Contraceptive Options Flashcards

Question

# Emergency Contraceptives oral methods

Answer 1

* Less effective in individuals with BMI > 30 and individuals at higher risk of pregnancy (when UPI occurs) Options: * Taken as a single course as soon as possible after UPI * Ulipristal acetate 30 mg PO once (can be used up to 5 days after UPI) (preg rate 1.5%) * Oral levonorgestrel 1.5 mg PO once (can be used up to 3 days after UPI) (preg rate 2-3%) * combined EC pills taken at higher doses than normal as soon as possible after UPI (often causes nausea and vomiting) **Time in the menstrual cycle that EC is administered and the patient’s BMI are major factors in the likelihood of pregnancy!**

Answer 2

Risk of venous thromboembolism (VTE): * ↑ risk with ethinyl estradiol > progestins and is dose dependent * Ethinyl estradiol should be avoided in people at risk for VTE * Progestin-only methods are recommended Abnormal bleeding (unscheduled bleeding (spotting), prolonged bleeding) * More often associated with progestin-only methods * Estrogen tends to stabilize bleeding patterns * Worst with etonogestrel implant Ovarian cysts * Associated with progestin-only methods * Ethinyl estradiol generally suppresses cyst formation

Answer 3

* breast sx: fibrocysticc breast changes, mestalgia (pain), decreased milk production during breast feeding (ethinyl estradiol only) * wt gain: progestin injections (avg < 5 lbs); due to changes in appetite not metabolism * other sx: n/v, HA, migraine, decreased libido, melasma

Answer 4

* pregnancy * current, hx of, or risk factors for VTE (< 21d postpartum, coagulopathies, smoking if > 35 yrs, SLE) * CV disease (HTN, ischemic heart disease, valvular disorders, peripartium CM) * migraines w/ aura in women > 35 yrs * undiagnosed abnormal uterine bleeding (AUB) * current/past breast cancer * liver disease (cirrhosis, hepatocellular adenoma, liver cancer) * DM > 20 yrs or w/ -pathy (neuro, nephro, retino) * solid organ transplantation w/ complication * hyperTGs

Answer 5

* pregnancy * current/past breast cancer * undiagnosed AUB * liver disease * IUDs: uterine anomalies, PID, endometritis, acute vaginitis

Answer 6

* Metabolism of COCPs and POPs is increased by any drugs that increase liver microsomal enzyme activity, resulting in reduced contraceptive efficacy Meds * Anti-Convulsants: penytoin, carbmazepine, barbiturates, topiramate, felbamate, oxcarbazepine, lamotrigine * Anti-bx: rifampin, rifabutin * anti-viral: NRTIs, protease inhibitors

Answer 7

* Has no effect on the reproductive hormones * Each method has a different mechanism and extent of efficiency in preventing pregnancy Includes: * Physiological methods - high failure rates * Barrier methods * Copper IUD * Surgical methods (permanent) - highly effective

Answer 8

* A traditional method that has been in use for centuries * Complete withdrawal of the penis from the vagina prior to ejaculation * Prevents fertilization by preventing the sperm from reaching the egg, however, pre-ejaculate from the cowper gland may contains sperm * High failure rate

Answer 9

* Based on the woman’s menstrual cycle * The cycle has to be regular * the greater the variance in cycle length, the longer the abstinence required * High failure rate Interval of abstinence: * Subtract 18 from the shortest of the previous 12 cycles and 11 from the longest * Example: cycle varies from 26 to 29 days…abstinence is required from day 8 through 18 of each cycle

Answer 10

* Periodic abstinence determined by signs and symptoms that correlate with different hormone levels as indicators for an approximate timeframe when ovulation is likely to occur * high failure rate Basal Body Temperature (BBT) * Based on an ↑ in body temperature at rest (by 0.5–1.0 degrees) during and after ovulation Cervical Mucus * End of the follicular phase/ovulation - the mucus is increased, thinner, clearer, and elastic (Peak levels of FSH and LH; ↑ estrogen at the end of the follicular phase) * Luteal phase – mucus is thick and sticky (↓ FSH and LH; ↑ progesterone)

Answer 11

* Mechanism: Infant’s suckling leads to increased prolactin production → increased milk production Effects: * ↓ Gonadotropin-releasing hormone * Delay in ovulation Only viable for women who are/have: * Exclusively breastfeeding * Within the 1st 6 months postpartum * Not seen a return of their menstrual period (amenorrhea)

Answer 12

* Create a physical barrier between the male and female genitalia and secretions * Best to use with a water-based or silicone lubricant to prevent tearing and breaking Effects: * Protects against pregnancy * ↓ STI risk (including HIV) * Protects against HPV infections → ↓ risk of cervical neoplasia Types: * Male condoms * Female condoms

Answer 13

* Reversible male contraceptive method * Use: A thin sheath with a reservoir at the tip and a base ring; Applied to an erect penis before penetration Advantages: * Does not affect fertility * Protection from STIs * Easily accessible and inexpensive * Minimal side effects Disadvantages: * Latex allergy is a contraindication * Potential ↓ in sensitivity * Slippage or breakage can occur Pregnancy rate at 1 year: * 2% with perfect use * 18% with typical use

Answer 14

* Use: A pouch with an inner and an outer ring, The inner ring holds the condom in place, The outer ring remains outside and covers the perineum * Should be used no more than 8 hours before intercourse Advantages: * Does not affect fertility * Protection from STIs * Does not require medical evaluation or special fitting * Minimal side effects * Offers protection to women whose partners refuse to use a male condom Disadvantages: * Allergy to nitrile is a contraindication * Not as readily available as male condoms * May be difficult to insert and remove properly * Possibility of: Semen to spill when removing, Breakage Pregnancy rate at 1 year: * 5% with perfect use * 21% with typical use

Answer 15

Mechanism: * Provide a chemical barrier by killing or immobilizing sperm * Most spermicides contain nonoxynol-9 Use: * Can be used alone or with other barrier methods * Form: foams, creams, gels, films, and suppositories * Should be placed in the vagina close to the cervix at least 10‒15 minutes (no more than 1 hour) before sexual intercourse * Effective for 1 hour after insertion * Reinsertion is required for each act of intercourse Advantages: * Does not affect fertility * Does not require a prescription * Easy to use Disadvantages: * Should be used with other barrier methods due to limited efficacy * Does not protect against STIs * Can cause vaginal irritation or dryness → ↑ risk of HIV transmission Pregnancy rate: * 18% with perfect use * 20% with typical use

Answer 16

Mechanism: * Foam disk impregnated with nonoxynol-9 * Acts as both a barrier device and spermicidal agent Use: * Moisten with water before insertion into the vagina → activates spermicide * Should cover the cervix * Can be inserted up to 24 hours before intercourse * Should be left in place for ≥ 6 hours after intercourse * Cannot be worn for longer than 30 hours * No need to be replaced for additional acts of intercourse Advantages: * Available without a prescription or special fitting * Does not affect fertility Disadvantages: * Less effective than other barrier methods * Can cause vaginal irritation or dryness → ↑ risk of HIV transmission * May be difficult to remove (can break apart during removal) * Associated with ↑ risk of toxic shock syndrome (rare) Pregnancy rate: * 12% for nulliparous women * 24% for multiparous women

Answer 17

Mechanism: * A reusable, dome-shaped rubber cup with a flexible rim that fits over the: Cervix, Upper and lateral wall of the vagina * Provides a physical barrier to sperm Use: * Usually with a spermicide (applied before insertion) * Ideally, placed < 1 hour before intercourse * Should remain in place for 6‒8 hours (no more than 24 hours after intercourse) Advantages: * Does not affect fertility * Can be placed at a convenient time before intercourse * Durable and reusable (can last up to 2 years) Disadvantages: * Can be difficult to use properly * Requires a prescription * Does not prevent STIs * Should be avoided during menses due to the risk of infection * can become dislodged Adverse Effects: * vaginal discomfort/irritation * UTIs * increased risk UTIs Pregnancy Rate * 6% w/ perfect use * 12% w/ typical use

Answer 18

Mechanism: * Resembles a diaphragm but is smaller and more rigid * Provides a barrier against sperm entering the cervix Use: * A spermicide should always be used * Must be inserted before intercourse * Should remain in place for ≥ 6 hours after intercourse (no more than 48 hours) Advantages: * Does not affect fertility * Can be placed at a convenient time before intercourse * Durable and reusable (can last up to a year) Disadvantages: * Can be difficult to use properly * Requires a medical visit and fitting * Refitting required after childbirth, weight gain, and weight loss * Does not prevent STIs * May cause vaginal irritation * Associated with urinary tract infections Pregnancy rate: * 12% for nulliparous women * 24% for multiparous women

Answer 19

Mechanism: * Gel that lowers the vaginal pH to 3.5‒4.5 (even in the presence of alkaline semen) → immobilizes sperm Use: * Used as an alternative to spermicide * Comes in single-dose, prefilled vaginal applicators * Should be applied within one hour of intercourse Advantage: * Lower risk of vulvovaginal and penile irritation compared to spermicide Disadvantages: * Requires a prescription * Typically used in conjunction with other products (condoms, diaphragms) * FDA approved, but newer product with less data regarding efficacy

Answer 20

Mechanism: * T-shaped polyethylene device with a fine copper wire wound around the stem (and often the horizontal arms) and inserted into the endometrial cavity * Causes local, sterile inflammation and releases small amounts of copper → affects sperm mobility and egg implantation Use: * Inserted by a clinician * STI testing is done just prior to insertion * Can remain in place for 10 years * Can be used for emergency contraception if placed within 5 days of unprotected intercourse Advantages: * Highly effective * Provides long-term efficacy * Convenient * Does not affect fertility * Minimal systemic effects * Can be used as emergency contraception * May be removed at any time Disadvantages: * Requires a medical visit for placement and removal * Does not protect against STIs * Side effects: Heavy menstrual bleeding, Severe cramping

Answer 21

Contraindications: * Current STIs or pelvic inflammatory disease (PID) * Anatomic abnormalities that distort the uterine cavity * Unexplained vaginal bleeding * Known cervical cancer or endometrial cancer * Pregnancy * Wilson disease or copper allergy Complications: * Expulsion rates are < 5% within the 1st year after insertion * Uterine perforation * Ectopic pregnancy * ↑ Risk of PID Pregnancy rate: * 0.5%‒0.8% * Higher failure rate in younger women

Answer 22

Mechanism: * Disrupts the patency of the fallopian tubes Can be accomplished surgically by: * Cutting and excising a segment of the fallopian tubes * Complete removal of the fallopian tubes (salpingectomy) * Fallopian tube closure via: Ligation, Fulguration, Various mechanical devices (plastic bands or rings, spring-loaded clips) Indications and contraindications: * Indicated for women with a desire for permanent contraception (should be given extensive counseling) * No absolute contraindications Risk factors for complications should be assessed: * Severe obesity * Prior abdominal surgery * Previous PID or abdominal infections * Comorbidities Complications: * Death: 1–2 per 100,000 women * Hemorrhage or intestinal injuries: approximately 0.5% of women * Failure of tubal occlusion: up to 2-3% of women * Ectopic pregnancy: approximately 30% of pregnancies that occur after tubal occlusion

Answer 23

Mechanism: * Disrupts the patency of the vas deferens * Sterility requires about 20 ejaculations after the procedure and should be documented by 2 sperm-free ejaculations Can be accomplished surgically by: * Transection of the vas deferens * Ligation or fulguration of the ends Indications: * Indicated for men with a desire for permanent contraception (should be given extensive counseling) Contraindications: * Scrotal hematoma * Infections Complications: * Hematoma (≤ 5%) * Sperm granulomas (inflammatory response to sperm leakage) * Epididymitis * Post-vasectomy pain syndrome * Spontaneous re-anastomosis (usually occurs shortly after the procedure) | preg rate 1.1% at 5 yrs