Monday - Contraceptives - Pearson Flashcards
Method effectiveness vs user effectivness
method - theoretical
user - actual
Natural methods
don’t have sex
not ejaculation around ovulation - 5days prior or 3 days after ovulation
checking basal temperature
cervical mucous - ovulating when it’s abundant/egg white/watery
require a regular cycle
When does ovulation happen in the menstrual cycle (normal)
14 days in 28 day cycle
day
day 18 in longer cycle
luteal phase is constant 14 days prior to period
Barrier methods
female condom male condom spermicide diaphragm cervical cap sponge
Male Condoms
BEST STI protection
many have spermicide on them
recommended to use along with other options
Female Condomas
non-latex
also prevent STI
more expensive
make them less noisy now -_-
Diaphragm
requires fitting
use with spermicide
need to leave in for 6 hours after intercourse
they are latex
cervical cap
silicone
must be fit
leave in for 6 hours after intercourse
sponge
moisten and insert for up to 24 hours, not super effective
increase UTI’s
spermicide
damages cell membranes of sperm and bacteria, can cause irritation. best if used with condom or diaphragm
Primary moa for hormonal methods
estrogen and progesterone inhibit Gonadotropin release - prevents ovulation
contraindications with estrogen/progesterone
stroke CAD estrogen dependant tumor pregnancy smoker over 35 migraine with nuro sx
off label oses for OCP’s
reduce dysmenorrea/menorrhagia
decreases ovarian, endometrial and colorectal cancers
improves acne
improves osteopenea
Main differences in pill contraceptives
all have ranging amounts of estrogen
range in amount and type of progesterone
side effects of the pill
breast tenderness
headaches
nausea
bad lipid profile
first gen oral drug with fewer side effects
norethindrone
most common oral pill
levonorgestrel (plan B)
3rd gen oral pill good for acne
norgestimate
higher stoke rate
pill that’s a spironolactone analog
drospiridone
mineralocorticoid effects
less weight gain
4th gen pill, best for what
dienogest
metromennorhagia
monophasic pill
same dose for 3 weeks then placebo week
biphasic/triphasic pill
varrying doses for 3 weeks then placebo week
extendend cycle pill
saesonale - 84 days fixed dose then placepo week
lybrel - fixed dose always
prescribing the right pill
start with low dose. wait 2-3 cycles to asses side effects
how to start the pill
start on sunday after period
take at same time every day
common side effects
breakthrough bleeding in forst 10 days - increase estrogen
after 10 days - increase progestin
vaginal ring
wear 3 weeks. out 1 week
similar effecacy as oral
transdermal patch
change once per week for 3, then off for a week
Progesterone only options good for who?
if they have a lot of side effects or they are contraindicated for a combination
downfall to starting a progesterone only pill
irregular bleeding for a while, but over time they will stop having periods
benefits to progesterone only
reduced menstrual flow
little risk for stroke
reduced risk for cancer
downfall of progesterone only pills
have to take within 3 hours every day
injectable (4x per year) progesterone and it’s limitation
medroxyprogesterone (depo-prevara)
only be on it for 2 years or else bones weaken
Implant progesterone
implanon, nexplanon
effective for 3 years
Ermergency contraceptives
are effective when
within 72-120 hours
Plan B
Progestin only
less nausea and vomitting - 2 step and 1 step options
Ella can be used when
up to 5 days
has to be perscribed
Yuzpe method
can just take 4 pills of lose dose or 2 pills of high dose within 72 hours of intercourse
causes nausea
IUD 3 options
copper (paragard)- pre-fertilization effect. foreign body - infammation. still have periods, may be worse.
- 10 years (mirena)
slow dose levonorgesrel - 5 years (skyla)
low dose levonorgesrel - works for 3 years
IUDs dont cause PID unless
you have and infection during insertion
Tubal Ligation
Laparoscopic
can do during c section
decreases risk for cancer
vasectomy
adverse effects
can do under local anesthesia
procedural effects
need semen analysis to show no motile sperm
