contraceptives Flashcards
List the 5 barrier methods
spermicide
sponge + spermicide
condoms
diaphragm
cervical cap
List the 5 non-barrier methods
periodic abstinence/fertility awareness
combination OCP
progestin only OCP
patch
vaginal ring
spermicide MOA
destroys cell wall to inactive sperm
disadvantages of spermicide
increased discharge
could take time to melt
sponge + spermicide MOA
mechanical barrier that inactivates sperm
advantages of sponge + spermicide
absorbs excess fluids
lower risk of UTI than diaphragm
disadvantages of sponge + spermicide
increase risk of STI transmission
slight risk of toxic shock/infection
hard to place & remove
do you NEED condoms w/ the sponge method?
it may be needed in first few months
when can you put in the sponge?
put in up to 24 hrs before and can leave in for up to 30hrs
condom MOA
mechanical barrier
most have spermicide
which one is more effective- male or female condom?
male is more effective and less expensive
diaphragm MOA
sperm inactivation– mechanical barrier
disadvantages of diaphragm
must keep in for 6hrs AFTER sex but not more than 24hrs
increased risk of urethritis/cystitis
should add spermicide
discomfort
cervical cap MOA
sperm inactivation– mechanical barrier
what is the least effective barrier method?
spermicide (28% failure rate)
what is the most effective barrier method?
diaphragm w/ spermicide
fertility awareness MOA
avoid sex 5 days before and 3 days after ovulation; keep track of basal temp
fertility awareness disadv
some ppl cant identify cervical mucus changes and BBT patterns
irregular cycles make it hard
restricts spontaneity
needs extensive record for several cycles before its reliable
combination OCP MOA
suppresses GnRH, FSH, LH, LH surge, ovulation by giving hormones to induce negative feedback
stops follicle development
stops sperm penetration at cervix via cervical changes
Progestin only OCP MOA
keeps uterus at basal layer (right after menses) so proliferative phase never happens
suppresses the same things as combination OCP
combination OCP advantages
less menses, anemia, dysmenorrhea
can tx endometriosis, fibrocystic breast dz, functional cysts, PCOS, acne
progestin only OCP advantages
no estrogen makes it safer for lactating people
safer in smokers compared to combined OCP
disadvantages of progestin only OCP
must take everyday w/o placebos
breakthrough bleeding is common
less non-contraceptive benefits
contraceptive patch MOA
ovulation suppression
cervical mucus & endometrium changes
contraceptive patch user directions
change patch 1/week for 3 weeks then one week patch-free
contraceptive patch benefits
same non-contraceptive benefits as combined OCP bc it has both estrogen and progesterone
contraceptive patch disadvantages
less effective in ppl >198 lbs based on serum estrogen levels
possible increased risk of venous thromboembolism
vaginal ring MOA
same as patch and OCP
user directions for vaginal ring
keep ring in for 3 weeks, remove for one week
nuva ring disadvantages
placement and expulsion issues
if it comes out it must go back in within 3 hrs!
systemic side effects like OCPs
what are the Long Acting Reversible Contraceptives (LARCs)?
IUD
nexplanon
Depo shot
IUD mechanism
inhibits sperm migration, fertilization
inhbits ovum transport
copper is toxic to sperm
which IUD DECREASES menstrual sx and dysmenorrhea?
progesterone IUD
which IUD could INCREASE dysmenorrhea
Copper IUD– also heavier periods initially
which IUD could cause irregular bleeding or amenorrhea?
non-copper/progesterone IUDs
life span of various IUDs
progesterone lasts 3-6 yrs
paraguard/copper lasts 10 years
risks of IUD
rare- expulsion
risk of perforation of uterus or cervix
risk of infection w/ possibility of secondary infertility or long term pelvic pain
extra caution when inserting into soft uterus
nexplanon MOA
changes in cervical mucus
ovulation suppression
advantages of nexplanon
no estrogenic SE
decreased menstrual flow & related anemia
good for lactating women
disadvantages of nexplanon
irregular bleeding patterns– frequent spotting, amenorrhea
SE– wt gain, HA, abdominal pain, acne, mood swings
user instructions for nexplanon
inserted while patient has period, use backup for 7 days
Depo shot MOA
changes in cervical mucus and endometrium
ovulation suppression
two most effective LARCs
IUD & Nexplanon
Depo shot instructions
shot ever 3 months
advantages of Depo
no estrogenic SE
disadvantages of Depo
risk of osteopenia esp in first 2 yrs of use; calcium, Vit. D intake needed
irregular bleeding common early, unpredictable, often leads to amenorrhea after several injections
possible delay to fertility
4 SEs of Depo shot
HA, wt gain, nausea, dizziness
how does emergency contraception work
1+ of the following:
delays ovulation
interfere w/ fertilization or tubal transport
altered endometrial receptivity to implantation
regression of corpus luteum
which contraceptives can be used for emergency?
any IUD, paraguard can be used up to 5 days after
combination OCP
Plan B, progestin only contraceptive
what are the two methods of sterilization?
tubal ligation and vasectomy
tubal ligation MOA
disruption of tubal patency
removal of fallopian tube
disadvantages of tubal ligation?
difficult to reverse
requires anesthesia since its a laparoscopic surgery
complications involved
complications of tubal ligation
hemorrhage
adhesions
bowel damage
uterine perforation
infection
vasectomy MOA
disruption of vas deferens
complications of vasectomy
hemorrhage
hematoma
infection
contraindications for IUD
PID
fibroids (+/-)- not all super bad
contraindications for OCP
> 35 + smoker
liver, CV, PV dz
DVT
estrogen based tumor
undiagnosed AUB
NON-contraceptive benefits to OCP
it can be used to address:
dysmenorrhea
acne
anemia from heavy periods
menstrual HA
w/ OCP what happens if patient misses 2+ pills, 48hrs
take 2 pills and use backup for 1 week
w/ OCP what happens if patient misses a pill in week 3?
skip placebo pills & start next pack
what happens if a pill missed in first week & person had unprotected sex in the 5 days before?
they should consider emergency contraceptive
