Ex. 5 L1: Preventative Health/Nonhormonal Contraception (43) Flashcards
Menstrual cycle
Two Phases:
Follicular
-Onset of menses through ovulation
Luteal
-Ovulation through onset of next menses
Drop in estrogen -> LH surge -> release of matured follicle (ovulation)
Preventative health: annual exam
Vital signs
Breast exam
Pelvic exam and or screening
Breast exam
Average risk women:
-Self exam or clinical breast exam (varying recommendations)
-Mammogram
Recommended to start by age 40-50
Complete every 1-2 years
Continue until age 75 or when life expectancy is less than 10 years
High risk women:
-I.e. BRCA1 or BRCA2 gene mutations and first-degree relatives
Recommended to receive breast MRI and a mammogram annually starting at age 30
Pelvic exam
Utility
-Screening tool for STIs, gynecologic cancers, pelvic inflammatory disease, ovarian cysts, polyps or fibroids
Components
-Assessments of external genitalia, internal speculum exam or rectovaginal exam
Recommendation
-Not routine in asymptomatic patients
-Performed when indicated by medical hx or symptoms
Cervical screening (PAP) recommendations:
21-29: Pap every 3 years
30-65: Anyone:
-Pap smear every 3 years
-HPV testing every 3 years
-Co-testing (Pap + HPV testing) every 5 years
> 65 years (no prior screenings were normal)
-No screening
Hysterectomy with cervix removal
(no screening)
Additional screening and counseling (PAP)
Cancer
-Endometrial, ovarian, colorectal
Substance use
Domestic violence
Hyperlipidemia
HTN
Diabetes
STIs
Thyroid function
Infertility
Osteoporosis
Obseity
Eating disorders
Sexual dysfunction
Depression
Anxiety
Contraception
Immunizations
HPV
-Most common STI in the US, containing >150 viruses
-14 million new infections every year
-Genital HPV affects 42.5% of adults aged 18-59
-Commonly causes warts (papilloma)
-Genital warts may lead to an increased risk of multiple cancers
HPV transmission
HPV associated cancer cases per year - female
Cervix
11,869
11%
Vagina
875
75%
Vulva
4238
69%
Anus
5150
93%
Oropharynx
3557
63%
HPV associated cancer cases per year - male
Penis:
1,364
63%
Anus:
2,410
89%
Oropharynx
17,248
72%
HPV prevention
Barrier protection (condoms, dental dams)
Mutually monogamous
Male circumcision
HPV screening
HPV vaccination
HPV screening
Patients w/a cervix
-Follow recommended cervical screening guidelines
Patients w/a penis
-Routine screening not currently recommended
Patients at higher risk include men who have sex w/men and or HIV+
May benefit from anal PAP smears
HPV Vaccines
Cervarix (2vHPV)
Serotypes: 16, 18
Admin - no longer available in the US
Gardasil (4vHPV) - no longer available in the US
Gardasil 9 (9vHPV)
Serotypes:
6,11,16,18,31,33,45,52,58
Admin schedule:
Start <15y/o: 2 dose series
-0,6-12 months
Staer >15y/o: 3 dose series
0,2,and 6 months
Females 9-45
Males 9-45
HPV vaccines ages
Ages 19-26:
-Administer 2 or 3 doses series in those who did not start or finish the vaccine series
Ages 27-45:
Vaccination provides less benefit after exposure
Risk vs benefit discussion
HPV vaccine - efficacy
Aged 16-26:
F: 98% cervical cancer
100% vulvar cancer
100% vaginal cancer
M: ~75%
Aged 27-45:
~88-95% effective genital warts, vulvar cancer, vaginal cancer, and cervical cancer in Females
Efficacy in men aged 27-45 is inferred based on this data
HPV Vaccine safety
Injection site reactions
Dizziness/Fatigue
HA
Syncope (fainting)
Vomiting
Myalgia
Role of provider in HPV assessment
Educate about HPV related risks
Give strong and clear recommendations
Utilize standing orders
Process or monitoring and follow up
-Protecting your patients from preventable cancers
_% of women aged 15-49 are currently using contraception
65
Ideal contraception
100% safe and effective
Easy to use
Independent of timing of intercourse
Affordable
Reversible
HIV/STI protection
Reasons for Non-Hormonal Contraception
Back-up hormonal method
SE or contradictions to hormones
No need for ongoing contraception
No alteration to body’s natural menstrual cycle
Behavioral Methods
Coitus Interruptus
Lactation Amenorrhea Method (LAM)
Fertility Awareness Methods (FAM)
Natural Family Planning (NFP)
FAM + NFP
Basal Body Temp (BBT)
-Predict Ovulation
-Regular cycles
-Initial drop in temp followed by a significant rise indicates ovulation
Billings Ovulation Method
-Cervical Mucus
-Irregular Cycles
Calendar/Rhythm Method
-based on past cycles
Standard Days Method
-26-32 day cycles
Two-Day method
-Cervical secretions
FAM + NFP Other methods
Sympothermal method
-Uses a minimal of 2 indicators at the same time
-May include other symptoms of ovulation
Electronic Monitoring
-Detect luteinizing hormone (LH) in urine
ClearBlue Fertility Monitor
OvuSense Fertility and Ovulation Monitor
Marquette Method
-Combination of ClearBlue Fertility Monitor and Other NFP methods
FAM + NFP App
Natural cycles
-First app approved by FDA to be marketed as a contraception method
Based on BBT and cycle data
App will prompt user to use protection on likely fertile days
Typical use failure rate: 7%
Perfect use fail: 1%
Monthly Subscription costs: $14.99
Partnership w/Oura Ring - Allows patient to skip manual temperature checks
FAM + NFP Summary
Advantages:
-No effect on hormones or menstrual cycle
-No SE
-Inexpensive or free
-Acceptable in many cultures and religions
Disadvantages
-No protection against STI
-Difficulty predicting ovulation in those w/irregular cycles
-Requires consistent and accurate record keeping
-Requires extended periods of abstinence or backup contraception
Effectiveness: 1-34% failure rate
Barrier Methods
Physically prevents sperm from entering the uterus
Used each time a person has intercourse
Used CORRECTLY each time
Many different options
Fewer SE and less efficacy compared to hormonal Contraception
Barrier method types
Male condom
Female condom
Vaginal sponge
Diaphragm
Cervical cap
Contraceptive Gel
Spermicide
Barrier Methods Summary:
Male Condom
Adv:
Low $$
HIV/STI protection
Easy to obtain
Disadv:
User dependent
Slippage/breakage
Female Condom
Adv:
-Insert up to 8 hrs before
-HIV/STI protection
Disadv:
-user dependent
Vaginal Sponge:
Adv:
Protects for 24hrs from insertion
Disadv:
User dependent
No HIV/STI protection
Diaphragm
-Insert 6-8 hrs before
-No systemic SE
Disadv:
-No HIV/STI protection
-Need proper fitting
-UTI/TSS risk
Cervical cap
Protects for up to 28 hrs
No systemic SE
Disadv:
-No HIV/STI protection
-Need proper fitting
UTI/TSS risk
Contraceptive Gel
-Insert immediately before or up to 1 hour
Disadvantage:
-1 dose for each act of interocourse
Vaginal infections
-No HIV/STI protection
Spermicide
-Low $$
-Easy to obtain
Disadvantage:
No HIV/STI protection
Irritation
Long Term Method
Copper IUD
-Prevents pregnancy up to 10 years
Can also be used for emergency contraception
Inserted and removed by HCP
Extremely effective - typical fail rate 0.8%
Non-hormonal - copper acts as a spermicide and prevents sperm from fertilizing eggs
$$$
No STI prevention
SE
-Heavy/painful bleeding
-Spotting
Permanent Methods
Surgery Sterilization
Effectiveness ranking
MOST:
Implant
IUD
Sterilization
Injection
Pill
Patch
Vaginal Ring
Diaphragm
Male Condom
Female Condom
Cervical cap
Sponge
FAM
Spermicide
