Module 9: Contraception/Family Planning & Early Pregnancy Loss Flashcards
1
Q
Contraceptive Health Benefits
A
Can help to treat
- Acne
- Heavy Menstrual bleeding
- Dysmenorrhea
- Most popular methods of contraception in 2017
- Sterilization
- Pills
- LARCs
2
Q
Best Contraceptive?
A
- The “best” method is one that is “SAFE” and will be used consistently and correctly
3
Q
1 Key Question for Primary Care of Women?
A
- 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
4
Q
NON-HORMONAL METHODS
A
- Physiologic - Being aware of fertile times and avoiding sex during those times
- Barrier
- Permanent
- Abstinence is the ONLY 100% effective way to prevent pregnancy
5
Q
Fertility Awareness Methods
A
- Fertility Awareness Based on
- ID fertile window
- Abstain during fertility
- Typical use 24% failure - Lactational Amenorrhea (Prolactin keeps pt from menstruating after birth)
- Exclusive breastfeeding
- Amenorrhea
- Infant <6 months old
6
Q
Male Condoms (External Condoms)
A
- 18% failure rate
- Disadvantages
- Decreased sensation
- Break/slip off
- Partner dependent
- May cause genital irritation (monoxyl 9 causes most irritation) - Advantages
- Easy to buy
- Assist with premature ejaculation
- Can be used for oral, vaginal, anal sex
- Protects against STIs
7
Q
Less popular barriers
A
- 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 - Today sponge - physical and chemical barrier for 24 hrs. No STI prevention. Can cause irritation
- Diaphragm - Needs to be fitted by clinician
—Increased risk of UTI - Refer to GYN
8
Q
Permanent Sterilization - Tubal Ligation
A
- Failure rate 0.5%
- Advantages
- Highly effective
- Decreased risk of ovarian cancer
- Permanence - Disadvantages
- Regret
- Surgical complications
- Post tubal syndrome - Increased pain and flow post sterilization
9
Q
Sterilization - Vasectomy
A
- 0.15 % failure rate
- Advantages
- Outpatient, non-surgical
- No scalpel option
- Lower cost than female sterilization - Disadvantages
- Not immediately effective
- Follow up visit required to ensure sterility
- Regret
- Higher reversal rate than female sterilization
10
Q
SHORT-ACTING REVERSIBLE CONTRACEPTION
A
NEXT SLIDES
11
Q
Pills containing both Progetin and Estrogen
A
- 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 - Estrogen
- Regulates bleeding by stabilizing endometrium
- Suppresses FSH
- Prevents emergence of dominant follicle
- Not used alone for contraception
12
Q
Combined Oral Contraceptives
-Contraindications
A
- Smoking over age 35 yrs old
- Migraines with aura
- chronic HTN
- Personal hx of DVT or PE
- Immobility
- Less than 6 wks postpartum
- Risk factors for CVD
13
Q
Combined oral Contraceptives - COCs
-Info
A
- 9% failure rate w/ typical use
- Advantages
- Decreased cancer risk
- Improved acne
- Improved menstrual Sx’s - Disadvantages
- Daily dosing
- Privacy
- Medication interactions
- Increased VTE risk
- Cost and need to get to a pharmacy
14
Q
Progestin Only pills POPs
-Info
A
- 9% failure rate
- Advantages
- Rapid return to fertility
- No estrogen
- Breastfeeding acceptable - Disadvantages
- Irregular bleeding
- Amenorrhea possible
- Must be taken at the same time each day
15
Q
Almost all Women are candidates for POP’s
-Including
A
- Personal hx of thrombosis
- Recently postpartum
- Exclusively breastfeeding
- Smokers >35 yrs
- Migraine w/ aura
- HTN, CAD, CV disease
Contraindications
- Personal hx of breast cancer
- Lupus
- Anti-phospholipid positive or unknown
16
Q
Nuva ring info
A
- 9% failure rate *
- Combined hormonal method 2 inch flexible vaginal ring placed for 30 days - Advantages
- No daily hormone fluctuation
- Less breakthrough bleeding
- Lowest serum estrogen/progestin levels - Disadvantages
- Need to remove/insert ring
- Partner may feel during intercourse
- Estrogen contraindications similar to COC’s
17
Q
The Patch
A
- 9% failure rate
- Combined method delivered transdermal — Applied weekly for 3 weeks then off for one week for menstruation - Advantages
- Similar to COC’s
- Weekly application
- No continuous cycling - 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
- 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 - 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
- 0.2% failure rate
- Advantages
- Approved 3-5 years
- Highly effective
- Safe for most women
- Same day placement - Disadvantages
- Fear of insertion
- Insertion risks
- Irregular bleeding likely
21
Q
Mirena/Liletta IUD LNG 52
A
- FDA approved for 5 years — Off label up to 7 years
- FDA approved for heavy menstrual bleeding
- Protects against endometrial hyperplasia
- Post placental placement - immediately after delivery
- Disadvantages
- Pain w/ insertion
- Hormonal S/Es
- Expulsion rate 8%
22
Q
Kyleena LNG 19.5
A
- Similar to Mirena
- Physically smaller
- Lower hormone level - Lower rates of amenorrhea
- Approved for 5 years of use
23
Q
Skyla LNG 13.5
A
- Mirena’ s baby sister
- Approved 3 years
- FDA approved for nulliparous women
- Irregular bleeding more common
24
Q
Copper IUD Paragaurd
A
- FDA approved for 10 years but effective up to 12 years
- Copper is spermicidal
- 0.8% failure rate
- Regular cycles and non-hormonal
- Emergency Contraception - most effective form of ER contraception within 5 days of unprotected intercourse **
- Disadvantages
- Increased blood loss
- Increased dysmenorrhea
25
Q
Nexplanon
A
- 0.05% failure rate
- Works up to 3 years** - Advantages
- Highly effective
- Rapid return to fertility
- Reduced menstrual bleeding/pain - Disadvantages
- Irregular bleeding
- Requires trained clinician to place/remove
- Difficult removal
- Hormonal S/Es
26
Q
Emergency Contraception
A
- Copper IUD is the most effective form of post coital contraception
- Emergency contraceptive Pills
- Ulipristal acetate — NOT effective in women with BMI > 30
- Progestin
- High doses of COC’s - Plan B ER contraception is not effective in women with BMI > 25
