family planning

Question 1

STD Prevention

Answer 1

• patient will be advised to combine two methods to enhance pregnancy prevention but also STDs
• condoms = barrier to STDs
• is not effective against protection against STDs

Question 2

example of STD prevention

Answer 2

condoms and spermicidal foam or condoms and OCs

Question 3

IUD

Answer 3

○ IUDs are t shaped and made of plastic
○ Some have copper wire coating
○ Some release hormones
○ Inserted by a gyn provider in an outpatient clinic setting
○ ParaGard
○ Mirena
○ Have a string attached at the base of the “T” that hangs down through the cervix into the vagina
○ Make sure its in place by feeling for the string
○ Clinician uses string to remove IUD

Question 4

How does an IUD work?

Answer 4

■ Prevent sperm from joining with an egg by affecting the way they move
■ Hormone in mirena increases effectiveness
■ Thickens cervical mucus, which provides a barrier that prevents sperm from entering the uterus
■ IUDs prevent some women’s ovaries from releasing eggs (ovulation)
■ Alter the lining of the uterus

Question 5

mirena

Answer 5

continously releases a small amount of the hormone progestin, effective 5 yrs

Question 6

paraguard

Answer 6

contains copper and can be left in place 12 years

Question 7

what is one of the most effective and reversible methods of BC

Answer 7

IUD!!!
■ Fewer than one pregnancy with perfect use
■ Risk of pregnancy decreases even more with continued use
MOST POPULAR FORM OF BC AROUND THE WORLD!

Question 8

Advantages of IUD

Answer 8

■ IUDs may improve sex life
■ Nothing to put in place before intercourse
■ Feel free to be more spontaneous
■ Ability to become pregnancy quickly returns when IUD is stopped
■ Private method of birth control

Question 9

Who is an IUD good for?>

Answer 9

■ Want a long term birth control method
■ Are breastfeeding
■ Cannot or do not want to use a hormonal method

Question 10

contraindications for IUD

Answer 10

■	Pregnancy
■	Cervical cancer-untreated
■	Cancer of the uterus
■	Pelvic TB
■	Allergy to copper (paragard only)
■	Wilson’s disease (paragard only)
●	Inability of body to clear copper
■	Severe liver disease (minera only)
■	Breast cancer (minera)
■	Unexplained bleeding
■	Pelvic infection following childbirth or an abortion in the past 3 mons
■	Past or current STI or other pelvic infection

Question 11

Oral contraceptives

Answer 11

• works by suppressing ovulation
• thinning the uterine lining
• changing the consistency of the mucus in the woman’s cervix, making it harder for sperm to get in contact w egg
• all combination OCs contain 20-50 mcg of estrogen
• ○ Some require taking a constant dose of both meds for 21 days followed by one week of placebo tablets
  ○ Others vary the dose of estrogen/progestin that a woman gets throughout her cycle, or add 5 additional days (tablets) of estrogen at the end of the 21 day cycle
  ○ Some newer preparations allow for 3 months of continuous use

Question 12

three types of oral contraceptive

Answer 12

• combination pill (estrogen and progesterone… most commonly used)
• mini pill
• emergency one

Question 13

advantages

Answer 13

■ Safe, simple, convenient
■ One of the most effective forms of reversible birth control
■ Perfect use; fewer than 1 pregnancy per 100 women if taken as directed
■ Typical use; fewer than 8 pregnancies per 100 women
■ Fewer menstrual cramps, lighter periods

Question 14

absolute contraindications

Answer 14

■	Hx of thrombophlebitis or clotting disorders
■	Cardiovascular or CAD
■	Known or suspected breast cancer
■	Known or suspected endometrial cancer
■	Undiagnosed genital bleeding
■	Cholestatic jaundice
■	Impaired liver function
■	Hepatic adenomas, cancer or tumors
■	Known or suspected pregnancy
■	Type II hyperlipidemia
■	Factor 5 Leiden mutation
■	At age 35 it pt is smoker → need to come off OCPs

Question 15

coincidental benefits of oral contraceptive

Answer 15

■ Improved acne
■ Protection against ovarian cysts, endometrial cancer
■ Decreased premenstrual symptoms: depression and headaches
■ Decreased iron deficiency anemia r/t heavy periods
■ Decreased vaginal dryness and painful intercourse associated with changes or perimenopause

Question 16

possible side effects

Answer 16

■	Bleeding btwn periods
■	Breast tenderness
■	Headaches
■	Nausea
■	Weight gain or loss
■	Change in sexual desire
■	Depression
■	Mood changes

Question 17

potentially life threatening side effects of oral contraceptives

Answer 17

■	“ACHES”
■	Abdominal pain
●	Blood clot in pelvis or liver
●	Benign liver tumor or gallbladder disease
■	Chest pain
●	Blood clot in the lungs
●	Heart attack
●	Angina
●	Breast lump
■	Headaches
●	Stroke
●	Migraine with neurological problems (blurred vision, spots, zigzag lines, weakness, difficulty speaking)
●	Other headaches caused by pills
●	High BP
■	Eye problems
●	Stroke
●	Blurred vision, double vision, or loss of vision
●	Migraine w neuro problems
●	Blood clots in the eyes
●	Change in shape of cornea (contacts don’t fit)
■	Severe leg pain
●	Inflammation and blood clots of a vein in the leg

Question 18

what would decrease the efficacy of medications w oral contraceptives

Answer 18

■	Oral antibiotics
■	Rifampin
■	Dilantin
■	Phenobarbital
■	St. Johns wort

Question 19

likelihood of prego w oral contraceptives

Answer 19

○ For perfect users, oral contraceptives have the following perfect experiencing accidental pregnancies:
■ Progestin only: 0.5%
■ Combined estrogen and progesterone: 0.1%

Question 20

depoprovera and lunelle

Answer 20

○ Injectable forms
○ DMPA- can prevent pregnancy for 13 weeks
○ Lunelle can prevent for a month
○ DMPA one of the most effective reversible methods
○ May impede ovulation in some women for up to 18 months○ May impede ovulation in some women for up to 18 months ** not a good temporary method **

Question 21

how does depoprovera and lunelle work

Answer 21

■ Prevents the ovaries from releasing an egg
■ Thickens cervical mucus
■ Alters lining of the uterus which may prevent implantation of a fertilized egg

Question 22

side effects of depoprovera and lunelle

Answer 22

decreased mensural flow
weight gain
perfect use 3/1000
typical use 3/100

Question 23

female sterilization

Answer 23

permanent
more invasive and need for anesthesia compared to men
○ AKA tubal ligation
○ A segment is cut from both of the fallopian tubes, then the ends of the tubes are tied or clamped and burned
○ High rate of efficacy for contraception
○ Failure rate is higher if done immediately after delivery
■ High vascularization after
○ Surgical risks involved: infection and uterine perforation
■ Women w their tubes tied and become pregnant - more likely to experience ectopic pregnancy
○ Other risks: menstrual cycle disturbances and gyno problems
● Vasectomy

Question 24

male sterilization

Answer 24

women take ownership - physically impacts them
○ A simple procedure that involves severing the vans deferens
○ Can be done in a doctor’s office and considered a permanent form of contraception
○ Often takes < 30 mins
○ Local anesthetic given
○ Aside from bruising and swelling, the most common complication is infection
○ After the operation, it can take several months (15-20 ejaculations) before a man is actually sterile
○ A man will be required to go in for periodic checks during the months following his vasectomy to evaluate the level of sperm in his ejaculate
● Emergency contraception

Question 25

diaphragm

Answer 25

○ Made out of a thin, flexible silicone rubber which looks much like a small dome or cup
○ Designed with a flexible ring around the edge, diaphragm is inserted into the vagina prior to sexual intercourse
○ Should be used with spermicidal cream
○ Need to be fitted by PCP
○ Fittings should be checked every year
○ Gains or loses weight, becomes pregnant, or gives birth → likely it will not fit
○ Works by creating a barrier between sperm and uterus
○ Slides into place behind the pubic bone, completely covering the cervix. It prevents any sperm deposited during sexual intercourse entering the cervix
○ The spermicide placed inside of the dome and around the rim of the diaphragm also helps to kill any sperm that comes into contact with it
○ Can be inserted up to 6 hours before intercourse
○ Patient will need to add more spermicide in the vagina every 2 hrs, or each time she has sexual intercourse
○ If left in 24+ hrs, increases risk of toxic shock syndrome (TSS)

Question 26

barrier methods

Answer 26

condoms
diaphragm
contraceptive sponge
cervical caps

Question 27

advantages of diaphragm

Answer 27

■ Easy to insert and remove
■ Inexpensive and reusable
■ When inserted correctly, it cannot be felt by either partner
■ Does not affect future fertility or the menstrual cycle

Question 28

disadvantages

Answer 28

■ Left in > 24 hrs → TSS
■ Continual use of spermicide can irritate the lining of the vagina and possibly increase the risk of contracting an STD
■ The diaphragm can increase the likelihood of bladder infections
● Puts pressure on urethra
■ Does not protect against STDs - in order to protect, it is imperative that the patient use a condom every time she has sex