Contraceptives Flashcards
IV treatment if needed to be hospitalized. name the patch that contain progestin and estrogen?
The patch (Ortho Evra®) and ring (NuvaRing®) are also highly effective forms of contraception containing estrogen and progestin with reported rates of 99% efficacy when used as directed.
List the natural method contraceptives?
cervical mucus, basal body temperature (BBT), and symptothermal and LAMs.
………………was recognized as a means to prevent pregnancy and was used by Alaska Natives, Native Americans, and ancient Egyptians
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Breastfeeding
what is cervical mucus method?
The cervical mucus method is based on detecting signs and symptoms of ovulation through consistent consistent observation of the cervical mucus, which is produced by cells in the cervix.
. Then mucus is present for a few days, in which the woman should feel vaginal wetness. After this
During ovulation, cervical mucus nourishes sperm, facilitates their passage into the intrauterine cavity, and probably helps select sperm of the highest quality. However, the peak day is only obvious the day after it occurs, when the mucus becomes less slippery and stretchy. After this day, the mucus starts to lose its slippery, stretchy, wet quality,
How is the cervical mucus after menstruation?
Immediately after the menstrual period, cervical mucus is scant and the woman should notice vaginal dryness for a few days
How is cervical mucus during ovulation?
After few days of menstruation, the mucus becomes clear (as differentiated from milky white, translucent, or creamy color) and slippery or stretchy, similar to raw egg white. The woman should notice increased wetness or a slippery sensation. The peak day of wetness signals ovulation.
What happen during ovulation?
During ovulation, cervical mucus nourishes sperm, facilitates their passage into the intrauterine cavity, and probably helps select sperm of the highest quality.
What is the other name of cervical mucus that occur during ovulation?
These characteristics are referred to as spinnbarkheit.
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How does Basal body temperature work?
The BBT method is based on the temperature change triggered by the progesterone rise that occurs when the ovum leaves the ovary.
During ovulation, the temperature ,,,,,,,,,,,, preovulatory BBT.
To use this method, the woman takes her temperature at the same time every day using a digital basal thermometer; before she eats, drinks, smokes, and/or participates in any physical activity. Then she documents her daily temperature on a chart, noting any variations.
During ovulation, the temperature typically rises up to 1° above the preovulatory BBT. To prevent conception, the woman should abstain from intercourse until after 3 days of temperature rise.
What is symptotherma method? what are primary and secondary sign of ovulation?
The symptothermal method relies on identifying the primary signs of fertility: changes in cervical mucus; BBT; and the position, consistency, and opening of the cervix.
s.
The symptothermal method also uses observation for secondary signs of fertility: cyclical breast, skin, hair, mood, and energy changes; vaginal aching; spotting; pelvic pain or aching; and mittelschmerz (normal, lower abdominal or pelvic pain some women experience during ovulation). By charting primary and secondary signs, the woman detects
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How is the cervix during ovulation phase?
To receive sperm, as ovulation approaches, the cervix becomes softer and changes position to midline and the cervical opening (os) dilates slightly.
After ovulation, it reverts to its preovulatory state.
While squatting or standing with one foot on a stool or chair, the woman may place a finger in her vagina and feel for position, softness, or firmnes
What is lactation amenorrhea method?
How lactation amenorhea pattern is determined
infant sucking patten
mother’s employement
socio-cultural belief
What is electronic hormonal fertility monitoring?
The electronic hormoning monitor can detect the level of LH and estrogen in urine, identifying peak fertility days.
What is the effectiveness of Combined oral contraceptives?
99.7%
Advantages of Combined oral contraceptives?
Furthermore, COCs are easy to take, are well tolerated, maintain efficacy when an occasional dose is forgotten, and result in lighter menses. However,
Disadvantages of Combined oral contraceptives?
Protection for sexually transmitted infections (STIs, to include HIV), and for that reason, many women require the addition of a barrier method (e.g., condoms).
What are the first component of COC?
The first component, estrogen, provides some contraceptive effect by suppressing the release of follicle-stimulating hormone (FSH) but more importantly stabilizes the endometrium in order to maintain bleeding regularity
What are the name of the estrogen found in COC?
ethinyl estradiol and less commonly mestranol are the synthetic estrogens used in COCs.
What is the dose of estrogen in the COC?
the amount of estrogen contained in COCs has been decreased to less than 35 mg, thereby significantly improving both safety and tolerability
What is the second component found in COC?
COCs is a synthetic progesterone, which is classified by “generation.”
How does progesterone work in COC?
Progesterone provides the vast majority of the contraceptive effect by suppressing both the FSH and LH. The result of these altered hormonal conditions is suppression of ovulation, thickening of cervical mucus, and the creation of hormonal conditions within the uterus that are unfavorable for implantation
Side effect of Progestin?
A side effect of the progestin component is androgenization, which can cause acne, hirsutism, and weight gain.
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How many pills does monophasic preparation have?
Most monophasic preparations contain a pill that is taken for 21 days followed by 7 days of inert pills (placebo) that exist only as a daily placeholder until the next round of active pills begins.
How many types of COC are found?
Monophasic, biphasic, triphasic, quadriphasic.
what are the absolute contraindication for COC?
(a) women who are breastfeeding and less than 6 weeks postpartum;
(b) those who are older than 35 years and smoke greater than or equal to 15 cigarettes per day;
(c) women with a systolic blood pressure greater than or equal to 160 mmHg;
(d) those with vascular disease;
(e) those with known heart disease, valvular disease, or stroke;
(f) those with current breast cancer; (
g) those with a history of diabetes with target end-organ damage; and
(h) those with active viral hepatitis, cirrhosis, or liver cancer (
. Thromoboembolism, pulmonary embolism and immobilization due to suergery.
It is considered safe to prescribe COCs to women with normal blood pressures
140 /90 mmhg
Women with poorly controlled hypertension and smokers are better candidates for 1, ,,, 2,,,, 3,,,,,,,
progesterone-only methods, IUDs, or barrier contraception
What type of hormonal contraceptive would be use ful for people who have Thromoboembolism, pulmonary embolism and immobilization due to suergery.
Progestin only
You should not give_________ migraine with aura
COC
You could give_________for migraine without aura
COC
Migraine with aura have more chances of having_______
stroke
Many women who take COCs (particularly triphasic preparations) experience a significant decrease of ________
acne
Most common side effect of COC?
The most common side effects of COCs include breakthrough bleeding (BTB), nausea, and mild headaches.
melasma (patches of pigmented skin discoloration), which usually dissipates slowly when the medication is stopped.
Most serious side effect of COC?
he acronym “ACHES” was developed as a mnemonic to help women remember these potential serious adverse effects.
Any woman who experiences ACHES should immediately stop taking her COCs and notify her provider. ACHES include: Abdominal pain (severe)
Chest pain (severe),
cough, or
shortness of breath
Headaches (severe),
dizziness,
weakness, or numbness
Eye problems (vision loss or blurring) or
speech problems
Severe leg pain (calf or thigh)
What is contraceptive patch?
The contraceptive patch and the contraceptive ring are estrogen/progesterone combination products that have the same mechanism of action as COCs.
Why contraceptive patch is more beneficial?
The patch and the ring are particularly advantageous to women who find the ritual of remembering a daily medication burdensome.
Do contraceptive patch and oral contraceptives share the same side effects, risks, contraindications, and noncontraceptive benefits as combined oral products.
Yes,Both products have a quick return to fertility, as ovulation usually occurs within a few cycles of cessation.
Contraceptive patch consist of a 20 cm2 square adhesive patch combining_________________
0.75 mg of ethinyl estradiol with 6 mg of norelgestromin,
How do you use this contraceptive patch?
Applied on the first Sunday after menses, the patch is worn for a week and then replaced for three consecutive weeks.
On the fourth week, no patch is worn, creating a withdrawal bleed.
Where do you use contraceptive patch?
It is placed on clean skin on any of the following areas: lower abdomen, upper arms, buttocks, and upper torso.
rs.
Contraceptive patch is avoided in which part of the body?
The breasts are to be avoided.
What happen if the patch is partially detached or become completely removed?
patch that partially detaches or becomes completely removed can be reapplied or taped on as long as it has been off for less than 24 hou
For obese patient ( or patient that are more than 198 pounds). What do you suggest?
No contraceptive patch
Suggest IUD or barrier method with hormonal pills.
What are contraceptive ring?
It is also called Nuva-Ring
. It is a soft and flexible 54-mm diameter ring that releases 120 mcg/day of etonogestrel and 15 mcg/day of ethinyl estradiol
what is the effectiveness of contraceptive ring?
It is 91%
When do you use contraceptive ring?
On the first Sunday after menses, the patient compresses the opposite sides of the ring and inserts it into her vagina.
Although the ring can be placed anywhere in the vagina to be effective, it tends to be less apparent to the patient and their partner in the deeper, posterior portion of the vagina.
The patient places the vaginal ring on the Sunday following menses and replaces it once a week for a total of 3 weeks. A ring-free fourth week creates a withdrawal bleed.
If it contraceptive ring falls out?
If it falls out, the patient should rinse it with water and put it back in place.
If the ring is out of the vagina for more than 3 hours during the first 2 weeks , what should you do>
If the ring is out of the vagina for more than 3 hours during the first 2 weeks it should be reinserted and a barrier method should be used for the next 7 days. n.
If the ring is out of place for more than 3 hours during the third week, what should you do?
If the ring is out of place for more than 3 hours during the third week, then a new ring should be inserted and a backup barrier method should be used for 7 days
Who commonly uses POP?
POPs are most commonly used by lactating mothers who are in the immediate postpartum period and do not wish a long-term progesterone-only solution, such as injectable medroxyprogesterone acetate. Efficacy rates may be lower for women who are not lactating.
Effectiveness of progesterone only contraceptives?
91% effective with typical use and 99.7% effective with perfect use
Efficacy rates may be lower for women who uses progesterone only pills and _____________________
who are not lactating
When can you start using POP?
POPs can be started as quickly as 6 weeks postpartum.
A woman who takes POP ( progesteron only pills) who is more than 3 hours late taking her medication __________________
should use a backup barrier method for any intercourse following the next 48-hour period
Which emergency contraceptive does not do abortifacient and not harm existing pregenancy?
EC is not an abortifacient and does not harm an existing pregnancy.
What are the common reason for prescribing Emergecny contracpetive?
Common reasons for prescribing EC include unprotected intercourse, a mistake in or failure of a contraceptive, or sexual assault.
name of the OTC that is used as emergency contraceptive?
levonogesteral
what is levonogesterol?
progesterone only product EC
How should you use levonogesterol?
one 1.5 mg tablet to be taken within 72 hours of unprotected intercourse.
Should you take levonogestrol if you are pregnant?
Levonorgestrel should not be taken if the patient believes she is pregnant; yet it will not harm an already existing pregnancy.
When does efficacy decreases for levonorgesteral?
Levonorgestrel is most effective if taken within 48 hours of unprotected intercourse; efficacy decreases at the 48 to 72 hour postintercourse time period
What is the effectiveness of levonogesterol?
85% effective in preventing a pregnancy, which otherwise would have occurred.
Common side effect of Levonogesterol?
Common side effects include spotting, spotting, mild abdominal pain, fatigue, headache, dizziness, and breast tenderness.
what are the other emergency contraceptive used except levonogestrol?
ULIPRISTAL
What is the trade name for Ulipristal?
ELLA
Why ELLA/ULIPRISTAL is better than levonogesterol?
that it can be taken up to 120 hours after unprotected intercourse.
What are the drawback for ULIPRISTAL?
are not found OTC
what is the single doese for ULIPRISTAL?
30 MG
COPPER IUD effectiveness?
99%
Copper IUD as per EC
It is 99% effective as EC and can be placed up to 5 days after the unprotected sexual intercourse event.
What is IUD?
T
Drugs that may decrease effectivness of Horomonal contraceptives
Drugs that may decrease effectiveness of CHC
- Antibiotics (rifampin only)
- HIV protease inhibitors
- Rifamycins
- Anticonvulsants
Side effect of IUCD?
•Local inflammatory response, alteration in cervical mucous
Contraindication for IUD
Contraindications
- Active PID, pregnancy, pelvic malignancy, undiagnosed vaginal bleeding, uterine abnormality
- Other contraindications exist, complete history necessary
How many IUD is present?
•5 IUDs available, all have slightly different insertion techniques
When do you place IUD?
•Place during menses or any time if reasonably certain woman isn’t pregnant
What medication can be for cramps related to IUD?
•NSAIDs can decrease cramping with procedure
Complication of IUD?
•Vasovagal reaction, perforation (uncommon), cramping, expulsion
F/up for IUD?
•Assess bleeding patterns, offer follow up in 6 weeks
Diaphragm method?
- 6 hours after intercourseSilicone dome, covers cervix
- Typical use 80-85% effective
- May increase urinary tract infections
- Wide seal, Caya
- Caya one size, Wide seal 6 sizes
- Pelvic exam required
Cervival cap
- Placed over cervix
- Effectiveness lower for parous women
- Can cause irritation
- Can’t be used during menses
- Available in 3 sizes
- Pelvic exam required
Cervical cap how many sizes
3
Can you use cervical cap during menses?
NO
Do you need pelvic exam for cervical cap and diaphragm
yes
Barrier method_ Vaginal contraceptive spong?
Polyurethane with hollow area that fits over cervix; placed over cervix.
How long can you use vaginal contraceptive sponge?
For 24 hours
Contraindication for vaginal contraceptive sponge?
HX of toxic shock syndrome
Barrier method- Spermicides?
Lower effectivenss if used alone, should be used with barirer method. Found OTC.
Condom types?
Male and female
Side effect of condom?
Decreas sensaton and cause irritation
Benefits of condom?
Offers protectiona gains STI and HIV
98% of effectiveness.
Condom technique on how to use?
The condom should have at least half an inch of space at the tip of the penis to serve as a reservoir for ejaculation. Immediately upon ejaculating, the male should withdraw from intercourse and the condom should be carefully removed and disposed
What kind of lubricant to use for condom?
Condoms can be used with either a water- or silicon-based lubricant—never with an oil-based lubricant as it places the integrity of the condom at risk. Condoms can be used with spermicidal applications. If a condom breaks or spills during sexual activity, health care providers should advise patients to consider EC.
Can you apply condom with spermicide?
Yes
What to do if condom break or spill during sexual activity?
If a condom breaks or spills during sexual activity, health care providers should advise patients to consider EC.
Effectiveness of femal condom?
With perfect use, female condoms are 95% effective
What kind of lubricant can be used for female condom?
Because female condoms are made of plastic, they can be used with any type of lubricant to include those that are oil based.
female condom break or spill, what should you be doing?
EC
Contraindication for diaphragm?
Women who have a prolapsed uterus are poor candidates due to inadequate diaphragm fitting.
How long should a diaphragm reamain after intercourse
A diaphragm must remain in place for at least 6 hours after intercourse, and for no more than 24 hours.
what makes contraceptive sponge?
a one-sized, absorptive polyurethane device that is impregnated with spermicide
How to use contraceptive sponge?
The concave portion of the device is placed against the cervix and the opposite side has a loop to use for removing the device after use.
Nulliparous or parous women- which women is more suitable.
The sponge is significantly more effective in nulliparous women than parous women
How long should contraceptive sponge be left ?
The sponge should be left in place for at least 6 hours and may be left in place for 24 hours.
Contraceptive sponge - does it need to be replaced after having sexual intercourse with one person?
It does not need to be replaced if there are multiple intercourse sessions within the 24-hour period
Depot medroxyprogesterone are two types; what are they?
DMPA-IM, given as a deep intramuscular injection, or DMPA-SC, given subcutaneously.
Depotmedoxyprogesterone defination
Injectable - progesterone only
Benefits of depo?
These progestin-only contraceptive injectables are highly effective, safe, convenient, long acting, reversible,
DMPA can be used postabortion or in postpartum breastfeeding mothers.
DMPA can be used for HIV person, and other medical condition.
because DMPA avoids first-pass metabolism, its efficacy is unaffected by a women’s use of other medications
DMPA can be initiated without a pelvic examination, blood or other lab tests, cervical cancer screening, and/or breast examination
choice for postpartum and lactating women, as well as women who cannot or do not want to take estrogen.
DMPA is associated with certain noncontraceptive benefits, such as a reduction in or elimination of premenstrual symptoms, absence of menstrual bleeding, a reduced risk of pelvic inflammatory disease (PID), a reduced risk of ectopic pregnancy, decreased risk of endometrial cancer, improvement in grand mal seizure control, and hematological improvement in women with sickle cell disease. DMPA-induced amenorrhea may make it a good contraceptive choice for women with menorrhagia, dysmenorrhea, fibroids, and iron deficiency anemia.
Side effect of Depo?
. Although women using this progestin-only contraceptive injectable often initially experience irregular bleeding and spotting, long-term DMPA use typically results in amenorrhea.
Side effects of DMPA include menstrual disturbances, weight gain, depression, decrease in bone density (reversible- once discontined), allergic reactions, metabolic effects, headaches, nervousness, decreased libido, and breast tenderness
70% of women experiencing infrequent but prolonged episodes of bleeding or spotting.
After the first year of use, close to 50% of women will experience amenorrhea
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Pathophysiology of depoprovera?
prevents pregnancy primarily through suppression of ovulation. A possible secondary mechanism of action includes thickening of cervical mucus, which decreases sperm penetration, and endometrial atrophy, which prevents implantation
When can you have DMPA?
DMPA can be started at any time during a woman’s menstrual cycle, as long as the health care provider is reasonably sure that the patient is not pregnant
Where do you insert DMPA IM or DMPA SC
DMPA-IM is injected into the upper arm or buttock. DMPA-SC can be injected into the upper thigh, upper arm, or abdomen
When can you give DMPA?
Every 12 weeks
DMPA has a 14-week duration of action and is recommended to be administered every 12 weeks, thereby providing a 2-week “grace” period for the patient.
The possibility of pregnancy should be ruled out in the case of any woman who is more than 2 weeks late for her DMPA injection.
What is the absolute contraindication for DMPA use?
A current diagnosis of breast cancer is the only absolute contraindication to DMPA use.
Impact of fertility while taking depo?
Women need to be informed of the likely delay in fertility after DMPA use. Return to fertility after a DMPA-IM injection averages between 9 and 10 months, with some studies showing that fertility may not be restored for as long as 22 months
DMPA is the best choice for what kind of patient?
DMPA is not the best choice for women who wish to become pregnant within the next 1 to 2 years and should be counseled about alternative contraceptive options.
Immediate attention while using DEPO?
If you think you might be
pregnant
Repeated, very painful headaches
Depression
Severe, lower abdominal pain
Pus, prolonged pain, redness, itching, or bleeding at the injection site
Any other concerning symptoms
For how long Copper IUD is approved for?
approved for 10 years of use, although studies indicate effectiveness for up to 12 years
How does IUD work?
creating a spermicidal environment.
It causes the uterine endometrium to initiate a foreign body reaction, which results in sterile inflammation and inhibits sperm from reaching the fallopian tube.
Side effect of Copper IUD?
Some women who use a copper IUD complain of heavier, longer, and more uncomfortable menstrual periods.
Blood loss increases
Levonorgestrel intrauterine system.
Skyla. Both levonorgestrel IUSs are made of soft, flexible plastic and contain a hormone-releasing reservoir
What are the types of levonorgestal intrauterine system?
Mirena releases 20 mg of levonorgestrel per day, while the Skyla releases 13.5 mg of levonorgestrel per day.
How does levonorgesterol work?
It works by thickening cervical mucus (making it difficult for sperm to penetrate), and also by inhibiting ovulation in some patients
Should you remove IUD when patient have PID?
Women who develop PID can be treated with antibiotics while the IUD is in place.
The IUD should only be removed if the patient fails to improve within 72 hours of initiation of antibiotic therapy
When can IUD be placed?
Insertion of an IUD may take place at any time during the menstrual cycle, provided the woman is not pregnant.
Procedure while inserting IUD?
Before insertion, a bimanual examination is done to determine the uterine position.
The procedure to place the IUD begins similar to a Pap smear, with the insertion of a speculum into the patient’s vagina.
If clinically indicated, a test for chlamydia and gonorrhea can be performed.
The cervix is then thoroughly cleansed and sounding of the uterus, with appropriate instrumentation, takes place.
The IUD is then inserted through the cervix, into the uterus per manufacturer guidelines, using sterile technique
. The IUD threads are made of a monofilament-type string and should be cut at a length to allow the thread to wrap up and around the cervix, approximately 3 cm. The length of the strings should also be noted in the patient’s record
What happen if the thread is too short?
If the threads are cut too short, the woman’s partner may complain of discomfort or a poking sensation with intercourse and/or the IUD may be more difficult to reach when removing.
Common side effect of IUD?
The most common side effect related to IUD use includes change in menstrual patterns. Although not medically harmful, menstrual pattern changes may prove uncomfortable or even unbearable to the patient. Irregular bleeding is common in the first few months of use and is a common reason for discontinuation.
Women’s Health Care in Advanced Practice Nursing (p. 402). Springer Publishing Company. Kindle Edition.
Common side effect of progesterone releasing IUS?
For women using progesterone-releasing IUSs, light bleeding or irregular spotting is to be expected in the early months of use.
Once endometrial suppression has been achieved, 25% of women will experience significantly decreased menstrual bleeding while 50% experience amenorrhea or no menstrual bleeding
These side effects can include hirsutism, acne, weight changes, nausea, headache, mood changes, breast tenderness.
What are the chances of expulsion?
Within the first year of IUD use, 2% to 10% of users spontaneously expel the device.
ulliparity, age less than 20 years, menorrhagia, severe dysmenorrhea, and placement immediately postpartum increase the chance of expulsion
What to do if you have expulsion?
Although expulsion is not a medical emergency, patients should use a backup method of birth control until they can see their health care provider.
What if you become pregnant while using IUD?
Ectopic pregnancy
What if the you get pregnant with IUD? What should you do with IUD?
If the pregnancy is intrauterine and the device is confirmed to be in the uterus, removal is most often recommended due to increased risk for sepsis, spontaneous abortion, and preterm birth
Diffferences between copper IUD and Progesterone releasing IUS?
Women who choose a copper IUD need to be counseled that they may experience heavier, longer, and more painful menstrual periods.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may help with bleeding and pain.
Conversely, women using progesterone-releasing IUSs may completely stop having menstrual periods.
Does the menstrual period will return once the IUD and IUS is removed?
Women should understand that menstrual periods will return once an IUD/IUS is removed.
How IUD is removed?
The IUD is removed by securely grasping the threads at the external cervical OS with ring forceps and gently and evenly pulling the IUD out. Asking the patient to bear-down and cough three times can be a useful distraction technique during removal. If significant resistance is met, all removal attempts any treatment. Women should understand that menstrual periods will return once an IUD/IUS is removed.
What are two female sterilization?
There are two methods of female sterilization available in the United States: transcervical sterilization and tubal ligation.
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What is the other name of transcervical sterilization?
the Essure® procedure.
later removed
What is tubal ligation?
Tubal ligation sterilization is performed using a laparoscopic approach under general anesthesia.
Surgical sterilization for women prevents fertilization by cutting, tying, or clipping the fallopian tubes.
what if patient become pregnant with tubal ligation?
If the procedure fails and the patient becomes pregnant, the chance that it will be ectopic is considerable
Complication of tubal ligation
there is a risk of hemorrhage, infection, and death from anesthesia-related complications.
Vasectomy
vasectomy, blocks fertilization by cutting or occluding both vas deferens so that sperm can no longer pass out of the body in the ejaculate
Success of a vasectomy must be confirmed through _________
.
semen analysis
Common complain after the vasectomy
The most common complaints after the procedure are swelling of the scrotum, bruising, and minor discomfort. Pain medication and local application of ice are helpful in the immediate post-procedure period.
What is nexplanon?
Etonogestrel-containing subdermal implants (Nexplanon®) is a LARC ( long acting reversible contraceptive) that consists of a single rod inserted in the upper arm by a qualified healthcare provider.
What does nexplanon contain? How long does it last? What is it effectiveness?
The progestin released from the rod provides effective contraception (>99%) for up to 3 years, thus making this a convenient option for women who seek long-term contraception without a need for daily pills.
How long after you remove nexplanon, the ovulation occur?
Ovulation returns soon after removal of the rod (within 7 days). Nexplanon® is radiopaque and visible on x-ray,
Common adverse reaction of nexplanon?
Common adverse effects include irregular bleeding patterns and headache.
Does nexplanon works like other progestin oral contraceptive.
YES. Check the chart from USMEC.
As with the other progestin-based hormonal contraceptive option, the implant is acceptable (US MEC 1 or 2) for use in women with a variety of health problems including known thrombophilia (US MEC 2).
