Contraception & sterilization Flashcards
What % of women use contraception?
90
what % of pregnancies are unintended?
55
theoretical & actual failure rates of: calendar method ovulation method symptothermal method postovulation method
theoretical: calendar = 9% ovulation = 3% symptothermal = 2% postovulation = 1%
actual failure rate for all these is 25%
theoretical & actual failure rate of:
male condom
female condom
theoretical:
male condom = 2%
female condom = 5%
which form of contraception has the lowest theoretical failure rate? highest?
lowest = monthly injection of combo ES and PG (Lunelle) close second = combo ES and PG pill, Mirena IUD, vasectomy highest = cervical cap w/spermicide in parous women; spermicide alone is pretty high too.
which form of contraception has lowest actual failure rate? highest?
lowest = Mirena IUD highest = cervical cap w/spermicide in parous women. Spermicide alone is pretty high too.
what is fialure rate of coitus interruptus?
15-25%
what is lactational amenorrhea?
hypothalamic suppression of ovulation during nursing
what % of lactating women will become pregnant while nursing?
15-55%
how long should lactational amenorrhea be used as a method of contraception?
no longer than 6 mos, and only as long as the woman is experiencing amenorrhea. It only works when breastmilk is the only form of nutrition.
what are best ways to increase effectiveness of condom?
leave well at tip to collect ejaculate
use a spermicide-containing condom or use a spermicide along with it
SE’s of condom use?
hypersensitivity to latex, lubricant, or spermicide
advantages of condom use?
also protects against STD, esp HIV
what is a female condom?
polyurethane pouch that penis is inserted into. Two rings, one hangs outside vagina, other is at cervix.
which has higher failure rate, male or female condom?
female
how is a diaphragm used?
spermicidal jelly placed on rim. It is placed in vagina over cervix before intercourse. Remains in for 6-8h after.
SE’s of diaphragm
bladder irritation
UTIs
S. aureus colonization, => TSS
hypersensitivity
disadvantages of diaphragm use:
m/b fitted & prescribed by physician :. more expensive.
needs t/b replaced q2y or when pt loses 20% or more of bw, and after pg’y
diff b/w cervical cap and diaphragm
cap fits directly over cervix, held in place by suction. It m/also be prescribed by physician and used w/spermicide.
what is most common cause of failure of cervical cap?
dislodgement. Esp in parous women.
advantages of cervical cap?
inserted 6h prior to intercourse, left in 1-2d
disadvantages of cervical cap?
foul discharge dvps after day 1
m/b refitted after a pg’y or large wt change
difficult technique to place and remove it
what are the 2 most widely used spermicides?
how do they work?
nonoxynol-9
octoxynol-9
work by disrupting cell mems of spermatozoa + act as mech’l barrier to cervix
what forms can spermicides come in?
vaginal creams, gels, films, suppositories, foams, tablets
when do spermicides need to be placed?
30 mins before intercourse, s/b used w/other barrier methods
do spermicides protect against STDs?
debatable. Some say yes, some say they make you more susceptible. Condoms recommended whenever STD protection is desired.
what are the 2 IUDs available in U.S. now?
copper (ParaGuard)
levonorgestrel (Mirena)
what is the most widely used method of reversible contraception is the world?
the IUD
what are absolute CI’s for IUD placement?
current pg'y undx'd abnormal vaginal bleeding suspected GYN malig acute cervical, uterine, or salpingeal infection hx of PID copper allergy (Wilson's dis)
what are relative CI’s to IUD?
nulliparity or desire for future childbearing
prior ectopic pg’y
hx of STDs, esp in past 3 mos
multiple sexual partners
moderate or severe dysmenorrhea
uterine anomaly/fibroid distorting uterine cavity
how does IUD work?
elicits a sterile inflam response => sperm are engulfed by inflam cells.
what does the addition of copper do for an IUD? Levonorgestrel?
copper hampers sperm motility
Levonorgestrel is a form of PG. Thickens cervical mucus, atrophies endometrium, prevents implantation, reduces tubal motility.
what are rare but serious SE’s of IUDs?
pain & bleeding pg'y expulsion perforation infection
IUD => increased risk of what?
insertion-related PID
SAB when becoming pg w/IUD in place
what to do if a pt becomes pg w/an IUD in place?
remove the IUD
how long is IUD good for?
Paraguard approved for 10 years
Mirena approved for 5 years
how soon after a SAB can a new IUD be inserted? How soon after an elective abortion? after delivery?
immediately after SAB or induced ab
1 week after delivery
how do IUDs influence rate of ectopic pregnancies?
decrease the overall risk, but in those who do become pregnant w/an IUD in place, a higher % will be ectopic
what % of women will experience amenorrhea with Mirena in place and for how long?
20% of women will be amenorrheic for 1 year. 60% will be amenorrheic for 5 years.
IUDs are less well-tol’d by who?
nulliparous women
IUDs are ideal for who?
monogamous multiparous woman for whom the pill is CI’d
why is failure rate of IUD higher during 1st year?
b/c of unrecognized expulsion
what is a monophasic OCP?
pill containing a fixed-dose of ES and progestin in each tablet.
Taken daily for first 21 days of a 28-d cycle. On last week, placebo or no pill is taken so that withdrawal bleeding occurs.
what is Seasonale?
a monophasic pill taken for 84d straight. Only get 4 periods per year. Used for pts w/menstrual-related disorders to allow longer hrm’l suppression and fewer withdrawal bleeds.
how do OCPs work?
provide - fdbk to ant pit => suppression of FSH and LH surge => no ovulation. Also thicken cervical mucus and decrease endometrial thickness.
what is a multiphasic OCP?
vary the dose of ES and/or progestin
what are common reasons for d/c’ing use of pill?
nausea, breakthrough bleeds, necessity of taking pill daily
what are some meds that reduce the efficacy of OCPs?
St. Johns wort nevirapine griseofulvin rifampin carbamazepine phenytoin barbiturates
what are some meds whose efficacies are changed by OCPs?
phenothiazides (chlorpromazine, anti-psych) diazepam theophylline (asthma) methyldopa hypoglycemics chlordiazepoxide TCAs
OCPs w/ES in what dose have higher rates of MI, stroke, VTE, PE?
50 micrograms
even at lower doses of ES, what kind of women are still at high risk of VTE dis?
women over age 35 who smoke
what is the effect of OCP use on breast cancer risk?
unsure. It has been studied a lot, no conclusive findings.
what are the complications ass’d w/OCP use?
DVT PE CVA MI HTN cholelithiasis cholecystitis benign liver adenomas (rare) cervical cancer (rare) retinal thrombosis (rare)
absolute CI’s of OCP use?
thromboembolism PE CAD CVA smoker over age 35 breast or endometrial ca. unexplained vaginal bleeding abnl liver fct known or suspected pg'y severe hypercholesterolemia or hyperTG
relative CI’s of OCP use?
uterine fibroids lactation DM sickle cell dis or sickle C dis hepatic dis HTN SLE age 40+ and high risk for CVD migraine HAs seizure disorders elective surgery
what are the health benefits of OCPs
decreased risk of ovarian ca decreased risk of endometrial ca. decreased risk of ectopic pg'y (b/c of decreased pg rates) decreased PID rates decreased benign breast dis
how do transdermal contraceptives work? How are they used?
suppress ovulation just like OCPs.
Apply to skin for 3 weeks straight, take it off and leave it off for 1 week => withdrawal bleed.
what is theoretical and actual failure rate of OCPs?
theoretical 0.1%
actual 3%
how does the nuva ring work? How is it used?
same as OCPs, suppresses ovulation. Inserted in woman’s vagina, one size fits all. Kept in 3 weeks, removed during 4th week for withdrawal bleed. Keep it in for intercourse, or put it back within 3 hrs if its taken out.
how do progesterone-only forms work?
thicken cervical mucus, thinning endometrial lining, suppress ovulation 50% of time.
how are POP (PG-only pills) different from traditional pill?
only contain a small daily dose of progestin. Are taken every day of cycle, no hrm-free days.
which is more effective, progestin-only or combo pills?
combo. POPs have a failure rate of 8%. Combo OCPs have a failure rate of 3%.
who are POPs ideal for?
nursing mothers
women over age 35 who smoke
women w/HTN, CAD, CVD, SLE, migraines, hx of VTE dis.
disadvantages of POPs?
irregular menses
irreg ov’y cycles
increased rates of ectopic pg’y
m/b taken at same time each day. Delay of +3h = “missed pill”
what is Depo-Provera
injectable medroxy-progesterone acetate (DMPA). Injected q3mos
SE’s of Depo-Provera
irregular bleeding (70% experience this during 1st year) depression wt gain hair loss breast tenderness
Women using DMPA for 2+ years may experience what? What to do about it?
a reversible decrease in bone mineralization (similar to lactating moms.) Encourage Ca2+, vit D, exercise, smoking cessation.
how long does it take for fertility to return after cessation of Depo-Provera?
6-18 mos (average is 10)
how does emergency contraception used?
high-dose ES and PG, or progestins alone taken within 72h after intercourse to suppress ovulation, fertilization, or implantation
what is Plan B?
Progestin-only ECP taken w/in 72h of unprotected sex
what is 1st-line choice of ECP?
Plan B
SE’s of ECP?
nausea vomiting (anti-emetic given) HA dizziness breast tenderness
what is the most effective form of ECP?
emergency IUD insertion
emergency IUD insertion is not acceptable for who?
women w/multiple sexual partners
rape victims
what are diff methods of tubal ligation? Which one is most effective?
occlusion w/Falope ring
clipping w/Hulka clips
ligation w/electrocaugery & sutures
Pomeroy method (usually immediately post-partum w/epidural still in place)
most effective = Falope ring
what is Essure?
polyester fibers & a spring coil is inserted into uterus into tubes. Over 12 weeks, tissue grows inward => tissue barrier.
Need to use a back-up method for 3 mos. HSG is done 3 mos later to confirm complete occlusion.
Essure is a good option for who?
obese women
women w/prior ab’l surgeries
those w/risk of anesthesia complications
highest success rates for tubal ligation occur in who?
post-partum sterilization
SE’s of tubal ligation?
pain menstrual disturbances (post-tubal ligation syndrome - but most cases are 2/2 d/c of hrm'l contraceptives)
who tends to seek reversal of tubal ligation?
highest regret is women under age 30
1% of women seek reversal procedures
how long of a period of back-up contraception is needed after vasectomy and why?
6-8 weeks, until azoospermia is confirmed by semen analysis
sperm can remain viable in proximal collecting tubules of testes
what are antisperm antibodies?
antibodies that form against sperm, occurs in 50% of pts who have vasectomies
SEs of vasectomy
rare
skin bleeding, infection
rxt to sutures or local anesthesia
which is better, tubal ligation or vasectomy?
vasectomy. Its safer, less expensive, can be performed as an outpt.
what is success rate of vasectomy reversal?
60-70%. Pregnancy rates are 18-60%
