Phillips - Contraceptives Flashcards
1
Q
What % of US pregnancies are unintended (pie chart)? Demographics?
A
- 48% unintended: highest among young and low-income women -> many have difficulty accessing or affording family planning care, and have unequal access to contraceptives
- 23% of all pregnancies end in elective abortion
2
Q
What are the 3 most common causes of unintended pregnancy?
A
- Contraceptive nonuse
- Contraceptive method failure: example -> broken condom
- Contraceptive user failure: example -> missing a dose of OC (aka, typical use)
3
Q
What contraceptive methods are most effective (graph of failure rates)?
A
- Impact of compliance on efficacy very real
- Methods requiring less user involvement have low failure rates and are highly effective with both perfect and typical use
1. Typical use rates show effectiveness in a lg pop, and are a better reflection of actual efficacy - Incorrect, inconsistent “typical use” of OC’s translates into an approximate 5% failure rate
4
Q
What is the one hormonal contraceptive that works locally?
A
- Progestin: thickening cervical mucus and reverse peristalsis of the tube
- Also causes some ovulatory dysfunction, and thins out endometrium to the point that the egg will not implant
- Fertilization never happens; prevents ALL pregnancies
5
Q
What are 5 factors to consider when determining the best contraceptive method?
A
- Reversibility
- Adherence issues
- Contraindications
- Non-contraceptive benefits (i.e., regularity of periods)
- Cost: ACA mandates that all insurance companies provide coverage for contraception
6
Q
Oral contraceptives: side effects, non-contraceptive benefits
A
- Daily use: 9% failure rate in 1st year (user failure)
- SIDE EFFECTS: nausea, irregular bleeding
1. Estrogen: VTE effects (NOT progestin)
2. More likely to have chlamydia, gonorrhea cervicitis -> having sex, but may not be using condoms bc using OC’s as contraception - NON-CONTRACEPTIVE BENEFITS:
1. Treats cramps, acne, heavy bleeding
2. Prevents PID; no lush menstrual cycle to feed bacteria, reverse peristalsis, thick mucous
3. Rate of ovarian cancer in 50s-60s goes down: longer you’re on the pill, the less likely to have ovarian, uterine, colon cancer
7
Q
Condoms: failure rate, benefits
A
- 21% failure rate in first year
- Effective for many couples
- Teach adolescents to use these bc they are not used to thinking ahead, i.e., may not be taking a pill
- BENEFITS: prevent STI’s
1. Empowering for a girl if she already knows how to use these and talk about them with her partner(s)
8
Q
What are the roles of estrogen and progestin in the combo pill?
A
-
Progesterin: INH the release of GnRH
1. PROGESTIN is what PREVENTS - Estrogen: stabilizes the endometrium to prevent irregular bleeding and promote a normal cycle
9
Q
Will taking OC’s delay menopause?
A
- NO
- Menopause is on automatic pilot
10
Q
What is Drospirinone?
A
- Related to Spironolactone
- Very low androgenic progestin: may help with hirsutism, bloating, acne
11
Q
Depo provera: admin, failure rate, benefits, side effects
A
- IM injection Q12 weeks: 6% pregnancy rate in first year of use (user failure)
- Non-contraceptive benefits: no menses
1. Nothing wrong with amenorrhea from taking these pills (endometrium doesn’t build up, so nothing to “flush” out) -> higher hemoglobin - SIDE EFFECTS: weight gain, INC risk of HIV (not sure why: may thin the vagina, causing micro-abrasions during sex)
1. BBW: bone loss -> cuts off estrogen, but goes back up once this is stopped: does NOT lead to fractures or osteoporosis, but don’t take for more than 2 years
12
Q
Mirena: admin, benefits
A
- Intrauterine device (IUD) levonorgesterol
- Q5 years: 0.2% failure rate in first year
- Non-contraceptive benefits: amenorrhea
- Cost
13
Q
Skyla
A
- Smaller device: levonorgestrel-releasing IUD
- Q3 years
- For nulliparous, younger pts
14
Q
Copper IUD
A
- Q10 years: 0.8% failure rate first year of use
- Spermicidal
- SIDE EFFECTS: dysmenorrhea, heavy periods (no hormones in these)
- CONTRAINDICATIONS: copper allergy, Wilson’s disease (accumulating copper)
- NOT hormonal
15
Q
What are the current thoughts on IUD’s?
A
- Safe, new design (compared to past)
- Can place in nulliparous women, teenagers, even those with past history of STIs and PID
- Depo provera: more likely to contract HIV, but no one knows why (may thin the vagina a little as well, causing micro-abrasions during sex)
16
Q
Nexplanon
A
- 3 years: 0.05% failure rate first year
- Easy in/easy out
- Side-effects: irregular menses
17
Q
Long-acting reversible contraception options? Benefits?
A
- Insert it, forget it
- Highly effective
- Few contraindications
- Rates going down:
1. Teenage pregnancy rate
2. Medicaid births - Consider these for ADOLESCENT PATIENTS
18
Q
Sterilization
A
- Female: 0.5% failure rate first year
- Tubal ligation: may have 1/100 pregnancy risk if followed out 10 yrs and include ectopic pregnancies
- Performed through laparoscope if done between pregnancies
- Performed with a Cesarean section or through an umbilical incision after vaginal birth
19
Q
What is this?
A
Filshie clips: contraception
20
Q
What is going on here?
A
- Tubal occlusion: Essure -> non-surgical transcervical sterilization
- May be side effects associated with these
