Family planning Flashcards
Actions of estrogen
- ovarian & pituitary inhibition
thinning/increase the cervical mucus - endometrial proliferation
- cycle control
Actions of progestin
- ovarian & pituitary inhibition
- thickening of cervical mucus
- endometrial atrophy/transformation
- cycle control
How to be reasonably sure that a woman is not pregnant
no symptoms of pregnancy and
- <7 days after start of normal menses
- no intercourse since start of last menses
- correct/consistent use of reliable contraception
- <7 days after spontaneous/induced abortion
- within 4 weeks postpartum
- breastfeeding, amenorrheic, and <6 months postpartum
antibiotic that reduces combined oral contraceptive effectiveness
Rifampin
COC 2-3 weeks postpartum is avoided because
2-3 postpartum = highly prothrombotic state
advice for women on COC taking potentially interacting medication
- continue taking COC even if spotting occurs
- use backup contraceptive for duration of time taking the interacting medication plus an additional 7 days
Category 3 conditions for COC
- migraine headaches without aura
- CVD risk: old age, smoker, DM, HTN
- taking anticonvulsants: phenytoin, topiramate, barbiturates, oxcarbazepine, lamotrigine, primidone
- taking Rifampin or rifabutin therapy
- acute or flare of viral hepatitis
- IBD/Crohn’s disease/gastric bypass
- breastfeeding <1 month postpartum
- current/medically treated gallbladder disease
- history of cholestasis COC-related
Category 4 conditions for COC
- current breast disease
- severe cirrhosis
- DVT risk esp if immobilized
- adv DM with neuropathy or PVD
- migraine headaches with aura
- HTN SBP ≥160 or CVD
- current/history ischemic heart disease or stroke
- <21 postpartum
- age >35 smoking >14 cigs/day
- complicated organ transplantation
- thrombogenic mutation: factor V Leiden mutation
Copper-containing IUD approved to remain in place for
10 years
Levonorgestrel-containing IUD (Mirena/Skyla) approved to remain in place for
Skyla 3 years
Mirena 5 years
Etonogestrel (Nexplanon, Implanon) Implant action
- daily constant release of low dose progestin
- effective for at least 3 years
Adverse effects of Etonogestrel (nexplanon, impanon) implants
Irregular bleeding
- can be managed with COC use for 3 months or timed NSAIDs for 2 weeks
Emergency contraception options
- Copper IUD (most effective)
(ECP) Pills effective taken within 3 days: - Ulipristal acetate (UPA) single dose 30 mg (rx only) > Levonorgestrel (LNG) 1-2 doses (OTC)
Most common adverse effects of levonorgestrel pills
- nausea/vomiting repeat in 2 hours
- next menstrual period should occur within 3 weeks, if not obtain pregnancy test if later than 1 week than anticipated
ella (ulipristal acetate) mechanism of action
- progesterone agonist and antagonist
- changes in endometrium that can alter likelihood of fertilized being implanted
