E1: Contraception Flashcards
What populations are at higher risk for unplanned pregnancy?
- 18-24 years old
- black or Hispanics
- education less than high school diploma
- low income
- women who are cohabiting but never married
In order to start contraception, what must your confirm with your patient?
That they are NOT pregnant
Other than a pregnancy test, how can you confirm that your patient is not pregnant?
- ≤ 7 days after start of normal menses
- No sexual intercourse since the start of the last normal menses
- Has been correctly and consistently using a reliable method of contraception
- is ≤ 7 days after spontaneous or induced abortion
- is w/in 4 weeks postpartum
- is fully breastfeeding, is amenorrheic, AND < 6 months postpartum
What are the methods for natural family planning?
- Standard days/calendar method
- cervical mucous/two day method
- basal body temp method
- symptothermal method
What is the standard days/calendar method of family planning?
- standard days: for women with menstrual cycles from 26-32 days long, abstain from sex on days 8-19
- calendar: for women who dont have 26-32 cycle lengths, monitor cycles for 6 months.
How do you calculate the fertile period in the calendar method of family planning?
The first day of the fertile period is by taking the length of the shortest menstrual cycle ( the first day of period to the first day of the next period) and subtracting 18. The last days of the fertile period is by taking the length o the longest menstrual cycle and subtracting by 11. Avoid sex in the fertile period.
What is the basal body temperature method of natural family planning?
-check basal body temperature upon awakening every AM before getting out of bed. Rise in temp of 0.5-1 F indicated ovulation. Abstain from sex from end of menstrual period until 3 days after temperature increase
What is the symptothermal method of natural family planning?
A combination of cervical mucus and basal body temperature methods
What are the barrier methods of birth control?
Diaphragm, condoms, cervical caps, and cervical sponge
How is a cervical cap used?
May be left in for 48 hours, but must be left in for a minimum of 6 hours after sex
How is a diaphragm used?
Can be left in place for 24 hours, but must leave in for a minimum of 6 hours after sex
-increased risk of UTI
How does a cervical sponge work?
- releases continual spermicide
- must leave in for a minimum of 6 hours after sex
How do spermicides work?
- attacks sperm flagella and body, reducing motility
- immediately active
What are the two forms of EC?
Oral tablets and IUD insertion within 5 days of unprotected sex (paraguard interferes with implantation)
How are oral tablet EC used?
Two doses of contraceptive pills taken within 72 hours of unprotected sex
How does the EC Ulipristal acetate work?
- Brand name Ella
- Selective progesterone receptor modulator, effective for up to 120 hours (5 days) post intercourse
What are the short acting or frequent use options for birth control?
- oral contraceptive pills
- Nuva ring
- orthoevra patch
- Depo
Who are the best candidates for short acting or frequent use birth control?
- women who have a short interval prior to wanting a pregnancy
- women who are not looking for long term pregnancy prevention
- women using these methods for non contraceptive benefits
- uninsured women with financial concerns
What are combination oral contraceptives (COCs)?
- Combination of an estrogen and a progestin (progestin type differs in different pills)
- main mechanism is ovulation suppression (inhibits GnRH, LH, and FSH)
- Thickens cervical mucous and thins endometrial lining
What are monophonic combination pills?
-single dose of estrogen and progesterone for 21-24 days, and placebo pills for 4-7 days after
What are triphasic combination pills?
-differing dose of estrogen and progesterone throughout the course of the pack, plus placebo pills usually for 7 days
What are continuous combination pills?
- usually monophonic
- packaged with 84 active pills and 7 placebo pills or 365 of active pills
What are the side effects of COCs?
- unscheduled bleeding
- nausea
- breast tenderness
- headache
- intentional amenorrhea
What are the advantages to using COCs?
- reversible almost immediately
- safe
- can be used for extended periods
- decreased blood loss and cramps
- decreased acne
- prevention of ovarian cysts
What are the risks associated with COCs?
- HTN
- DVT
- MI/Stroke
- lipid changes
What kind of medication are norethindrone and drospirenone?
Progestin only pills (POP) or the “mini pill”
How do progestin only pills work?
- thickens cervical mucous to prevent sperm entry, thins endometrium to inhibit implantation, slows sperm motility, and ovulation suppression in 50% of cycles
- can be initiated at any time
What are the advantages to progestin only pills?
- Reversible
- safe
- may be used by women with contraindications to estrogen
What are the side effects of POPs?
Increased posting and intermenstrual bleeding, intermittent amenorrhea
What are the limitations to POPs?
-Limited window for missed pills (>3 hours late taking dose will decrease effectiveness)
What are the contraindications for COCs?
- Age ≥ 35 yers and smoking ≥ 15 cigs/day
- uncontrolled HTN
- Migraine with aura
- DM of >20 yrs or with nephropathy, retinopathy, or neuropathy
- VTE
- Known ischemic disease
- Hx of stroke
- complicated valvular HD
- Risk factors for arterial CVD
- Breast CA
- cirrhosis
- Hepatocellular adenoma or malignant hepatoma
What does it mean when a birth control is category 1?
There is no restriction for use of the contraceptive method for a women with that condition
What does it mean if a birth control method is category 2?
Advantages of using the method generally outweigh the theoretical or proven risks
What does it mean if a birth control method is category 3?
Theoretical or proven risks of the method usually outweighs the advantages- not usually recommended unless more appropriate methods are not available or acceptable
What does it mean if a birth control method is category 4?
Unacceptable heart risk if the contraceptive method is used by a women with that condition
What is the MOA of Depo Provera?
Supper ovulation, thin endometrial lining, and thicken cervical mucous
What are the advantages of Depo Provera?
- Reversible (but there can be a delay up to a year to resume ovulation)
- safe for all ages
What are the side effects of Depo Provera?
- Changes in bleeding pattern (occasional heavy bleeding)
- Weight gain
- Decreased bone mineral density
What are the transdermal birth control options?
Nuva ring, ortho Evra patch, and annovera
What are the contraindications to transdermal birth control?
Same as COCs
What hormones are in transdermal birth control?
Estrogen and progesterone
What is the MOA for sub dermal implants?
- Thickened cervical mucus and inhibits tubal motility
- inhibits follicular maturation and ovulation
What kind of hormones are in the sub dermal implants?
Progestin only
What are the advantages to sub dermal implants?
- Long acting
- reversible
- safe
What are the side effects of sub dermal implants?
- unpredictable unscheduled bleeding or amenorrhea
- weight gain
- good for women with estrogen contraindications
What is the MOA of Levonorgestreal IUDs?
Changes cervical mucous to become thicker, alteration of endometrium prevents implantation of fertilized ovum
What are patients who are on Levonorgestrel IUDs at increased risk for?
-Increased likelihood of amenorrhea the longer the are on it, leading up to amenorrhea the will have increased spotting and increased risk of ovarian cysts
Which IUD has been FDA approved for menorrhagia?
Mirena
What is the MOA of copper IUDs?
- Copper ions inhibit sperm motility so sperm rarely reach the Fallopian tubes and are unable to fertilize the ovum
- Inflammatory reaction in the endometrium phagocytizes the sperm
What are the side effects of Copper IUDs?
-May increase menstrual blood loss and dysmenorrhea
What are the associated risks with all IUDs?
-increased risk of ectopic pregnancy, spontaneous abortion, and preterm delivery if become pregnant
What are the 4 kind of progestin containing IUDs?
Mirena, Kyleena, Skyla, and liletta
What are the options for female sterilization?
- Laparoscopic or abdominal tubal ligation
- Salpingectomy
- and Hyesteroscopic sterilization (ensure, off market)
What is the MOA of tubal ligation?
Interrupts Fallopian tube and prevents fertilization
What the is the MOA of vasectomy?
- Interrupts vas deferens preventing passage of spermatids into seminal fluid
- alternative contraceptive needed until 2 consecutive sperm samples show no motile sperm
