Lecture 3: Contraceptive Methods Flashcards
When is peak fertility
Day 9-15 of menstrual cycle
What types of contraceptives are NOT reversible
surgical methods: tubal ligation, vasectomy
Which methods are quickly reversible when stopped?
Which method is reversible but NOT quickly?
Copper IUD, natural family planning, BC
Not quickly reversible = Depot Medroxyprogesterone
What 4 types of contraceptives can be used AFTER sex?
- Copper IUD (Most effective)
- Ulipristal
- “Plan B”: high dose progesterone pills
- Combo E/P pills
What 3 types of contraceptives can be used before sex and are permanent?
- Tubal ligation
- Vasectomy
- Transcervical sterilization
What 4 types of contraceptives can be used before sex, are short acting and non-hormonal?
- Family Planning
- Diaphragm
- M/F condom
- Cervical sponge/cap/spermicide
What 2 types of contraceptives used before sex, are short acting, hormonal and contain progesterone only?
What are the 3 forms of E/P combo?
- DMPA
- Prog pill
- vaginal ring
- transdermal
\
patch
3. combo pill
What type of contraceptive used before sex, are long acting and non-hormonal?
What 2 types are hormonal?
non-hormonal
- copper IUD
hormonal
- implant
- prog IUD
What are the secondary benefits to contraceptives?
what 5 things can it help Tx?
(what does it control?)
(what does it prevent?)
(what does it decr the risk of?)
- Txs PMS, heavy pds, acne, dysmenorrhea, endometriosis
- Helps control menstrual cycle
- Prevent STIs
- Decr risk of ovarian, endometrial and colon CA
3 main ways E/P combo pills work?
- suppress follicle dev
- thicken cervical mucus
- inhibit ovulation
How do Progestins specifically work?
How do Estrogens specifically work?
P - suppresses LH, thickens mucus, atrophic endometrium
E- suppresses FSH, altered tubal transport
What type of estrogen is in the E/P combo?
2 types of progestin in the E/P combo?
E = ethyl estradiol
Progestin
- monophasic (less withdrawal bleed)
- multiphasic (mimics natural cycle–> incr estrogen over 3 wks)
What do ALL E/P combo cause and how can this be avoided?
ALL cause withdrawal bleeding
- avoid by using E/P combos continuously
What is one AE of the E/P combo that is caused by progestin but is mitigated by Estrogen?
P –> Androgen effects (acne, hirsutism, oily skin)
What a major secondary benefit of E/P combos?
decr risk of ovarian and endometrial cancer
Why is estrogen NEVER used alone?
caveat?
incr risk of endometrial CA
but can give to women w/ uterus
E/P combos:
how long is ring (Nuvaring) in for
How often change transdermal patch
Nuvaring = in for 3 wks
change transdermal patch = change weekly
CIs to combo E/P methods (8)?
- Uncontrolled DM (nephro, neuro & retinopathy)
- PMH of BCA
- high risk or h/o DVTs
- h/o ischemic heart dz
- uncontrolled BP (> 160/90)
- PMH/high risk for stroke
- Migraine w/aura
- Seizure d/o
- Smoker > 35
- Preg/Breastfeeding
- Vaginal bleed w/unknown cause
- Abn liver fxn
CIs to combo E/P methods (8)?
- Uncontrolled DM (nephro, neuro & retinopathy)
- PMH of BCA
- high risk or h/o DVTs
- h/o ischemic heart dz
- uncontrolled BP (> 160/90)
- PMH/high risk for stroke
- Migraine w/aura
- Seizure d/o
2 main types of IUDs
General MOA for IUDs
- Copper T IUD
- LNG-IUD
General MOA for IUDs: inhibits fertilization and 2ndarily inhibits fertilization
similar MOA for copper IUD & LNG-IUDs
2 additional MOAs for LNG-IUD
decr sperm motility and viability
- inhibits ovulation
- thickens cervical mucus
4 CIs to IUDs
- Current STI
- unexplained uterine bleeding
- deforming, large fibroids
- Wilson’s Dz or Copper allergy
5 S/Es of IUDs
- uterine perforation w/insertion
- expulsion
- cramping after insertion
- PID
- Pain w/insertion
When is there a risk of PID w/ IUDs
1st 30 days after insertion (insertion = opening of os)
Main S/E a/w Copper IUD specifically? LNG-IUD?
Copper IUD –> heavy menses
LNG-IUD –> irreg spotting
What is the problem getting preg w/IUD in?
get preg w/IUD = more likely ectopic
What is the problem getting preg w/IUD in?
get preg w/IUD = more likely ectopic
Major con a/w barrier methods?
short acting –> must have correct placement and must be used every time
Other cons: less eff than hormonal methods, lack sponaneity, messy, touch genitals, variable confidentiality, allergies to latex/spermicide
2 major pros a/w barrier methods
STI protection and most dont need prescription
What type of barrier method is hard to place, high failure rate and not commonly used
cervical caps
4 types of Natural Family Planning
- Calendar method
- Cycle beads
- Cervical mucus
- Ovulation thermometer
What color beads = peak fertility
what is cervical mucus like during ovulation?
what happens to temp before ovulation?
White beads
cervical mucus thinner during ovulation
temp incr before ovulation
Major con of natural family planning methods?
Abstinence
- must avoid sex during peak fertility (about 7 days)
What is the major problem w/the calendar method?
only effective for women w/regular cycles
What can interfere w/cervical mucus and affects its accuracy (4)?
- infection
- douching
- breastfeeding
4 perimenopause
What method is for conceiving? what indicates ovulating
stick method
- 2 lines = ovulating
What are the 5 types of Emergency contraceptives
- Levonorgesterol
- Ulipristal/Ella
- Copper IUD
- Combo E/P pills
- Mifepristone (not DoC for EC)
What is the MOA for all ECs?
Delays ovulation
Which type of EC is known as “Plan B”?
Levonorgesterol
What is the general window for ECs?
But which type of EC has decr effectiveness after 72 hrs
general window = 120 hrs
Levonorgesterol has less effectiveness after 72 hrs
What is the consideration when using E/P combo pills for EC?
must give multiple doses of E/Ps to mimic EC dose–> S/Es
4 main S/Es a/w ECs
- uterine bleeding
- N/V
- HA
- abd pain
#2-4 = more w/ulipristal #2 = a/w combo E/P
CI to using emergency contraceptives
one exception?
Known pregnancy
exception - Ulipristal may cause early abortion (embryotoxic in animals)
What is the 1 EC that can be used in all wt classes
Copper IUD
note: Ulipristal can be used w/higher BMI than Levonorgesterol
What drug is used for medication induced abortion
What type of med is it?
Mifepristone
- anti progesterone
- competitive antagonist of PRM
How long can mifepristone be used?
What should be done as f/u?
What other med is it given w/?
- up to 9 wks
- US to ensure effectiveness
- given w/Misoprostol
MOA of mifepristone: decidual breakdown, incr PG synthesis, sensitizes uterus to exogenous admin of PGs…. what is result?
cervix softens, uterine contraction –> destroy/shed lining –> abort pregnancy
Major AE a/w Mifepristone?
CI w/?
Serious bleeding (rare)
CI w/glucocorticoids
Other use for Ulipristal/Ella
Tx uterine fibroids
