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RGU 1 > Contraceptive Methods > Flashcards

Contraceptive Methods Flashcards

1
Q

What are the 3 different aspects to contraception?

A
  • social issues
  • biological issues
  • moral issues
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2
Q

What % of U.S. pregnancies are unintended?

A

60%

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3
Q

** What is the pearl index?

A
  • the number of failures per 100 women-years of exposure. (SEE WRITTEN CARD for EQUATION).
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4
Q

When a patient asks for contraception, what 2 general options will you tell them?

A
  1. hormonal

2. non-hormonal

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5
Q

What are the types of hormonal contraceptive methods?

A
  • BC pills
  • transdermal or intravaginal
  • implantable device
  • hormonal injections
  • anti-progesterones, male hormonal methods, and vaccines (experimental).
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6
Q

What are the most commonly used combined low dose BC pill?

A
  • 20-50 ug of estrogen (usually ethinyl estradiol + a progestin)= suppress pituitary release of LH and FSH (gonadotropins). Progestin is the more effective ovulation inhibitor bc this is what is produced when you are pregnant to prevent ovulation (aka we fool the brain). Progestin also causes changes in cervical mucus and endometrium, hindering sperm transport and embryo implantation.
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7
Q

What types of combo pills exist?

A
  • monophasic= constant does of hormones

- multiphasic= varying doses of hormones.

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8
Q

What changed from the 1st generation combo pills to the 3rd generation combo pills?

A

lower androgenic effects :)

  • Norgestrel and Levonorgestrel= HIGH androgens.
  • Ethynodiol, Norgestimate, Desogestrel= LOW androgens.
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9
Q

What is the “user” failure rate for combined low dose BC pills for the first year of use?

A

8% (since most women do not take them perfectly).

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10
Q

Will fertility return soon after discontinuation of combo low does BC pills?

A

YES :)

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11
Q

Are the side-effects with low dose combo-BC pills bad?

A

No they aren’t bad.

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12
Q

What are the options to relay to the pt about when to start their pill?

A
  • SUNDAY start= at the end of the month you will get your period in the middle of the week.
  • SAME DAY start= start in sync with their cycle. This is designed to decrease break-through bleeding.
  • QUICK start= start today in the office and do this every single day at this time.
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13
Q

What are the non-contraceptive benefits of taking a combined low dose BC pill?

A
  • helps menstrual cycle disorders, acne, hirsutism, bleeding due to leiomyomas, pelvic pain due to endometriosis, decreases risk of endometrial cancer, decreases risk of ovarian cancer, and decreases risk of colon cancer! :)
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14
Q

What are the contraindications for combined low dose BC pills?

A
  • older than 35 and smoking more than 15 cigarettes per day.
  • UNCONTROLLED HTN (systolic 160 or diastolic 100). Once treated they can go on BC.
  • VTE
  • ischemic heart disease
  • hx of stroke
  • valvular heart disease
  • SLE ?
  • migraine with AURA (lose vision or lose sensation somewhere in your body).
  • cirrhosis
  • breast cancer
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15
Q

What are some side effects of combined low dose BC pills?

A

nausea (19%), breast tenderness, headache, leg cramps, weight gain, mood changes, or decreased libido.
*most of these will ameliorate over the course of 6 cycles.

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16
Q

What is the Nuvaring?

A
  • transvaginal ring

- same as BC pill only very low dose and does not have 1st past metabolism bc it goes directly into the blood stream.

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17
Q

What are some advantages to the Nuvaring?

A
  • do not have to remember to take the pill.
  • cycle flexibility bc the ring has 5 weeks of therapy in every ring (meaning that if you wanted to leave it in for the 4th week instead of taking it out to allow for your normal cycle, you could).
  • local estrogen for vaginal dryness in perimenopause
  • lower rate of side effects
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18
Q

What is the contraceptive patch, Ortho Evra?

A
  • path placed on skin weekly x 3, then left off for a week for withdraw bleed.
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19
Q

What are the disadvantages of the Ortho Evra patch?

A
  • it is hard to hide and people will see it.
  • high rate of variability in absorption that allow for high estrogen levels.
  • 2 fold increase in non-fatal VTE
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20
Q

Who are candidates for progestin-only contraceptives?

A
  • women with CV risk factors, DM, lipid disorders, estrogen related side effects, migraine headaches, or are post-partum or breast feeding.
  • these are for longer term use.
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21
Q

What are the most common side effects of progestin-only contraceptives?

A
  • irregular bleeding and spotting
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22
Q

Do progestin0only contraceptives need to be taken continuously?

A

YES. There is NO hormone-free interval.

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23
Q

What happens if you delay more than 3 hours with progestin-only contraceptives?

A

requires back-up contraception for 48 hours.

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24
Q

What did a subgroup analysis confirm in regards to association between VTE risk and progestin-only PILLS or a progestin IUD?

A
  • there was no association

* HOWEVER, there was an increased risk for users of an INJECTABLE progestin like depo provera.

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25
Q

What is Depo Provera (Depot Medroxyprogesterone Acetate; DPMA)?

A
  • progestin-only IM injection given every 3 months.

- has been around for a long time.

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26
Q

What are the problems with depo provera?

A
  • return to fertility may be delayed 10-18 months.
  • menses may not return for months after discontinuation.
  • bone loss concerns only in those who are older.
27
Q

What is the progestin-only implant, Etonogestrel?

A
  • non-biodegradable rod implanted subdermally up to 3 years; then removed and replaced if desired.
28
Q

Will fertility return quickly after removal of the progestin-only Etonogestrel implant?

A

YES in days to weeks.

29
Q

What is the difference between the older version of Etonogestrel (Implanon) vs the newer Nexplanon?

A

Nexplanon is radiopaque with barium, so you can see it on x-ray. So be aware that you may get a pt using the older version, and know that you won’t see it on x-ray. Use ultrasound instead.

30
Q

What is coitus interruptus (withdrawal)?

A
  • the withdrawal method requires men to withdraw from the vagina before ejaculation.
  • failure occurs if withdrawal is not timed accurately or if the preejaculatory fluid contains sperm.
31
Q

What is lactational amenorrhea?

A
  • women who breastfeed have a delay in resumption of ovulation postpartum due to prolactin-induced inhibition of pulsatile GnRH release from the hypothalamus.
32
Q

What 3 conditions must all be met for lactational amenorrhea to be a reliable form of contraception?

A
  1. less than 6 months postpartum.
  2. breastfeeding exclusively (not providing food or other liquid to the infant).
  3. she is amenorrheic
33
Q

What is the rhythm method or natural family planning?

A
  • organizing coitus around the menstrual period. It is virtually impossible to get pregnant 24 hours after ovulation.
  • it is important to inform pts that sperm can stay viable for up to 6 after intercourse and that ovulation ALWAYS occurs 14 days PRIOR (not after) her period. So it is important to know if you’re on a 21 day cycle vs a 28 day or longer cycle.
  • the cycles must also be REGULAR.
34
Q

What happens to temperature 24 hours after ovulation?

A

it rises

35
Q

What chemical contraception is used today?

A

nonoxinol-9= spermicide that is used either alone as suppository dissolving jelly, or used together with a barrier method.
*some women are sensitive or allergic however.

36
Q

What is great about barrier method contraception (condoms)?

A

inexpensive, available w/o Rx and various sizes.

37
Q

What are some different types of condoms?

A
  • Latex (allergy), polyurethane, animal (lamb intestine), lubricated with or without spermicide.
38
Q

With what should you NOT use condoms?

A
  • oil-based lubricants like vaseline or petroleum jelly bc it breaks them down.
  • vaginal estrogen or anti-fungal creams.
39
Q

What is important to know about diaphragms, cervical caps, and female condoms?

A
  • diaphragms and cervical caps need to be fitted.
  • need to place before intercourse and left in for at least 6 hours after intercourse.
  • failure rate with these is high, and the sponge is about the same as using nothing.
40
Q

What are IUDs?

A
  • HIGHLY effective, convenient, and have non-contraceptive benefits.
  • can be inserted at any time in menstrual cycle, provided the woman is not pregnant.
41
Q

What are the 2 IUDs available in the U.S.?

A
  • Levonorgestrel (progesterone)= 3, 5, or 7 year use. 1% failure.
  • Copper T= 10 year use. 2% failure and periods can be a little more crampy and heavier.
42
Q

Are there concerns about infection with IUD use?

A

NO

43
Q

What are some slight concerns you should consider with IUDs?

A
  • can perforate the wall of the uterus.
  • may not be first line of choice in teens if they want to have children later. FDA says this is not an issue, but still keep it in the back of your mind.
44
Q

With what non-contraceptive benefits have IUDs been associated?

A
  • copper-IUC= reduction in endometrial cancer.
  • Levonorgestrel IUD= reduced measured blood loss in heavy menstrual bleeding, superior to oral progestins. Also prevents endometrial hyperplasia during menopausal treatment with estrogen.
45
Q

What are the 2 forms of sterilization?

A
  • vasectomy for men

- tubal sterilization for women

46
Q

When can tubal sterilization be done?

A
  • post-partum
  • via mini-laparotomy
  • colpotomy (incision in back upper part of vagina).
  • hysteroscopic
47
Q

What is important to tell men about a vasectomy?

A
  • must stay off of your feet for a day and ice. Don’t do any work and then you’ll good to go 2 days later.
  • can always check the results by looking at an ejaculate sample with a microscope for sperm.
  • aka compliance to recovery is key.
48
Q

How long can sperm remain viable in the vas deferens following a vasectomy?

A
  • 3 months so make sure they wait.

- must go back in 8 weeks to check.

49
Q

How is female tubal sterilization performed?

A
  • ligation with excision, occlusion with rings or coils, and electrocoagulation/cautery of portion of tubes.
  • mostly done laparoscopically or hysteroscopic tubal occlusion (office procedure).
50
Q

Will female tubal sterilization cause changes in menstruation?

A
  • NO
51
Q

Does tubal sterilization decrease risk for ovarian cancer?

A

YES

52
Q

What is hysteroscopic sterilization (Essure)?

A
  • soft, flexible micro coils with a cord are slid into the fallopian tube to occlude the tubes.
  • Hysterosalpingogram (HSG) follow up in 3 months to make sure it was effective.
53
Q

Is hysteroscopic sterilization (Essure) reversible?

A

NO

54
Q

What are the disadvantages of tubal ligation sterilization?

A
  • permanent
  • signficant risk of ECTOPIC pregnancy if it fails.
  • no effect on menstrual cycle, if you need something to help regulate you.
55
Q

How does emergency contraception work?

A
  • inhibits or delays ovulation.
  • hormones may alter sperm or ovum transport.
  • hormones may alter endometrium, making it inhospitable to implantation.
56
Q

Will hormonal emergency contraceptives affect an already established pregnancy?

A

NO, nor harm the fetus if taken inadvertently during early gestation.

57
Q

Within what time period should you take emergency contraception?

A

within 72 hours (3 days) of unprotected sex to reduce risk of pregnancy by 75%.

58
Q

Can you use insertion of copper-releasing IUD as emergency contraception?

A

YES

59
Q

How will you know if the emergency contraception failed?

A

menses will be delayed greater than 1 week.

60
Q

What EC is approved OTC for women over 17?

A

Plan B (Levonorgestrel). Take both pills or space them out 12-24 hours.

61
Q

What is ulipristal acetate (ella)?

A
  • emergency contraception that is a progesterone agonist/antagonist.
  • delays ovulation by 5 days.
62
Q

Up to how many days can you wait before placing a copper IUD as emergency contraception?

A

7 days after unprotected sex or 5 days after ovulation.

63
Q

What is our role as the provider when choosing a contraception method?

A
  • minimize risk and maximize benefit.

RGU 1 (17 decks)

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