should only be used for pregnancy prevention and not for preventing STIs?
Natural membrane condoms
because they are porous
What should be avoided when using condoms?
DO NOT use oil-based lubricants with
latex condoms – breakdown within
60 seconds
How is the female condom different from the male condom?
-2 rings covering labia cervix
-less prone to breaking, more prone to slippage
-tissue irritation, NOISY
-may be inserted 8 hours before intercourse
Do NOT use male and
female condoms together
How do Spermicides work?
-Nonoxynol-9
-Nonionic surfactant that damages the cell membrane of the sperm, immobilizing and killing it
Formulations: Gel, Foam
Suppository and Film (need time 10-15 min to activate)
Why are spermicide-treated condoms not recommended?
-Because there is NO benefit over regular condoms
-increases the risk of infections due to microlesions in the vaginal wall
What are the benefits of a Contraceptive Sponge?
-3in1 method: soaking (sponge), barrier, spermicide
-may be inserted 24 h prior to intercourse BUT must be kept inside for 6h after intercourse
-Complaints: vaginal dryness, fragmentation on removal
Fertility Awareness Methods
-using the likelihood of getting pregnant to plan pregnancy/prevent pregnancy
-most common: symptothermal method
-requires daily physical monitoring: basal body temperature and cervical mucus secretion (change throughout the cycle)
Downside of Fertility Awareness Methods
-Not as effective as the barrier options
-requires abstinence and NO STI protection
NEW OTC oral contraceptive
-Orgestrel 0.075 mg (Opill)
-Once-daily oral tablet to prevent pregnancy
MOA of Orgestrel
-Progestin-only pill aka POP or mini-pill
-MOA: Progestin thickens cervical mucus and may prevent ovulation
-Efficacy: In 8 clinical trials, prevented 98 out of
100 pregnancies per year (probably perfect use)
What are the Contraindications with Orgestrel?
-Pregnant
-Using another hormonal contraception method
-Current or history of breast cancer (Progestin can cause recurrence)
-Yellow No.5 (tartrazine) allergy -> Cross-allergy with Aspirin!!
When to refer the patient?
- Undiagnosed vaginal bleeding between periods
- Liver disease
- Other cancer history
Direction for Orgestrel
-Start on any day of the cycle
-One tablet daily at the same time each day (can’t be late for more than 3 hours) - there are some contraceptives with hormone-free days - here: NO GAPS!
Adverse effects Orgestrel
-Changes in periods are likely (timing, flow, spotting)
-Hormonal AEs: headache, dizziness, nausea, cramps, bloating, abdominal pain, increased appetite
Counseling points
-Only works in women capable of getting pregnant (no transwomen, no women in menopause, women who have undergone hysterectomy)
-NOT intended as Emergency contraception
When should a backup method (condom) be used
48h after:
-starting a new pack
-missing the dose or late for 3 hours
-vomiting or severe diarrhea within 4 hours
Signs of Risks for Pregnancy
-Period is late after missing a single tablet
-Period is missed for 2 months
-Contact MD in case of new onset of period or heavy period
What is the API for Emergency contraceptives?
-Levonorgestrel 1.5 mg (Plan B One-Step, Aftera, New Day, etc.) is the only OTC option
-prevents fertilization and implantation
-does NOT terminate an existing pregnancy and it doesn’t work as a contraceptive
-> This is a much higher dose of a hormone
-40-50$
-MOA of Levonorgestrel
-High-dose progestin that suppresses ovulation; may prevent fertilization and implantation
-Efficacy within 120 hours of unprotected intercourse (95% in 24h - decreases with time)
ADE of Levonorgestrel
-nausea and vomiting (due to high dose of hormones)
-Less common- headaches, breast tenderness,
dizziness
Counseling points
-Emergency contraception is not 100% effective
-May be less effective with BMI of 26 or more
-does NOT protect from STIs and does not replace contraceptive
-if the menstrual period has not occurred within 21
days after use, take a pregnancy test
Menstrual Cycle
Day 1-5: shedding of the uterus -> Bleeding
Day 6-14: estrogen rises -> uterus lining; FSH rises -> follicle development
Day 10-14: one of the follicles forms a mature egg
Day 14: LH causes release of the egg (ovulation)
Day 15-28: the egg leaves the ovary and travels to the uterus - progesterone helps with uterus lining
No pregnancy: progesterone and estrogen drops -> uterus shedding -> Bleeding
Function of Hormones during Menses
Corpus Luteum: produces progesteron and estrogen
estrogen: helps with the uterus lining
progesterone: helps with implantation (also prevents contraction that causes menses)
FSH: Development of Follicles (eggs) - activated by low LH and low Estrogen at the start of menses
LH: Triggers ovulation
What is the time window for pregnancy?
-2 days before and 24 hours after ovulation (4-6 days)
-Why before?: the sperm can survive in the uterus
What happens in case of a pregnancy?
-The progesterone and estrogen stays high and causes the uterus to stay thick
-the implementation of the egg into the uterus causes the production of hCG
What does the pregnancy test detect?
hCG in the urine
-can only detect pregnancy after implementation
-so could be a few days after ovulation
-Accuracy: 90-95% perfect use
50-75%: typical use
What may affect the results of pregnancy tests?
-cancers of the uterus: damaged cells causes a change in hormone levels
-medication: IVF
What can cause a False positive pregnancy test?
-Miscarriage or given birth in the last 8 weeks due to hCG in the body
-Medication (Pergonal, Profasi) used in IVF
-Unreliable results: menopausal, ovarian cysts, ectopic pregnancies
What can cause a False negative pregnancy test?
-testing too early
-inadequate level of hCG in the urine (diluted urine)
-if the period is missed and the test is negative -> repeat after one week
-the earlier the test, the higher the risk for FN
Why should patients be referred after 2 negative pregnancy tests and still missing periods?
-Possibility of ectopic pregnancy -> cause harm to the mother
Definition of Infertility
35+: having intercourse without contraceptives for 1 year
<35: having intercourse without contraception for 6 months
Primary infertility: never had a pregnancy before
Secondary infertility: had a pregnancy before
What are the difficulties in predicting ovulation with body temperature?
-slim change (0.5°C)
-measure once a day (morning)
-can be affected by: infection, emotions, movement
-don’t do anything before taking the temperature: coffee, food, smoking, talking
Ovulation tests require morning urine
True or False
False, but it is recommended
What are the difficulties of ovulation tests?
-Not helpful after discontinuing BC, because it takes about 3 mo reach normal hormone levels
-False +: menopause, PCOS (polycystic ovary syndrome), pregnancy, breastfeeding, ovulation meds
Male Infertiity test:
-measures: motility, morphology, volume
-<20 million cells/mL = infertility
-82.4-98% accurate
Best way to get the recommended daily dosage of vitamins and minerals
-Multivitamins
-For folic acid 600 mcg is recommended (400 mcg supplement 1 month prior to pregnancy)
What are the important vaccines for pregnant women?
-Flu (inactivated) → in flu season: September-October
-Tdap: as early as possible
-don’t give live vaccines
-COVID: if the mother is not vaccinated: get it as soon as possible, if they are she can get boosted, AVOID Johnson&Johnson
