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825 > Hormonal Contraception > Flashcards

Hormonal Contraception Flashcards

1
Q

Need for Hormonal Contraception

A
  • Large percentage of unintended/unplanned pregnancies (over 50%)
  • Extreme cost to federal and state governments
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2
Q

Causes of Low Contraceptive Use

A
  • Myths, fears about the risks of contraceptive methods
  • Ignorance about the reproductive system and pregnancy risk
  • Problems with use of the method, ranging from side effects to poor patient-method fit to poor partner cooperation
  • Poor access: Inadequate funds to allow purchase of contraceptives or inability to get to clinics and providers because of hours of operation, transportation issues
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3
Q

Pharmacist + Contraceptives

A
  • Most accessible healthcare professional
  • Decrease burden on physicians
  • Pharmacist involvement has been shown to increase adherence, improve outcomes, and decrease costs (Direct Access study)
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4
Q

US MEC Categories

A

Category 1/2 - Okay to use

Category 3/4 - Don’t use!

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5
Q

US MEC

A
  • Separated into Initiation and Continuation therapies if needed
  • Lists if conditions the patient has CI a certain contraception method
  • Includes evidence connected to this selection
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6
Q

US MEC Abbreviations

A
  • C=continuation of contraceptive method -CHC=combined hormonal contraception (pill, patch, and, ring)
  • COC=combined oral contraceptive
  • Cu-IUD=copper-containing intrauterine device
  • DMPA = depot medroxyprogesterone acetate
  • I=initiation of contraceptive method
  • LNG-IUD = levonorgestrel-releasing intrauterine device
  • NA=not applicable
  • POP=progestin-only pill
  • P/R=patch/ring
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7
Q

Barrier Methods

A
  • Products available: condom (male and female), diaphragm, cap, foam, film, gel
  • Mechanism: blocks the passage of sperm to the ovum by mechanical or chemical means
  • Access: over-the-counter
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8
Q

Hormonal Contraceptives

A
  • Products available: pill, patch, ring, injection, emergency contraception pills
  • Mechanism: inhibits ovulation, thickens cervical mucus
  • Access: prescription (non-invasive, injection is minimally invasive)
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9
Q

LARC

A
  • Products available: IUD, implant
  • Mechanism: inhibits ovulation, renders sperm unable to fertilize ovum
  • Access: health care professional with training in insertion procedure
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10
Q

Sterilization

A
  • Products available: tubal ligation, tubal occlusion, vasectomy
  • Mechanism: stops passage of sperm to ovum
  • Access: health care professional with surgical training
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11
Q

Progestin Only Pills

A
  • “Mini-pill”
  • No placebos
  • More irregular/unpredictive bleeding
  • Use backup if taken more than 3 hours late
  • Can be used in lactating women
  • Good for those who can’t take estrogen
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12
Q

Estrogen Contraception MoA

A
  • Prevents ovulation be inhibiting follicle development
  • No corpus luteum due to no ovulation
  • EX: ethinyl estradiol
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13
Q

Progestin Contraception MoA

A
  • Ovulation inhibition by blocking mid-cycle LH surge
  • Thickens mucus
  • EX: norethindrone, levonorgestrel, drospirenone
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14
Q

Common SE of Hormonal Contraception

A
  • Bleeding: break-through, irregular, decreased, increased, absent
  • N/V: rare
  • Breast tenderness: rare
  • If last past 3 months without decreasing, consult about changing contraception
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15
Q

Contraception + VTE

A
  • Higher risk than non-users

- Lower risk than pregnancy

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16
Q

Contraception + Smoking

A
  • Only smokers who are 35 y.o. + are a concern for CHC

- Always okay to use progestin only contraception

17
Q

Contraception + Weight Gain

A
  • Usually fueled from fluid retention when taking higher dosed pills
  • No studies show consistent weight gain
  • Can also be due to diet and age
18
Q

Contraception + Headache

A
  • Additional questions needed for those with migraine

- Always okay to give progestin-only contaception to those with headaches/migraines

19
Q

Contraception + Osteoporosis

A
  • Never been osteoporosis from DMPA
  • At most, BMD decreases about as much as when a women breast feeds
  • This BMD loss is recovered within 12-30 months after DMPA is discontinued
20
Q

Contraception + Antibiotics

A
  • Common antibiotics have been shown to not have an effect on birth control
  • Unusual antibiotics may have interactions like rifampin or rifabutin
21
Q

Severe Contraception Complications/CI

A 
ACHES
A - abdominal pain
C - Chest pain, SOB, coughing blood
H - Headaches (new, unusual, worsening)
E - Eye problems
S - Severe leg pain
22
Q

Other Contraception Benefits

A
  • Decreased menstrual bleeding/pain
  • Decreased cancer risk
  • Decreased pelvic inflammatory disease
  • Can Treat: endometriosis, acne, Hirsutism, ovarian cysts, premenstrual syndrome
23
Q

Continuing Methods

A
  • Pills: take at same time every day at a convenient time
  • Patch: Replace once a week and have 1 off week per month
  • Ring: leave in for 3 weeks, take out for a ring-free week
  • DMPA: repeat every 12 weeks
24
Q

Missed Pill

A
  • Take as soon as you remember, can double up pills for a missed day
  • Use backup method for 1 week while getting back on track
25
Q

Lost Patch

A
  • Can be put back on if it has been less than 24 hours and is still sticky
  • Buy replacement patch if this criteria is not met
  • Use backup method for 1 week
26
Q

Ring Dislodged

A
  • If 3 hours or less, rinse in cold water and reinsert

- Longer than 3 hours, use backup method or EC

27
Q

Delay DMPA Injection

A
  • Up to 2 weeks late: little pregnancy risk

- Over 2 weeks: use backup for 1 ewek and consider EC

28
Q

EC

A
  • Recommend having some on hand at all times
  • No CI
  • Sooner the better, best effectiveness within 72 hours
  • Doesn’t stop already established pregnancies
29
Q

EC Counseling

A
  • Will not cause an abortion
  • Take up to 72 hours for Levonorgestrel, 120 hours for Ulipristal (Ella)
  • If vomits within 2 hours, return to buy another
  • Seek medical attention if severe lower abdomen pain occurs 3-5 weeks after taking
30
Q

Contraception Considerations

A
  • Medical safety
  • Effectiveness
  • Comfort
  • Lifestyle
  • Pregnancy Intention
  • Patient experiences
  • Access/affordability
  • Privacy needs
31
Q

Continued Use of Contraception

A
  • Must have a medical history completed every year

- Only need PAP smear every 3 years

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