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
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
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)
4
Q
US MEC Categories
A
Category 1/2 - Okay to use
Category 3/4 - Don’t use!
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
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
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
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)
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
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
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
12
Q
Estrogen Contraception MoA
A
- Prevents ovulation be inhibiting follicle development
- No corpus luteum due to no ovulation
- EX: ethinyl estradiol
13
Q
Progestin Contraception MoA
A
- Ovulation inhibition by blocking mid-cycle LH surge
- Thickens mucus
- EX: norethindrone, levonorgestrel, drospirenone
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
15
Q
Contraception + VTE
A
- Higher risk than non-users
- Lower risk than pregnancy
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
