family planning Flashcards
STD Prevention
- 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
example of STD prevention
condoms and spermicidal foam or condoms and OCs
IUD
○ 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
How does an IUD work?
■ 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
mirena
continously releases a small amount of the hormone progestin, effective 5 yrs
paraguard
contains copper and can be left in place 12 years
what is one of the most effective and reversible methods of BC
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!
Advantages of IUD
■ 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
Who is an IUD good for?>
■ Want a long term birth control method
■ Are breastfeeding
■ Cannot or do not want to use a hormonal method
contraindications for IUD
■ 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
Oral contraceptives
- 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
three types of oral contraceptive
- combination pill (estrogen and progesterone… most commonly used)
- mini pill
- emergency one
advantages
■ 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
absolute contraindications
■ 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
coincidental benefits of oral contraceptive
■ 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
possible side effects
■ Bleeding btwn periods ■ Breast tenderness ■ Headaches ■ Nausea ■ Weight gain or loss ■ Change in sexual desire ■ Depression ■ Mood changes
potentially life threatening side effects of oral contraceptives
■ “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
what would decrease the efficacy of medications w oral contraceptives
■ Oral antibiotics ■ Rifampin ■ Dilantin ■ Phenobarbital ■ St. Johns wort
likelihood of prego w oral contraceptives
○ For perfect users, oral contraceptives have the following perfect experiencing accidental pregnancies:
■ Progestin only: 0.5%
■ Combined estrogen and progesterone: 0.1%
depoprovera and lunelle
○ 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 **
how does depoprovera and lunelle work
■ Prevents the ovaries from releasing an egg
■ Thickens cervical mucus
■ Alters lining of the uterus which may prevent implantation of a fertilized egg
side effects of depoprovera and lunelle
decreased mensural flow
weight gain
perfect use 3/1000
typical use 3/100
female sterilization
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
male sterilization
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
diaphragm
○ 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)
barrier methods
condoms
diaphragm
contraceptive sponge
cervical caps
advantages of diaphragm
■ 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
disadvantages
■ 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
