Contraception: Behavior, Barrier, Hormones Flashcards
Methods of contraception? (6)
1) behavioral
2) barrier
3) hormonal
4) IUD
5) sterilization
6) emergency
Failure Rate is?
% of preggos per yr on particular method
Typical Use vs Expected Rate?
Typical Use = actual fail rate due to human error
Expected = fail rate when used correctly
Most effective REVERSIBLE methods?
Implants
IUD
Most effective IRREVERSIBLE methods?
sterilization
Next most effective methods?
Hormones
Diaphragm
Behavioral Methods: Abstinence
Benefits?
Risks/Disadv?
Benefits:
↓ STI risks (NOT no risk)
No s/e
100% effective
Risks:
Difficult
Leaves situation open to NO contraception or STI prevention
Behavioral Methods: Fertility Awareness Based (FAB)
Includes? (5)
1) Basal temp
2) Calendar
3) Cervical mucus
4) Symptothermal (all 3 above)
5) Lactational amenorrhea
Behavioral Methods: FAB
Benefits?
Risks/Disadv?
Benefits:
no hormones or s/e
Risks:
Difficult
High failure ~24%
Behavioral Methods: Withdrawal
Benefits?
Risks/Disadv?
Benefits:
No hormones
Risks:
Difficult
High failure
Barrier methods action?
prevent sperm from contacting egg
Barrier Methods: Spermicides action?
Block entrance
Immobilized sperm
Barrier Methods: Spermicides
Use? (2)
Benefits? (3)
Risks/Disadv? (5)
10 min wait post insertion
leave in 8 hrs post intercourse
Benefits:
most W can use
convenient
easy to get/cheap
Risks: easy to use wrong irritation Not for HIV+ W ↑ HIV/STDs high fail
Barrier Methods: Sponges
Use? (4)
Benefits? (3)
Risks/Disadv? (4)
Use: cover cervix up to 24 hrs prior to action leave in 6 hrs post max placement 30 hrs
Benefits:
most W can use
immediate use
easy to get/cheap
Risks: can break apart sulfite allergy toxic shock high fail
Barrier Methods: Male Condom
Benefits? (5)
Risks/Disadv? (3)
Benefits: most effective barrier method w/ correct use, convenient, best STI protection (o/t abstinence), easy to get/cheap
Risks:
↓ sensation
irritation
(P) breakage
Barrier Methods:Female Condom
Benefits? (2)
Risks/Disadv? (3)
Benefits:
some STI protection
easy to get/cheap
Risks:
slippage
↓ sensation
irritation
Barrier Methods: Diaphragms/Caps
Use? (5)
Benefits? (3)
Risks/Disadv? (6)
Use: Must be fitted covers cervix use w/ spermicide leave in 6 hrs post max placement 24 hrs (diaph), 48 hrs (cap)
Benefits:
immediate use
not felt
good for 2 yrs
Risks: need pelvic exam Rx only BLADDER INFECTIONS allergy/irrit ↑ toxic shock high fail (esp caps)
Hormonal contraception action?
prevent ovulation
Hormonal Methods: Combined Oral Contraceptives Action? (6)
Estrogen (inhibit FSH) Progesterone (inhibits LH) Prevents ovulation Thickens cervical mucus (barrier) Alter endometrium (unreceptive) DOES NOT interrupt already implanted egg
Hormonal Methods: COC Types? (3)
1) Monophasic (constant E2/Prog thru entire cycle)
2) Biphasic (2 prog doses -> ↑ 1/2 way thru cycle)
3) Triphasic (3 E2 doses -> ↑ thru cycle)
Hormonal Methods: COC start options? (3)
1) Quick Start (begin immediately but need 7 days of backup method)
2) Sunday Start (start 1st Sunday after 1st day of bleed)
3) First Day of Start
Hormonal Methods: COC use? (3)
Pregnancy may happen if? (3)
R/O pregnancy first
Take daily
Works best if same time ea day
start pills too late in cycle
miss >1 pill in a row
take in wrong order
Hormonal Methods: COC
Contraindicated for? (14)
1) ≥ 35 and smokes
2) Hx MI or embolic CVA
3) Hx heart valvulopathy
4) Hx uncontrolled HTN
5) Controlled HTN and smokes
6) Hx thromboembolism
7) Hx blood coagulopathy
8) Unexplained vag bleeding
9) Hx breast/uterine CA
10) Liver dz
11) DM assoc’d vascular conditions
12) Pregnant
13) Prolonged bedrest post surgery
14) Migraine HA w/ Aura
Hormonal Methods: COC
Benefits? (10)
Reg/short/lighter periods ↓ cramps ↓ PMS/depression ↓ ectopics ↓ ovarian cysts/ovarian CA ↓ acne ↓ bone loss ↓ body hair ↓ vag dryness/painful intercourse Quick return of fertility
Hormonal Methods: COC
Risk/Disadv? (7)
Rx Daily Nausea, bloating, tender breasts (P) spotting No STI protection ↑ MI/Stroke/Clots esp if smoker Meds ↓ effectiveness: TB abx, anti-seizure, anti-fung, HIV meds
Factors that ↑ VTE w/ oral contraceptive?
1) ≥ 35 and smokes
2) < 21 days postpartum
3) Prolonged bedrest post surgery
4) Hx of DVT or PE
5) Hereditary thrombophilia
6) IBD
7) Corticosteroids
8) SLE
Hormonal Methods: Extended Cycle OC use?
E2/Prog combo
91 day: 12 wks active pills, one wk inactive
Hormonal Methods: ECOC
Benefits?
Risk/Disadv?
Benefits:
same as COC
fewer periods
Risks:
same of COC
(P) unrealized pregnancy
(P) unplanned spotting
Hormonal Methods: Patch
Use?
Benefits?
Risk/Disadv? (4)
Use:
weekly for 3 wks, 1 wk off
Benefits:
same COC
easier compliance
Risks: Rx and exam Weight max = 190# Irritation ↑ VTE than other COC (more E2)
Hormonal Methods: Ring
Action?
Use?
Action:
same as COC
E2/prog
Use:
in place 3 wks, out 1 wk,
loses effectiveness if out > 3hrs during “in” wks
Hormonal Methods: Ring
Benefits?
Risk/Disadv? (6)
Benefits:
convenient
no fitting necess
no spermicide necess
Risks: same COC Rx VAGINAL D/C Irritation (P) felt during action higher cost
Hormonal Methods: Progestin Only Pills
Action?
Use?
Action:
Less inhib of ovulation than COC
Thins endometrium
Thicken cervical mucus
Use:
MOST USED by breastfeeding
Continuous active pills (no placebo interval)
Do have to take at same time ea day
Hormonal Methods: POP
Benefits?
Risk/Disadv? (6)
Benefits:
E2 contraindication alternate
Safe for breastfeeding
Risks: Menstrual ∆s Depression ↓ libido Acne Breast tenderness ↑ follicular ovarian cysts
Hormonal Methods: Injections
Action?
Use?
Prevents ovulation
(P) thickening of cervical mucus
Use:
Q 3 monts (IM or SQ)
Preg test every time
Immediate protection if given during 1st 5 days of bleed
Hormonal Methods: Injections
Benefits? (5)
Risk/Disadv? (4)
Benefits:
VERY EFFECTIVE (better than tubal ligation),
No E2 so few s/e,
Safe in lactation,
PREVENTS endometrial CA (thins membrane),
Safer for >35yo, overweight, smokers w/ clot hx and high BP
Risks: (P) spotting or amennorhea ↓ BMD Weight gain HA/dizzy/fatigue Long lead time to returned fertility
Hormonal Methods: Implants
Action?
Benefits?
Progestin
Benefits:
MOST EFFECTIVE
lasts 3 yrs
rapid return to fertility
Risks:
same as injection
UNSCHEDULED bleeding
IUD: Copper
Action?
Imobilizes sperm in uterus
Prevents implantation by ∆ing uterine lining
Good for 10 yrs
IUD: Hormonal
Action?
Low progestin
Thickens mucus
Prevents implantation by ∆ing uterine lining
Good for 5 yrs
IUD insertion?
Complete H&P to r/o STIs and abnormalities
Insert at any time but heaviest day is best
MUST ensure not pregnant
Post delivery or abortion -> wait 4 wks
IUD Benefits?
Best for non-compliant pts
Works immediately
Remove any time
Not felt
IUD Risks/Disadv?
Cramping after placement Spotting Dysmennorhea Menorrhaiga Miscarriage Punctured uterus
