Contraceptive Methods Flashcards
1
Q
overview of contraception
A
- 50% of pregnancies in the US are unintended
- Almost 50% of these occur in women using a reversible contraceptive method
- Nearly 50% of these end in elective termination
- Almost 50% of these occur in women using a reversible contraceptive method
- What are the factors that affect a woman’s choice or use of contraception?
2
Q
factors to consider
A
- Efficacy
- Convenience
- Duration of action
- Reversibility and time to return of fertility
- Effect on uterine bleeding
- Frequency of side effects and adverse events
- Affordability
- Protection against sexually transmitted diseases
3
Q
overview of contraception
A
- Abstinence
- Natural family planning / withdrawal
- Lactation
- Barrier methods / spermicide
- Hormonal methods
- Intrauterine devices
- Permanent sterilization
- Emergency Contraception
4
Q
natural family planning
A
- Standard days method
- Calendar rhythm methods
- Basal body temperature method
- Ovulation method
- TwoDay method
- Symptothermal methods
- Nonhormonal, nonsurgical methods based on fertility awareness
5
Q
withdrawal method
A
- The withdrawal method (coitus interruptus) requires men to withdraw from the vagina before ejaculation
- Failure occurs if withdrawal is not timed accurately or if the pre-ejaculatory fluid contains sperm
- Failure rates as high as 18-20% have been reported
- Can offer emergency contraception options as long as they are not breastfeeding
6
Q
lactation amenorrhea method
A
- Breastfeeding causes delay in resumption of ovulation postpartum
- Only reliable if
- The woman is less than six months postpartum
- She is breastfeeding exclusively (ie: not providing food or other liquid to the infant)
- She is amenorrheic
- There are other methods of contraception available during the postpartum period
7
Q
barrier methods
A
- Nonhormonal, few side effects
- No prescription required for condoms, sponge
- Increased effectiveness if used with spermicide
- Condoms should be used once and discarded
- Cervical cap, diaphragm, sponge may be cleaned and reused
- Cervical cap, diaphragm need to be fitted
8
Q
barrier contraception: condoms
A
- Male condom
- Pregnancy rate 15% with typical use
- Best protection against STD
- Latex, polyurethane, natural membrane
- Do not use oil-based lubricants with latex condom
- Female condom
- Pregnancy rate 21% with typical use
- Polyurethane, prelubricated
9
Q
barrier contraception: diaphragm
A
- Diaphragm + spermicide
- Pregnancy rate 16% with typical use – even higher for women who have had babies
- Requires fitting by a clinician
- Not for preventing STD
- Leave in 6-8 hrs after intercourse then remove and wash
- May increase risk of UTI
- Not recommended for HIV positive pts
- Only effective when used with spermicide
- Not a very popular method in the US
10
Q
barrier contraception: cervical cap
A
- Cervical cap
- Pregnancy rate 16%; 32% if previous births
- Must be fitted by trained professional
- Latex or silicone rubber; 3 sizes
- Not for STD prevention
- Leave in vagina 6-8 hrs (up to 48 hrs), then remove and wash
- Less effective after previous births due to change in size/shape of cervix
- Not as effective as the diaphragm
11
Q
barrier contraception: sponge
A
- Vaginal sponge
- Pregnancy rate 16% for typical use; 32% if previous births
- Moisten with tap water before insertion deep in the vagina
- May be left in place, used repeatedly up to 24 hrs
- Nonprescription, no fitting required
- 2 inch wide circular disk, ¾ inch thick, containing 1000 mg of nonoxynol-9 and attached to a loop for removal
12
Q
barrier method: spermicide
A
- Spermicides (Nonoxynol-9)
- Available without a prescription
- Variety of forms including gel, foam, cream, film, suppository, and tablet
- Not a highly effective method of contraception when used alone (without a barrier method)
- Effectiveness is reduced if the patient does not wait long enough for the spermicide to disperse before having intercourse, if intercourse is delayed for more than one hour after administration, or if a repeat dose is not applied before each additional act of intercourse
- May cause local irritation, some increase in bacterial vaginosis infections, and may be messy
13
Q
hormonal methds
A
- Oral contraceptive pills
- Combined (estrogen-progestin) pills
- Monophasic / continuous
- Triphasic
- Progestin only pills
- Combined (estrogen-progestin) pills
- Vaginal estrogen ring
- Transdermal estrogen patch
- Injectable progestin
- Subdermal implants
- Mirena IUD
- The progesterone levels are the same throughout the pack. With the phasic ones, the estrogen is the only thing that is changed
14
Q
oral contraceptives
A
- Several mechanisms of action
- Estrogen/progestin-induced inhibition of the midcycle surge of gonadotropin secretion so that ovulation does not occur
- Reliable form of contraception
- Pregnancy rates 8% with typical use, < 1% with perfect use
- Other benefits include reductions in dysmenorrhea, menorrhagia, acne, risk of ovarian cancer, endometrial cancer
15
Q
Combined oral contraceptives
A
- May be given cyclically (21 or 24 active followed by 7 or 4 inactive pills) or by an extended cycle regimen (84 active followed by 7 inactive pills) or active pills taken indefinitely
- Ortho tricyclen, Seasonale, Loestrin shown
- If you only want to have your period 3 times a year, YOU HAVE TO BE ON MONOPHASIC PILLS!!! You cant do this with triphasic etc. pills.
- Monophasic pills must be used when prescribing longer cycles to avoid breakthrough bleeding
- Most current OCs contain 20 to 35 mcg of ethinyl estradiol and various types of progestin
- Norethindrone, levonorgestrel, norgestimate, desogestrel, drospirenone
- Different progestins may have different side effects
- Very low dose (20 mcg) pills may cause more breakthrough bleeding than higher doses
