family planning Flashcards
define perfect use effectiveness and typical use effectiveness
perfect use effectiveness describes effectiveness while the contraceptive method was being used correctly. The termtypical use effectiveness describes effectiveness while the contraceptive method was being used incorrectly.
- Relate the unintended pregnancy rate with the choice to use contraception.
7% of women don’t use contraception. 49% of all pregnancies are unintended. 47% of all unintended pregnancies occur in women not using contraception,
List the female barrier methods
female condom, diaphragm, cervical cap, sponge +/- spermicide
requirements for sperm transport
cervical entry, thin cervical mucus and patent fallopian tube
Methods for thickening cervical mucus and why this works as contraception
Thin cervical mucus is required for sperm transport. Progestin: pills, depot medroxyprogesterone acetate (depo-provera), implant, progestin IUD (mirena).
List methods for female sterilization
ligate fallopian tube, occlusion of fallopian tube or complete removal (salpingectomy)
The primary mechanism of action of hormonal contraceptives
suppress the secretion of gonadotropins (FSH and LH) through negative feedback inhibition. Inhibition of FSH prevents follicle development and inhibition of LH prevents the surge necessary for ovulation
List the forms of contraception used to prevent ovulation
- Progestin only: pills (micronor), medroxyprogesterone acetate (depot provera), progestin IUD (mirena). 2. estrogen and progestin: OCPs, transdermal patch, transvaginal ring
describe natural family planning methods
- billings ovulation method: recognize signs of feritlity. 2. symptothermal method: basal body temp rises after ovulation. Uses body temp, cervical mucus and calendar predictions. 3. LH predictor kits.
Concerns with natural family planning methods
sperm can last 3-6 days, variable cycles
Describe the temperature method
The woman is required to abstain from intercourse from the onset of the menses until the third consecutive day of elevated basal temperature
Describe cervical mucus method of contraception
Once the first day that copious, slippery mucus is observed to be present, abstinence is required every day thereafter until 4 days after the last day when the characteristic mucus is present
List methods for thinning endometrium and why this works as contraception
A thick endometrial lining is required for implantation. Progestin thins endometrium and estrogen stabilizes endometrium
Pharmacological Effects of Progestins as Contraceptives
- Inhibits ovulation by suppressing function of hypothalamic-pituitary-ovarian axis. 2. modifies mid cycle surges of LH and FSH. 3. diminishes ovarian hormone production. 4. reduces activity of cilia. 5. thins endometrium. 6. thickens cervical mucus to impede sperm transit
Concerns with progestin only pill
Plasma levels drop by 24 hrs. Thickening of cervical mucus lasts 27 hours. Missed pill >3 hrs puts woman at risk. Only causes anovulation in about 50% of cycles
Depoprovera length of efficacy
injection that is effective for 12 weeks.
Implanon MOA
progestin only implant - inhibits ovulation, thickens cervical mucus, causes atrophy of endometrium AND decreases tubal motility. Can cause amenorrhea or unscheduled bleeding
Levonorgestrel MOA and length of action
Lasts for 5 years. Has some ovulation inhibition, decreases tubal motility, atrophic endometrium, really thickens cervical mucus. Causes oligoamenorrhea and amenorrhea
MOA of combined hormonal contraception
ie pill, patch, ring with both E and P. Inhibits ovulation (mainly progesterone), thickens mucus, decreased tubal motility
Copper IUD mechanism of action and length of action
Spermicidal via release of copper ions. Copper acts as spermicide at cervix and causes inflammatory reaction in uterus. Causes increase in enzymes, prostaglandins, WBCs and copper ions that impair sperm function. Approved for 10 years but shown to be effective for 12.
Contraceptive and noncontraceptive benefits of estrogen
Contraceptive: stabilizes uterine lining (less breakthrough bleeding), and less follicle development. Noncontraceptive: reduces SHBG (less acne, etc). Reduces ovarian cancer, endometrial, colon cancer risks
Risks of estrogen
•Estrogen increases clotting factors II, VII, X, XII, factor VIII and fibrinogen. Shift towards thrombus formation and prevention of clot dissolution. Greater risk of venous and arterial clots (more venous).
Who should avoid combined hormonal contraception
Smoker >35 years, CAD, risk of/ history of clots, uncontrolled HTN, diabetes with vascular changes, migraines with aura, liver/gallbladder dz, breast cancer, major surgery with prolonged immobilization
MOA of emergency contraception and uses
Prevents pregnancy AFTER sex (not the abortion pill). High dose of hormones disrupts follicular development, blocks LH surge, inhibits ovulation, disrupts luteal phase
List the emergency contraceptives
- Yuzpe method: combined OCPs in high dose. 2. Plan B: high dose. 3. Copper IUD. 4. Ella: Ulipristal acetate (progesterone receptor modulator)
spermicides MOA and use
Nonoxynol 9- Surfactant that immobilizes or kills sperm on contact by destroying the cell membrane. A sponge containing the surfactant is inserted into the vagina before intercourse
spermicides risks
increased risk of vaginal erosions and HIV transmission
describe use of a diaphragem
Must be left in place for at least 8 hours after last coital act and should be used with spermicide. Usually more comfortable for women who have had babies
Risks of diaphragm use
increased risk of UTIs due to mechanical obstruction of urine outflow
Describe use of cervical cap
silicone rubber fits over the cervix. Placed before intercourse and used with spermicide applied to cervical and vaginal surfaces. Fit nulliparous women better than parous
Which condoms are best
latex condoms have less slippage/breakage and are better than polyurethane and animal tissue. Animal tissue condoms don’t prevent transmission of STDs
describe periodic abstinence as contraception
conception can only occur if coitus takes place during the 5 days preceding ovulation or the day of ovulation. Thus, if couples would only avoid coitus on these 6 days each month, conception would not occur.
complications of vasectomy
hematoma (in up to 5% of the subjects), sperm granulomas (inflammatory responses to sperm leakage), and spontaneous reanastomosis
describe vasectomy
outpatient procedure- 20 mins. Cut vas deferens then seal the ends
describe female sterilization
general anesthesia- The most common techniques used today include the Filshie clip and the Silastic band (Falope ring). Both techniques require the surgeon to completely visualize the entire tube. The tube is grasped with the clip applier in the mid-isthmic portion such that the free end of the clip extends beyond the tube into the mesosalpinx. The isolated tubal segment undergoes necrosis
What is a microinsert
A device inserted in proximal oviduct to occlude the tubes
