Family Planning (contraceptive options) Flashcards
Efficacy and method of use Progestin Minipill
1) Similar to that of________ but is highly dependent on consistent use.
—a) Must be taken with precise accuracy.
—b) Within the same ____ window every day.
2) Begun on the ____ day of a menstrual cycle and then taken
continuously for as long as contraception is desired.
—a) There is no “placebo week”.
1) combined oral contraceptives
b) 3 Hour
2) first
What type of IUD?
The mechanism of action is thought to involve either spermicidal or inhibitory effects on sperm capacitation and transport.
Copper bearing (Paragard)
Male sterilization
(a) Vasectomy
–1) Safe, simple procedure
–2) ______ is severed and sealed through a scrotal incision
under local anesthesia.
—3) Follow up semen analysis at ___ months post procedure to confirm sterility
2) Vas deferens
3) 3 Months
General considerations Family Planning
(1) __% of the 213 million pregnancies in 2012 were unintended.
–(a) __% end in abortion
–(b) __% end in miscarriage
–(c) ___% resulted in unplanned births
1) 40%
a) 50%
b) 13%
c) 38%
Transdermal contraceptive patch - Ortho Evra
(a) Combined _____ and ____ contraceptive
(b) The patch is applied to the lower abdomen, upper torso, or buttock once a week for ___ consecutive weeks, followed by__ week(s) without the patch.
(c) Mechanism of action, side effects, and efficacy are similar to those
associated with oral contraceptives, although compliance may be better.
—1) However, discontinuation for side effects is (MORE or LESS) frequent.
a) Estrogen and progestin
b) 3 weeks, 1 week
1) MORE
DoD prohibits the use of DoD facilities and funds to perform abortions, except when what?
1) the life of the Service member would be endangered if the fetus were carried to term,
2) in cases in which the pregnancy is the result of an act of rape or incest.
Mechanism of action for what Contraceptive?
1) Effects the endometrium rendering less suitable for implantation.
2) Thickening of cervical mucus to prevent penetration by sperm.
3) Impairment of normal tubal motility and peristalsis which alters ovum transport.
Progestin Minipill
Combined oral contraceptives (COC) Efficacy
1) Perfect use failure rate: __%
2) Typical use failure rate: __%
1) 0.3
2) 8%
What type of UID can be placed within 5 days following a single
episode of unprotected coitus as postcoital contraceptive?
(Emergency contraception)
Copper IUD
True/false
Women who are not in mutually monogamous relationships do not need to use condoms for protection from sexually transmitted diseases.
FALSE
SHOULD USE
What type of IUD can have the below as a complication
a) Heavier menstrual periods
b) Bleeding between periods
c) More cramping
d) It is generally not suitable for women who already suffer
from these problems.
Copper IUD
IUD can be inserted at almost anytime as long as what?
patient has not become pregnant
Insertion of IUD
(a) Must be inserted by ________.
(b) Can be performed during or after the menses, at mid-cycle to prevent implantation, or later in the cycle if the patient has not _________.
a) specially trained provider
b) become pregnant
What is the brief abdominal midcycle discomfort used in Symptothermal Natural family planning
mittelschmerz
True/FAlse
IUD must not be inserted into a pregnant uterus.
True
Symptothermal Natural Family Planning
1) Patient-observed increase in _______ mucus,
2) Brief abdominal midcycle discomfort called _______
3) A sustained rise of the basal body temperature about ___ weeks after onset of menstruation.
1) clear elastic cervical
2) (“mittelschmerz”),
3) 2
True/False
Nulliparity is a contraindication to IUD use
FALSE
is not a contraindication
What type of Emergency Contraception
1) Ethinyl estradiol (at least 100mcg per dose)
2) Levonorgestrel (at least 0.50 mg per dose)
3) Given twice in 12 hours may be used
4) Used within 72 hours, the failure rate of these regimens is approximately 3%,
—a) Anti-nausea medication is often necessary
Combination oral contraceptive
Contraceptive vaginal ring – NuvaRing
(a) Ring is soft and flexible and is placed in the upper vagina for __ weeks, removed, and replaced ___ week(s) later,
–1) or can be removed and replaced after ___ weeks for continuous cycling, similar to oral contraceptives.
(b) The efficacy, mechanism of action, and systemic side effects are similar to those associated with ________.
(c) Ring users may experience an increased incidence of ________.
a) 3 Weeks, 1 Week
1) 4 weeks
b) oral contraceptives
c) vaginal discharge
What type of Emergency Contraception
1) Plan B
2) Available over-the-counter for women aged 17 years and older
3) Has a 1% failure rate when taken within 72 hours
4) Efficacious up to 120 hours after intercourse
Levonorgestrel, 1.5 mg orally as a single dose (progestin only pill).
Advantages of what Contraceptive
1) Low dose of progestin and absence of estrogen make the this safe during lactation.
—a) It may increase the flow of milk.
2) Safe for patients who are over age 35.
—a) They lack the cardiovascular side effects of combination pills.
3) The contraceptive benefit of this may outweigh the risks for patients who
–a) Smoke
—b) Over the age of 35
—c) Who have such conditions as:
——(1 deep venous thrombosis
——(2 known thromboembolic disorders
——(3 diabetes with vascular disease
Progestin minipill
What type of condoms do not offer STD protection
Animal membrane
What are the types of IUD
-Levonorgestrel (LNG)- releasing
-Copper bearing (Paragard)
What contraceptive?
(1) If unprotected intercourse occurs in midcycle is effective in preventing implantation.
(2) These methods should be started as soon as possible and within 120 hours (5 days) after unprotected coitus.
Emergency Contraception
Combined oral contraceptives (COC) Efficacy
-If an active pill is missed at any time, and no intercourse occurred in the past 5 days, __#__ pills should be taken immediately, and a backup method should be used for ___ days
Two Pills
7 Days
What type of Emergency Contraception
1) More effective than levonorgestrel
2) Especially when used between 72 and 120 hours, particularly among overweight women.
Ulipristal, 30 mg orally as a single dose, (Ella)
What Contraceptive?
Mechanism of action, advantages and contraindications similar to that as for the mini pill except.
—(a) Injectable
——-1) Associated with bone mineral loss that is reversible after discontinuation of the method.
——-2) Users commonly have irregular bleeding initially and subsequently develop amenorrhea.
——-3) Ovulation may be delayed after the discontinuation.
Route: Intramuscular or subcutaneous
—a) Given every 3 months (11-13 weeks)
Injectable progestin- DMPA
TRUE/FALSE
Adolescents can be candidates for IUD use.
TRUE
Male Condom
Failure rates are ___% among couples who use condoms perfectly, only __% become pregnant after 1 year.
18%
2%
Contraindications for what Contraceptive
1) bleeding irregularities (e.g., prolonged flow, spotting, or amenorrhea);
—a) such patients may need regular pregnancy tests.
2) Ectopic pregnancies are more frequent.
3) Minor side effects of combination oral contraceptives such as weight gain and mild headache may also occur with this.
Minipill
True/False
All victims of sexual violence should be offered emergency contraception.
TRUE
Advantages of what contraceptive?
1) Lighter menses
2) Improvement of dysmenorrhea symptoms
3) Decreased risk of ovarian and endometrial cancer
4) Improvement in acne
5) Functional ovarian cysts are less likely with oral contraceptive use
6) The frequency of developing myomas is lower
7) Beneficial effect on bone mass.
COC
Missing IUD strings
1) If transcervical strings cannot be visualized on pelvic exam there is a concern for _______
2) Pelvic ultrasound
3) Gynecology referral
1) unnoticed expulsion or migration through the uterus into the abdomen.
Mechanism of action for what Contraceptive
1) Suppression of ovulation by inhibition of gonadotropin releasing
hormone (GnRH), luteinizing hormone (LH), follicle stimulating hormone (FSH) and the mid-cycle LH surge.
2) Suppression of FSH prevents folliculogenesis.
3) Progestin specific effects
–a) Effects the endometrium rendering less suitable for implantation
–b) Thickening of cervical mucus to prevent penetration by sperm
–c) Impairment of normal tubal motility and peristalsis which alters ovum transport
Combined oral contraceptives (COC)
electively performed Abortion is known as…
Induced
Basal Body Temperature Method
(a) Indicates the safe time for intercourse after _____ has passed.
(b) Temperature must taken immediately upon ______, before any activity.
—1) A slight drop in temperature often occurs ____ hours before ovulation,
—2) A rise of about ___°C occurs 1-2 days after ovulation.
—3) The elevated temperature continues throughout the remainder of the cycle.
(c) Risk of pregnancy increases starting ____ days prior to the day of ovulation,
(d) Peaks on the day of ovulation,
(e) Then rapidly decreases to ____ by the day after ovulation.
a) ovulation
b) awakening,
1) 12-24 hours
2) 0.4°
c) 5
e) zero
What is naturally occurring miscarriage known as?
Spontaneous
Symptothermal Natural Family Planning
Unprotected intercourse is avoided from shortly after the menstrual period, when fertile mucus is first identified, until _____hours after ovulation, as identified by a sustained rise in temperature and the disappearance of clear elastic mucus.
48
References regarding abortion
1) BUMEDINST 6300.16 series
2) OPNAVINST 6000.1 series
What is the only female controlled method of birth control that offers significant protection from both pregnancy and STDs?
-What is the Failure rate?
Female Condom
-Failure rates range from 5%-21%
These issues ate contraindications for what Contraceptive?
a) Pregnancy and breast feeding
b) Thromboembolic disorders
c) Stroke or coronary artery disease, also HTN > 160 systolic OR 100
diastolic.
d) Cancer of the breast
e) Undiagnosed abnormal vaginal bleeding
f) Age over 35 and smoking more than 15 cigarettes daily
g) Migraine with aura
COC
Female sterilization
(a) Most often achieved with _____
—1) Prevents an ovulated ovum from reaching the _____ and prevents sperm from reaching the unfertilized ovum.
—2) Multiple ways to achieve this.
—3) Tubes can be clipped, clamped, cauterized, tied, and/or cut
a) tubal ligation
1) uteru
Combined oral contraceptives (COC) Efficacy
If intercourse occurred in the previous ____ days, emergency contraception should be used immediately, and the pills restarted the following day.
–a) A _______ should be used for 5 days.
5 Days
a) backup method
True/False
Women have an increased risk of pelvic infection in the first month following insertion of an IUD.
True
What contraceptive?
Devices are highly effective, with failure rates similar to those
achieved with surgical sterilization.
IUD
What Contraceptive?
(a) Single rod progestin implant – Etonogestrel
(b) Inserted in the proximal aspect of the nondominant arm
–1) Effective for 3 years.
(c) No delay to return to fertility after discontinuation.
(d) Irregular bleeding is the most common reason for discontinuation.
Nexplanon
Combined oral contraceptives (COC) Efficacy
Ideally started on the______ day of the menstrual cycle, However, may start on any day.
—-a) If started on any day other than the first day of the cycle, a backup method should be used for how long?
first day
-the first Sunday after the onset of the cycle or on any day of the cycle.
a) the first month
What method?
(a) Length of the menstrual cycle has been observed for at least 8
months, then calculations are made to determine fertile period.
(b) Relies on strict documentation and regular predicable periods.
Calendar Method
Women using an IUD who become pregnant should have the IUD
removed if the ____ is visible
String
What type of IUD?
1) Causes thickening of cervical mucus, prevent endometrial thickening, and can inhibit ovulation.
2) Reduces cramping and menstrual flow.
3) May have a protective effect against upper tract infection similar to
that of the oral contraceptives.
Levonorgestrel (LNG)- releasing
