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Adv Practice Women’s Health 6032 Test 3 > Module 9: Contraception/Family Planning & Early Pregnancy Loss > Flashcards

Module 9: Contraception/Family Planning & Early Pregnancy Loss Flashcards

1
Q

Contraceptive Health Benefits

A

Can help to treat

  1. Acne
  2. Heavy Menstrual bleeding
  3. Dysmenorrhea
  4. Most popular methods of contraception in 2017
    - Sterilization
    - Pills
    - LARCs
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2
Q

Best Contraceptive?

A
  1. The “best” method is one that is “SAFE” and will be used consistently and correctly
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3
Q

1 Key Question for Primary Care of Women?

A
  1. Would you like to become pregnant in the next year?

Other questions
-Do you ever plan to become pregnant and when?
-Are you currently having sex with a male partner
-What have you used in the past to prevent pregnancy
—What did you like or dislike about that method

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4
Q

NON-HORMONAL METHODS

A
  1. Physiologic - Being aware of fertile times and avoiding sex during those times
  2. Barrier
  3. Permanent
  4. Abstinence is the ONLY 100% effective way to prevent pregnancy
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5
Q

Fertility Awareness Methods

A
  1. Fertility Awareness Based on
    - ID fertile window
    - Abstain during fertility
    - Typical use 24% failure
  2. Lactational Amenorrhea (Prolactin keeps pt from menstruating after birth)
    - Exclusive breastfeeding
    - Amenorrhea
    - Infant <6 months old
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6
Q

Male Condoms (External Condoms)

A
  1. 18% failure rate
  2. Disadvantages
    - Decreased sensation
    - Break/slip off
    - Partner dependent
    - May cause genital irritation (monoxyl 9 causes most irritation)
  3. Advantages
    - Easy to buy
    - Assist with premature ejaculation
    - Can be used for oral, vaginal, anal sex
    - Protects against STIs
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7
Q

Less popular barriers

A
  1. Spermicide - 28% failure when used alone. Chemical barrier. OTC. Higher risk of HIV for women when using monoxyl-9
    - Can cause microtears in mucosa which facilitate transfer of HIV
  2. Today sponge - physical and chemical barrier for 24 hrs. No STI prevention. Can cause irritation
  3. Diaphragm - Needs to be fitted by clinician
    —Increased risk of UTI - Refer to GYN
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8
Q

Permanent Sterilization - Tubal Ligation

A
  1. Failure rate 0.5%
  2. Advantages
    - Highly effective
    - Decreased risk of ovarian cancer
    - Permanence
  3. Disadvantages
    - Regret
    - Surgical complications
    - Post tubal syndrome - Increased pain and flow post sterilization
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9
Q

Sterilization - Vasectomy

A
  1. 0.15 % failure rate
  2. Advantages
    - Outpatient, non-surgical
    - No scalpel option
    - Lower cost than female sterilization
  3. Disadvantages
    - Not immediately effective
    - Follow up visit required to ensure sterility
    - Regret
    - Higher reversal rate than female sterilization
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10
Q

SHORT-ACTING REVERSIBLE CONTRACEPTION

A

NEXT SLIDES

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11
Q

Pills containing both Progetin and Estrogen

A
  1. Progestin - Primary mechanism of primary prevention in hormonal contraception methods
    - Inhibits LH surge
    - Increases cervical mucus
    - May inhibit ovulation
    - Impaired tubal transport
    - Doesn’t regulate bleeding
  2. Estrogen
    - Regulates bleeding by stabilizing endometrium
    - Suppresses FSH
    - Prevents emergence of dominant follicle
    - Not used alone for contraception
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12
Q

Combined Oral Contraceptives

-Contraindications

A
  1. Smoking over age 35 yrs old
  2. Migraines with aura
  3. chronic HTN
  4. Personal hx of DVT or PE
  5. Immobility
  6. Less than 6 wks postpartum
  7. Risk factors for CVD
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13
Q

Combined oral Contraceptives - COCs

-Info

A
  1. 9% failure rate w/ typical use
  2. Advantages
    - Decreased cancer risk
    - Improved acne
    - Improved menstrual Sx’s
  3. Disadvantages
    - Daily dosing
    - Privacy
    - Medication interactions
    - Increased VTE risk
    - Cost and need to get to a pharmacy
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14
Q

Progestin Only pills POPs

-Info

A
  1. 9% failure rate
  2. Advantages
    - Rapid return to fertility
    - No estrogen
    - Breastfeeding acceptable
  3. Disadvantages
    - Irregular bleeding
    - Amenorrhea possible
    - Must be taken at the same time each day
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15
Q

Almost all Women are candidates for POP’s

-Including

A
  1. Personal hx of thrombosis
  2. Recently postpartum
  3. Exclusively breastfeeding
  4. Smokers >35 yrs
  5. Migraine w/ aura
  6. HTN, CAD, CV disease

Contraindications

  • Personal hx of breast cancer
  • Lupus
  • Anti-phospholipid positive or unknown
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16
Q

Nuva ring info

A
  1. 9% failure rate *
    - Combined hormonal method 2 inch flexible vaginal ring placed for 30 days
  2. Advantages
    - No daily hormone fluctuation
    - Less breakthrough bleeding
    - Lowest serum estrogen/progestin levels
  3. Disadvantages
    - Need to remove/insert ring
    - Partner may feel during intercourse
    - Estrogen contraindications similar to COC’s
17
Q

The Patch

A
  1. 9% failure rate
    - Combined method delivered transdermal — Applied weekly for 3 weeks then off for one week for menstruation
  2. Advantages
    - Similar to COC’s
    - Weekly application
    - No continuous cycling
  3. Disadvantages
    - More nausea and breast irritation
    - Skin irritation
    - Patch detachment (partial or complete)
    - Possible increased risk of VTE
18
Q

Depo-Proverá “the shot”

A
  1. 6% failure rate
    -IM 150mg depo medroxyprogesterone acetate every 13 wks injected into gluteal muscle
    -Inhibits LH and FSH and thickens cervical mucus
    -Progestin ONLY method and changes bleeding pattern
    —At one year 50% of patients are Amenorrheic and by 5 years 80% of women are amenorrheic **
    -Sickle cell dx, those on Anticoagulation, and women with epilepsy might benefit from depo-provera
  2. Disadvantages
    Clinically significant WEIGHT GAIN - 5 lbs in year one and up to 16 lbs in 5 years.
    -10 months to return to fertility
    -Hypoestrogenism due to high dose progestin can mimic menopause while taking
19
Q

LONG-ACTING REVERSIBLE CONTRACEPTION & EMERGENCY CONTRACEPTION

A

LONG-ACTING REVERSIBLE CONTRACEPTION & EMERGENCY CONTRACEPTION

20
Q

Hormonal IUDs

A
  1. 0.2% failure rate
  2. Advantages
    - Approved 3-5 years
    - Highly effective
    - Safe for most women
    - Same day placement
  3. Disadvantages
    - Fear of insertion
    - Insertion risks
    - Irregular bleeding likely
21
Q

Mirena/Liletta IUD LNG 52

A
  1. FDA approved for 5 years — Off label up to 7 years
  2. FDA approved for heavy menstrual bleeding
  3. Protects against endometrial hyperplasia
  4. Post placental placement - immediately after delivery
  5. Disadvantages
    - Pain w/ insertion
    - Hormonal S/Es
    - Expulsion rate 8%
22
Q

Kyleena LNG 19.5

A
  1. Similar to Mirena
    - Physically smaller
    - Lower hormone level
  2. Lower rates of amenorrhea
  3. Approved for 5 years of use
23
Q

Skyla LNG 13.5

A
  1. Mirena’ s baby sister
  2. Approved 3 years
  3. FDA approved for nulliparous women
  4. Irregular bleeding more common
24
Q

Copper IUD Paragaurd

A
  1. FDA approved for 10 years but effective up to 12 years
  2. Copper is spermicidal
  3. 0.8% failure rate
  4. Regular cycles and non-hormonal
  5. Emergency Contraception - most effective form of ER contraception within 5 days of unprotected intercourse **
  6. Disadvantages
    - Increased blood loss
    - Increased dysmenorrhea
25
Q

Nexplanon

A
  1. 0.05% failure rate
    - Works up to 3 years**
  2. Advantages
    - Highly effective
    - Rapid return to fertility
    - Reduced menstrual bleeding/pain
  3. Disadvantages
    - Irregular bleeding
    - Requires trained clinician to place/remove
    - Difficult removal
    - Hormonal S/Es
26
Q

Emergency Contraception

A
  1. Copper IUD is the most effective form of post coital contraception
  2. Emergency contraceptive Pills
    - Ulipristal acetate — NOT effective in women with BMI > 30
    - Progestin
    - High doses of COC’s
  3. Plan B ER contraception is not effective in women with BMI > 25

Adv Practice Women’s Health 6032 Test 3 (4 decks)

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