OTC contraception Flashcards
Risk factors for unintended pregnancy
- not using contraception
- inconsistent or incorrect use of contraceptive methods (or failure; lots of error with the pill)
- forced intercourse
unintended pregnancy adverse maternal and child health outcomes
- delayed prenatal care
- premature birth
- negative physical and mental health effects (unexpected and increased costs)
Menstrual cycle: FSH and LH
regulate follicular development and ovulation in ovaries
Menstrual cycle: LH surge
signal for ovulation
Menstrual cycle: Estrogen and Progesterone
regulate changes in uterus to lining (endometrium)
Menstrual cycle: first day of menses
day 1 of cycle
Three contraceptive mechanisms
- block sperm (condoms)
- disable sperm (spermicide)
- suppress ovulation (pill)
Fertilization and implantation cycle
- ovulation
- oocyte
- fertilization
- zygote (fertilized egg)
- 4-cell stage (2 days)
- Morula (solid ball of blastomeres, 3 days)
- early blastocyst (4 days)
- implanting blastocyst (7 days)
OTC contraceptive considerations
- Efficacy (#1)
- safety
- cultural and religious beliefs
- future reproductive plans
- complexity
- STD protection (only condoms)
- Cost
Natural contraceptive methods
- ovulation test
- withdrawal
Non-hormonal contraception
- Barrier methods
- IUD
- Sterilization
Barrier methods
- diaphragm
- cervical cap
- condom
- spermicide
- sponge
IUD
Copper Intrauterine Device
Hormonal methods: combined estrogen/progesterone
- combined oral contraceptives (also emergency)
- Transdermal (patch, Zulane)
- Vaginal ring
Hormonal methods: progestin only
- progestin only pills (also emergency)
- long-acting injectable (depo)
- long-acting implantable
- intrauterine
Perfect vs typical use
Perfect: potential for effectiveness
Actual: actual effectiveness
Tiers of family planning methods
Tier 1: implant/IUD; may be dispensed with Rx at specialty pharmacy
Tier 2: diaphragm/cervical cap
Dispensed with RX or Behind the counter
Tier 3: OTC
Which tier is least effective
Tier 3 (OTC): condoms, sponge, spermicide
Natural: Fertility awareness method effectiveness
Typical use: 76% effective
Natural: withdrawal effectiveness
perfect use: 96%
typical use: 78%
Barrier methods
block sperm: mechanical or chemical barrier
Disable sperm: harmful to sperm itself, disrupts motility (cannot enter cervix)
Spermicides
Active drug: Nonoxynol-9 (N-9)
MOA: damages sperm cell membranes (disables)
Least effective (perfect: 82%, typical: 72%)
Spermicides: counseling
- apply intravaginally before intercourse
- may be used with other barrier methods
- wash hands before and after use
- douching NOT necessary; if desired, wait at lease 6 hours after intercourse
- NO protection from STD
Spermicide fomulations
Gynol jelly: nonoxynol-9 2%
Foam: nonoxynol-9 12.5%
suppository: nonoxynol-9 100mg
film: 28%
Gel advantages/disadvantages
A: lubricating
D: some available only for purchase with barrier device
Foam advantages/disadvantages
A: distributes more evenly and adheres better than gel
D: less lubricating than gel
Suppository advantage/disadvantage
A: easy to use and carry; less messy
D: must dissolve first and may not completely dissolve
Film advantage/disadvantage
A: easy to use and carry, longer duration of action, less messy
D: most difficult form to use, must dissolve first
Gel (alone): onset and duration
O: immediate
D: 1 hour
Application time before intercourse: up to 1 hour
Gel (diaphragm): onset and duration
O: immediate
D: 24 hours
Application time: up to 1 hour before
Gel (cervical cap): onset and duration
O: immediate
D: 48 ours
Application time: up to 1 hour before
Foam: onset and duration
O: immediate
D: 1 hour
Application time: up to 1 hour before
Suppository: onset and duration
O: 10 min
D: 1 hour
Application time: 10 min before
Film: onset and duration
O: 15 min
D: 1-3 hours
Application time: 15 min before
Sponge
Today sponge: nonoxynol-9, 1000mg
Least effective: perfect 91%, typical 88%
Sponge: counseling
- may be left in vagina and used for repeated use for 24 hours
- remove sponge 6 hours after last act of intercourse
- do not leave in for more than 6 hours
What can condoms protect against
most STD’s
Will not protect against herpes, HPV, or any open sores not covered
Condoms
complaints: localized itching (switch brands)
Risk factors for use-related failure: use of oil based lubricants with latex condoms
common cause of use-related failure: lack of consistent, proper use
Male condoms
SEE CHART
Condoms: lubricants
Lubricant must also be applied outside of the condom after it is placed:
Use water-based NOT oil based
Male Vs Female Condom
SEE CHART
Female condom: only one size; least effective (perfect: 95%, typical: 79%)
Diaphragm and Cervical cap
- moderately effective
- wait 6 hours after sex to remove
- can be washed and reused
- risk for UTI with extended use
Diaphragm
- moderately effective (perfect: 94%, typical: 88% with spermicide)
- latex or silicone
- larger than cervical cap
- may need fitting by physician
- can be worn up to 24 hours
Cervical cap
- moderately effective (perfect: 74%, typical: 60% with spermicide)
- silicone
- 3 sizes, fitting not necessary
- can be worn up to 48 hours
Barrier methods advantages and disadvantages
A: STI protection (condoms)
no hormonal SE
D: less effective than hormonal, increased risk for UTI/STDs, vaginal insertion/removal
Emergency contraception (EC): candidates
- women who have had unprotected intercourse
- failure of contraceptive method
- exposure to teratogenic material
EC options
- levonorgestrel (progestin only): Plan B, Next Choice
- ulipristal acetate (Ella)
- Combo oral contraceptive (estrogen-progestin): Yuzpe method
- Copper IUD (paragard)
EC mechanisms
- disables sperm (chemical barrier): thickens cervical mucus, inhibition of motility
- prevents follicular maturation and ovulation
- prevents implantation of fertilized egg as long as implantation has not occurred
- will not cause abortion
EC mechanims
- disable sperm
- suppress ovulation
EC efficacy
- relative to time AFTER unprotected intercourse
- 95% if taken within 24 hours
- 89% if taken within 72 hours
- efficacy declines the closer a woman is to ovulation
EC accessibility
SEE CHART
Estrogen actions
- ovarian and pituitary inhibition –> suppresses ovulation (estrogen more effective)
- thins and increases cervical mucus
- endometrial proliferation
Progestin actions
- ovarian and pituitary inhibition –> suppresses ovulation (estrogen more effective)
- thickens cervical mucus –> disables sperm
- endometrial thinning and transformation –> inhibits implantation of fertilized egg
Levonorgestrel
- progestin only
- 1.5 mg tablet ONCE
- or 0.75 mg x 2 tablets once
- Plan B, My Way, Take Action, Next Choice
- approved for up to 3 days after intercourse
- may be less effective in BMI > 26
Ulipristal Acetate (UPA)
- Ella
- 30mg tablet PO at once
- Rx needed (or via EC protocol without)
- Mechanism: Selective-progesterone receptor modulator (SPRM)
- Delays or inhibits ovulation (like progestin)
- Directly blocks follicular rupture
- Endometrial thinning –> prevents implantation
Combo: Yuzpe Method
- high doses of combined EE (100mcg) and Levonorgestrel (0.5mg)
- 2 doses, 12 hours apart
- available via EC protocol
- less commonly used
Yuzpe method dosing
SEE CHART
- dose is dependent on drugs contained in the pill
EC - General counseling
- how and when to take
- Side effects:
- vomiting: take with food, take antiemetic before and after, if vomiting occurs within 2 hours, another dose should be taken
- encourage barrier method use for 7 days
- most effective when used as soon as possible after intercourse
Copper Intrauterine Device (IUD)
- ParaGard
- 5 days after unprotected intercourse
- Copper ions block sperm motility
- 99% effective
- long term
