Hormonal Contraception Flashcards
T/F: Condoms and Hormonal contraceptives can prevent STIs?
F; ONLY condoms (ONLY latex and synthetic)
What is the MOA of condoms?
Mechanical barrier between vagina and semen/genital lesions/infectious secretions
What are some counseling points for condoms?
- Do NOT combine vaginal and penile condoms
- Penile condoms sold with pre-lubricated spermicide is NOT recommended
- AVOID mineral oil and latex: medications (Monistat, Premarin, Cleocin), lubricants, and lotions
What is the preferred lubricant?
Water soluble lubricant
* Astroglide and K-Y jelly
What is the MOA of Spermicides and Spermicide-implanted barrier techniques?
Chemical surfactant
* Destroy sperm cell wall
* Barrier–> prevents sperm accessing cervix
What are some counseling factors for Spermicides and Spermicide-implanted barrier techniques?
- Most products contain **Nonoxynol-9 **which can increase the risk of transmission of HIV if used more than 2/day
- Does NOT protect against STIs
- Can improve efficacy of barrier methods
What is the MOA of Nonoxynol-9?
Small disruptions of the vaginal epitheliu
What activity types does progestin have?
- Progestin activity
- Estrogenic and antiestrogenic activity (dependent on extent of progestins’ metabolism to estrogenic substances)
- Androgenic effects (dependent on presence of SHBG and androgen-to-progesterone activity ratio)
What are the MOA of progestins?
- Sustained progestin exposure blocks LH surge–inhibiting ovulation
- Decrease ovum motility in fallopian tubes
- Thins endometrium, reducing chance of implantation
- Thickens cervical mucus, producing barrier to sperm
What are some counseling points for Oral Progestin only “mini pills”?
- Irregular periods and unpredictable periods
- Strict adherence is necessary for efficacy
- Do NOT block ovulation (risk for ectopic pregnancy)
What happens if you take your oral progestin only “mini pills” late?
If taken more than 3 hrs late, then need backup contraception for 48 hrs
When do you administer DMPA?
Administered every 3 months within 5 days onset of menstrual bleeding
Where do you administer DMPA?
- Deep IM injection to gluteal/deltoid muscle
- SubQ in abdomen/thigh
What are some counseling points for DMPA?
- Requires medical visit
- In ABSENCE of pregnancy
What happens if you miss a dose of DMPA?
- No backup need if administered between day 1-7 of menstrual cycle in patients who have NOT used CHC
- If given any other time of the menstrual cycle, 7 day backup contraception needed
What are some contraindications of DMPA?
Current breast cancer diagnosis
Which patients should DMPA used in caution for?
- Breast cancer
- Vascular/cardiovascular/cerebrovascular disease
In which patient does injected progestins benefit?
- Breastfeeding
- Estrogen intolerance (estrogen-related headache, breast tenderness, nausea)
- Sickle cell disease (reduction in sickle cell pain crises)
- Seizure disorders (reduction in seizures)
- Return to feritlity may be delayed
What are some adverse effects of injected progestins?
- Menstrual irregularities (most common in first year of use)
* Spotting
* Prolonged bleeding
* Can take NSAID for 5-7 days
* Short course of estrogens (10-20 days) if not contraindicated
* Amenorrhea - Breas tenderness
- Depression
- Weight gain-wide variability
- Short term bone loss
Nexplanon
- Subdermal progestin implant
- Taper down until end of 3 year use (FDA recommends 3 year use but can be up to 5 for off-label use)
- Possible decreased efficacy if 130% of ideal body weight
- Placed under the skin in the upper arm
When can Nexplanon be administered and do we need backup?
- Reasonable absence of pregnancy
- Can be inserted any time
- No back up needed if inserted day 1-5 of menstrual cycle
- Backup for 7 days if inserted at any other time
What are the adverse effects of subdermal progestin implant?
- Irregular menstrual bleeding
- Amenorrhea with continued use
- Prolonged bleeding (short course of NSAIDs/estrogens)
- Prolonged spotting
- Frequent bleeding
What is a potential drug interaction of Nexplanon?
CYP450 inducers
What is the MOA of IUD?
- Progestin containing (endometrial suppression, thickening cervical mucus)
- Inhibition of sperm migration
- Damaging ovum/disruption transport
- Damaging fertilized ovum
What patients should NOT have an IUD?
- Pregnancy
- PID
- Current STI
- Puerperal/post-abortion sepsis
- Purulent cervicitis
- Undiagnosed abnormal vaginal bleeding
- Malignancy of genital tract
- Uterine anomalies/fibroids distorting uterine activity
- Allery to components
What are some patient counseling points for Copper IUD (ParaGard)
- Highly effective, can be left in place for 10 years
- Increases menstrual blood flow/dysmenorrhea
When do you administer IUD?
- Days 1-7 menstrual period–> no backup needed
- Any other day backup is needed for 7 days
What are the adverse effect of each IUD?
- Irregular effects
- Copper IUD: heavy bleeding
- Levonorgestrel: Spotting for first 6 months
- Amonorrhea
- Prolonged bleeding (Short course of NSAID/estrogen)
What is the first line emergency contraception?
- Progestin only products
- Progestin receptor modulatory products
What is the MOA of progestin-only formulations (levonorgestrel 1.5 mg)?
Inhibiting or delaying ovulation
Ulipristal acetate
Selective progesterone receptor modulator with mixed progesterone agonist and antagonist properties
What are some counseling points for ulipristal acetate?
- Take within 5 days
- NOT recommended in breastfeeding
- AVOID using hormonal contraception method and avoid initiating new hormonal contraception for at least 5 days after administration
What are some adverse effects of emergency of emergency contraception?
- Nausea/vomiting (occur less with progestin only and progesterone receptor modulator EC)
- Irregular bleeding (menstrual period occurring 1 week before or after expected time)
Compare the efficacy of emergency contraception
Copper IUD > Ulipristal acetate > levonorgestrel
What is the MOA of estrogen?
Bind to the nuclear receptors in estrogen responsive tissue, impacts secretions of:
- Gonadotropins
- LH
- FSH
