Contraception / Sterilization

Question 1

Options for contraception with variable efficacy….

Answer 1

Periodic abstinence with ovulation kits, calendars
Coitus interruptus
Lactational amenorrhea (but will start to ovulate before return of menstruation usually in 6-12 mo

Question 2

Condoms

Answer 2

15% failure rate, but protect against STDs

Question 3

Birth control pills

Answer 3

8% real life failure rate

Decrease ovarian / endometrial cancer

Question 4

Side effects of OCPs

Answer 4

Can get nausea, h/a, breakthrough bleeding

Risk of DVT / PE / CVA / MI / HTN (lower with low dose). Also cholelithiasis,cholecystitis, benign liver adenomas

Question 5

Estrogen and progesterone OCPs.

Answer 5

Have to remember to take every day

Question 6

Progesterone only OCPs

Answer 6

Have to take at same time every day, higher failure rate.

Decrease PID risk, OK for use during nursing as well.

Question 7

Options for menses on OCPs

Answer 7

Bleeding every month, every 3 months, or continuous dosing (more breakthrough bleeding)

Question 8

How to start OCPs

Answer 8

Starting on day 1 of cycle: least likely to ovulate during cycle
Sunday start: backup for 7 days, leaves next weekend free.
Anytime start is actually fine: just backup method for 7 days

Question 9

Depo

Answer 9

Progesterone. Shot in arm every 3 months.

Question 10

Depo side effects

Answer 10

Can cause irregular bleeding, especially at beginning
Also decreased bone density (reversible). Can cause depression, wt gain, hair loss, h/a. Can lead to amenorrhea.
May take 6-18mo for fertility to return.

Question 11

Implanon

Answer 11

3 years, progestin implant
Most women have lighter periods (some none at all)
Really effective (the MOST) but can have irregular / unpredictable light bleeding

Question 12

IUDs

Answer 12

Long term reversible contraception
Very effective
Hormonal or copper

Question 13

Mirena IUD

Answer 13

Progesterone.
5 years.
Lighter or no periods.

Question 14

Paragard IUD

Answer 14

Copper.
10 years.
Can cause irregular bleeding.

Question 15

Patch

Answer 15

Not if overwt > 198 lbs or high thromboembolism risk

Question 16

Nuvaring

Answer 16

3 wks in, 1 wk out, or 3mo in with changes, 1 wk out, 0.8% failure rate

Question 17

Diaphragm

Answer 17

Fit by clinician; leave in place 6-8h after intercourse, risk toxic shock syndrome

Question 18

Cervical cap

Answer 18

Fitted by clinician, use with spermicide can be hard to use

Question 19

Spermicides

Answer 19

Nonoxyl-9, etc, should use with condoms, can irritate mucosa & increase STI transmission

Question 20

Emergency contraception: plan B

Answer 20

Plan B (progestin only) within 72h
Need Rx if < 18, OTC if > 18
Plan B, the levonorgestrel pills can be taken in one or two doses and cause few side effects.
Oral contraceptives need to be taken 12 hours apart if using those.
Indicated sooner than 72h if possible and no later than 120h
Can insert second dose of ocps per vagina or take an antiemetic 1 hr before administration to decrease nausea/vomiting (major side effect)

Question 21

Emergency contraception: copper IUD

Answer 21

Copper IUD can be put in within 5-8 days, actually the most effective form of emergency contraception

Question 22

Sterilization

Answer 22

Tubal ligation

Vasectomy

Question 23

Tubal ligation

Answer 23

Can be done laparoscopically (clips, cautery, banding)or hysteroscopically (Essure, Adiana)
Can do immediately postpartum through small subumbilical incision
Essure - takes 12 weeks, use backup birth control until HSG confirms complete occlusion
Leads to a slightly decreased risk of ovarian cancer (mechanism unknown)

Question 24

Vasectomy

Answer 24

Not immediately effective!
Use alternate contraception until repeat semen analysis in 6-8wks
Simpler, safer, more effective than BTL
Can form antisperm antibodies, but no long-term effects.