Emergency Contraception Flashcards
What are the indications for using emergency contraception?
- when no contraceptives have been used
- when a contraceptive method may have failed
What is the efficacy of emergency contraceptives?
80%
What is the mechanism of action of the levonorgestrel in plan B?
- it interferes with ovulation (prevents or delays ovulation is taken before ovulation)
- affects muscle contractility of the fallopian tubes, impairing oocyte transport and concentration of glycodelin A (an inhibitor of sperm binding)
- does not affect the endometrium or sperm implantation
- it delays the way that ova travels down the fallopian tubes and delays the sperm binding
Does plan B interfere with an established pregnancy?
- no
When in the cycle is taking plan B ineffective?
- when it is taken the day of or after ovulation
Does levonorgestrel have an effect if the sperm and the egg have already met?
no, it does not
In which subset of patients is levonorgestrel less effective?
- if the woman is weighing from 165 to 176 lbs – not at all effective for women weighing over 176 lbs
The effectiveness of levonorgestrel is dependent on the time it is taken after intercourse. What are the time frames and efficacies of this?
< 24 hours: 95%
25-48 hours: 85%
49-72 hours: 58%
What is the dose of levonorgestrel in plan B?
2 tablets of levonorgestrel 0.75 mg to be taken together for a single dose of 1.5 mg as soon as possible after unprotected sex
What are the adverse effects associated with using levonorgestrel?
nausea, vomiting, cramps, fatigue, breast tenderness
for nausea can take dimenhydrinate 30 minutes prior
When should a patient see a physician after taking levonorgestrel if they have not has their period?
21 days after
If vomiting has occurred less than _____ after taking the pill, then tell the patient that it is important that they take another 2 pills of levonorgesterol
2 hours
What is considered to be the most effective form of emergency contraception?
copper IUD
How long after unprotected sex can the copper IUD be inserted to still have benefits as an emergency contraceptive
7 days
- can remain in the uterus for 30 months after insertion
What is the mechanism of action of the copper IUD as an emergency contraceptive?
- causes inflammation of the uterus, as well as the copper ions are toxic to the sperm and oocyte
- it inhibits implantation
What is the mechanism of action of uliprisal acetate as a method of emergency contraceptive?
- inhibits or delays folicular rupture when given prior to the LH surge
- ineffective if given on day of the LH surgery (ovulation)
- endometrium is not affected
- requires an rx
- single dose of 30 mg, to be taken as soon as possible within 5 days after unprotected intercourse
- more effective than levonorgestrel especially at day 4 or 5
Ulipristal acetate may have less efficacy in women with a BMI over what?
35 kg/meter squared
What is the dose of medication in the Yuzpe method?
- 2 doses of 100 mcg ethinyl estradiol and 0.5 mg levonorgestrel given 12 hours apart
- it is less effective and more SE versus levonorgestrel and ulipristal
What is so finicky about yuzpe method?
- have to be taken exactly 12 hours apart
What is contained in mifegymiso?
200 mg of mifepristone (oral) and 800 micrograms of misoprostol which is taken 24 to 48 hours after mifepristone
Mifegymiso is indicated for pregnancy termination up to _____
49 days
What are the advantages associated with using a male condom?
- acts as a mechanical barrier
- prevents against STIs
- pregnancy prevention
- convenient, widely available, easy to use
- used only when needed
- no systemic effects
- inexpensive
- discreet
What is the disadvantage of using a male condom?
- requires motivation to use and practice for proper use
- may reduce sensitivity
- may interfere with an erection
- may deteriorate in storage or when oil based lubricants are used
- allergies or sensitivity to latex in some women
- there is a typical failure rate of 18%
What kind of lubricants can latex condoms be used with?
with oil based lubricants
What kind of condoms are used for individuals with latex allergies?
- polyurethane or polyisoprene
Are condom breakage and slippage more common in latex or polyurethane?
more common in polyurethane – polyisoprene is a synthetic version of latex and is softer and more stretchy
What kind of lubricants can be used with polyurethane and polyisoprene condoms?
water based lubricants
What comprises a female condom?
nitrile sheath with 2 flexible rings
How should a female condom be disposed of?
- need to squeeze and twist the outer ring before standing up to keep the semen inside of the condom
What are the advantages of using a female condom?
- can be inserted 8 hours prior to intercourse
- safe to use with a latex sensitivity
- no deterioration when exposed to oil based lubricants
- has a longer shelf life than male condoms
What are the disadvantages of using female condoms?
- typical failure rate is 21%
- no data for nitrile polymer regarding efficacy and prevention
- more expensive than male condoms
- fit is affected by the vaginal anatomy
- difficult to insert
What is the most commonly used spermicide
nonoxynol-9 - this destroys sperm
What does frequent use of spermicide sometimes lead to?
- may lead to irritation and lesions on genital mucosa (which may increase risk of transmission of infections) -inflamed, open skin increased STI transmission
Spermicide use should be avoided in the case of what?
if multiple acts of daily intercourse
Spermicide gels should be used with a ____ or _____-
diaphragm or cervical cap
How should contraceptive foam be used?
- VCF foam - insert 1 applicator full no more than 1 hour prior to each act of intercourse
How should contraceptive film be used?
- should be inserted 15 minutes (up to 3 hours) before intercourse
- one film should be use per act
How many times can you use a contraceptive sponge?
- single use
What are the timeframes that patients should be aware of when using a contraceptive sponge?
- inserted up to 24 hours before intercourse
- must be left in the vagina for at least 6 hours after the last act of intercourse
- should remain for no more than 30 hours in the vagina (risk of TSS increases after 30 hours)
- mechanism of action:
- provides a physical barrier to sperm
- absorbs the sperm
- contains a spermicide
What are the advantages of contraceptive sponges?
- 12% failure rate in nulliparous women
- 24% failure rate in parous women
- one size fits all
- 24 hours of protection
- protection begins right away
- no need to change with repeated acts of intercourse
- can be used with male condoms
What are the disadvantages of contraceptive sponges?
- contraindicated in those with allergies or sensitivity to spermicidal
- difficulty in removing
- must remain in the vagina for at least 6 hours after intercourse
- must not be left in the vagina for over 30 hours
- recommended to avoid in those with a history of TSS
- increased changes of urinary infections
- no protection from HIV
- sponge may damage vaginal tissue and increase chances of HIV transmission
What are the contraindications of using a sponge or spermicide?
- being at high risk of HIV
- being HIV positive, or having AIDS due to increased chance of transmission to uninfected sexual partners
- allergy to nonoxynol-9
- history of TSS
- inability to correctly insert
- repeated UTIs
- full term delivery (within 6 weeks), recent abortion (spontaneous or induced), vaginal bleeding
Describe the diaphragm being used as a contraceptive?
- diaphragm is an intravaginal barrier used with gel (used with spermicidal gel)
- woman has to be fitted for this, and then an rx is written for the woman
What are the three types of diaphragms that are available in Canada?
- Milex wide seal silicone
- Milex arcing
- Caya SILCS
What is the steps for properly using a diaphragm?
- insert up to 2 hours prior to intercourse
- additional acid-buffering lubricant needed to be inserted with an applicator for repeated acts of intercourse or if more than 2 hours since diaphragm is inserted an intercourse has not yet occurred
- must remain in place for a minimum of 6 hours after intercourse
- must be removed before 24 hours after initial insertion
- wash with warm water and mild soap
What are the advantages of diaphragm?
- 12% failure rate
- can be inserted up to 6 hours prior to intercourse
- easier to insert than the cervical cap
- can be used during menstruation
- can be re-used for subsequent acts of intercourse
- re-usable for several years
What are the disadvantages of using a diaphragm?
- higher risk of UTIs
- required practice to insert prior to first time use
- risk of TSS
What hormone is used to detect pregnancy?
- use human chorionic gonadotropin (HCG)
- detected in blood or urine after 6-8 days after conception
- highest concentration between 9 am - 12 pm
- concentration doubles every 2 days, peaks in 60-70 days
- initial tests use urine, then confirmed with a blood test
What are the concentrations of HCG after conception?
- after 1 week: 5 mlU/ml
- peaks at 100000 mlU/ml
- blood tests can detect levels at 1 mlU/ml
- urine tests can detect levels at 20 to 100 mlU/ml
False negative tests can occur up to ____ days after insemination
17
What are some other errors that can lead to false results?
- expired test kit
- no following time recommendations
- testing too early
- testing too late
- soap residue, blood or protein in urine sample
- cloudy, pink or red urine
- strong urine odour
- warm or hot water rinsed of surface before or after the sample
- use of fertility drugs
Low levels of what during perimenopause and menopause may result in vaginal dryness?
estrogen
Decrease in estrogen can cause what?
- thinning of the vaginal tissue
- loss of collagen support
- increased vaginal pH
- reduced production of vaginal lubrication even with sexual arousal
What is considered perimenopause?
when menopause has not quite occurred - less than 1 full year that a woman has not had her period
What is the difference between a vaginal lubricant and a vaginal moisturizer?
Lubricants: used for vaginal dryness, dyspareunia and comfort with condom use
- used during intercourse
Moisturizers: replens contains bioadhesive polymers that bind to vaginal epithelium and provide water and electrolytes to cells
- longer duration of action compared to lubricants (2 to 3 days)
- used on a routine basis - not immediately before intercourse
