Exam 1 - Contraception Flashcards
In order to start contraception, a patient needs to meet reasonable certainty that she is not pregnant. What are the points that a women must meet at least one of?
- 7 days or less 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 or less after spontaneous/induced abortion
- Is within 4 days postpartum
- Is fully or nearly fully breast feeding, is amenorrheic AND < 6 months postpartum
What are some advantages and disadvantages of using male condoms?
Advantages: reduces transmission/acquisition of STIs, readily available, usually inexpensive
Disadvantages: May break or fall off
How is a cervical cap used for contraception?
- Can be left in place for 48 hours
- Must leave in for minimum of 6 hours after sex
How is a diaphragm used for contraception?
- Can be left in place for 24 hours
- Must leave in for minimum of 6 hours after sex
How is a condom for women used for contraception?
Can be inserted up to 8 hours in advance
How does a sponge work for contraception?
- Releases continual spermicide
- Must leave in for at least 6 hours after sex
How does a spermicide work for contraception?
- Attacks sperm flagella and body, reducing their motility
- Can be used alone or with other barrier methods
What are some advantages versus disadvantages of using female controlled barriers?
Advantages: immediately active, no effect on menses/hormones
Disadvantages: UTI risk w/ diaphragm, no HIV protection
What are the emergency contraception options?
- Plan B or Preven are available OTC and must be taken within 72 hours of unprotected intercourse
- Paragard IUD must be inserted by HCP within 5 days of unprotected intercourse
What is the MOA of combined oral contraceptives?
- Main: Inhibits GnRH, LH, FSH, and mid-cycle surge; ovulation suppression
- Also thickens cervical mucous and thins endometrial lining
What should you test prior to prescribing combined oral contraceptives?
Test BP prior to starting to look for severe/uncontrolled HTN
What are some major risks of taking combined oral contraceptives?
- Hypertension
- Venous Thromboembolism
- MI and Stroke
What are two names of progestin only oral contraception?
When is it typically used?
Norethindrone and drospirenone
Usually used in nursing mothers or if estrogen is contraindicated
What is the MOA of progestin only oral contraception?
- Thickens cervical mucous to prevent sperm entry
- Thin endometrium
What are some side effects and limitations of progestin only oral contraception?
Side Effects:
- Increased spotting/intermenstrual bleeding
- Intermittent amenorrhea
Limitations:
- Limited window for missed pills ( > 3 hours late taking doses will decrease effectiveness)
What are absolute contraindications of combined oral contraceptives?
- Age 35 or older and smoking 15 or more cigarettes per day
- Uncontrolled HTN (SBP 160 or greater, DBP 100 or greater)
- Migraine with aura
- DM of > 20 years duration or with nephropathy, retinopathy, or neuropathy
- VTE (unless on anticoagulation)
- Known ischemic heart disease
- History of stroke
- Complicated valvular heart disease (pulmonary HTN, risk for A-fib, hx of subacute bacterial endocarditis)
- Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and HTN)
- Breast cancer
- Severe cirrhosis
- Hepatocellular adenoma or malignant hepatoma
What is the MOA of Depo Provera?
- Suppress ovulation
- Thin endometrial lining and thicken cervical mucous
When can Depo Provera be started and does it require any form of backup?
How often must you receive the injections?
Can be started at any time. No back up needed if starting within first 7 days of bleeding.
Repeat injections every 13 weeks.
What are advantages and side effects of Depo Provera?
Advantages: Reversible, safe for all ages including adolescents
Side effects: Changes in bleeding pattern (occasional heavy bleeding), weight gain, decreased bone mineral density (esp. in adolescents)
What are the transdermal contraception options?
- Nuva Ring
- Ortho Evra Patch
- Annovera
What are contraindications of using transdermal contraception options?
Same as COC:
- Age 35 or older and smoking 15 or more cigarettes per day
- Uncontrolled HTN (SBP 160 or greater, DBP 100 or greater)
- Migraine with aura
- DM of > 20 years duration or with nephropathy, retinopathy, or neuropathy
- VTE (unless on anticoagulation)
- Known ischemic heart disease
- History of stroke
- Complicated valvular heart disease (pulmonary HTN, risk for A-fib, hx of subacute bacterial endocarditis)
- Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and HTN)
- Breast cancer
- Severe cirrhosis
- Hepatocellular adenoma or malignant hepatoma
What is the MOA of the sub-dermal implants (Implanon, Nexplanon)?
- Thickened cervical mucous and inhibit tubal motility
- Inhibits follicular maturation and ovulation
What are advantages and side effects of using sub-dermal implants?
Advantages: long acting (up to 3 years), reversible, safe for all ages
Side effects: Unpredictable unscheduled bleeding, amenorrhea, weight gain (few pounds)
What is the MOA of the Levonorgestrel IUD?
- Changes cervical mucus to become thicker
- Alteration of endometrium prevents implantation of fertilized ovum
What are advantages of Levonorgestrel IUD?
What is a specific advantage of Mirena?
- Long acting (3-6 years of use)
- Mirena has been FDA approved to treat menorrhagia
What are advantages and side effects of the Copper IUD?
Advantages: Long acting (10 years of use)
Side effects: May increase menstrual blood loss and dysmenorrhea
What can occur if one becomes pregnant with an IUD?
Increased risk of pregnancy, spontaneous abortion, and preterm delivery
What is the MOA of the Copper IUD (Paragard)?
- Inhibits sperm motility so sperm rarely reach the fallpian tubes and are unable to fertilize the ovum
- Inflammatory reaction in the endometrium phagocytizes the sperm
What are the four types of progestin containing/Levonorgestrel IUD?
- Mirena (5 years)
- Kyleena (5 years)
- Skyla (3 years)
- Liletta (6 years)
