Phillips - Contraceptives Flashcards
What % of US pregnancies are unintended (pie chart)? Demographics?
- 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

What are the 3 most common causes of unintended pregnancy?
- Contraceptive nonuse
- Contraceptive method failure: example -> broken condom
- Contraceptive user failure: example -> missing a dose of OC (aka, typical use)
What contraceptive methods are most effective (graph of failure rates)?
- 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

What is the one hormonal contraceptive that works locally?
- 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
What are 5 factors to consider when determining the best contraceptive method?
- Reversibility
- Adherence issues
- Contraindications
- Non-contraceptive benefits (i.e., regularity of periods)
- Cost: ACA mandates that all insurance companies provide coverage for contraception
Oral contraceptives: side effects, non-contraceptive benefits
- 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
Condoms: failure rate, benefits
- 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)
What are the roles of estrogen and progestin in the combo pill?
-
Progesterin: INH the release of GnRH
1. PROGESTIN is what PREVENTS - Estrogen: stabilizes the endometrium to prevent irregular bleeding and promote a normal cycle
Will taking OC’s delay menopause?
- NO
- Menopause is on automatic pilot
What is Drospirinone?
- Related to Spironolactone
- Very low androgenic progestin: may help with hirsutism, bloating, acne
Depo provera: admin, failure rate, benefits, side effects
- 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
Mirena: admin, benefits
- Intrauterine device (IUD) levonorgesterol
- Q5 years: 0.2% failure rate in first year
- Non-contraceptive benefits: amenorrhea
- Cost
Skyla
- Smaller device: levonorgestrel-releasing IUD
- Q3 years
- For nulliparous, younger pts
Copper IUD
- 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
What are the current thoughts on IUD’s?
- 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)
Nexplanon
- 3 years: 0.05% failure rate first year
- Easy in/easy out
- Side-effects: irregular menses

Long-acting reversible contraception options? Benefits?
- Insert it, forget it
- Highly effective
- Few contraindications
- Rates going down:
1. Teenage pregnancy rate
2. Medicaid births - Consider these for ADOLESCENT PATIENTS

Sterilization
- 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

What is this?

Filshie clips: contraception
What is going on here?

- Tubal occlusion: Essure -> non-surgical transcervical sterilization
- May be side effects associated with these
Male sterilization
- Ligation of the vas deferens: failure rate 0.15%
- More easily reversed than female procedure
- Office procedure takes 20 minutes
Emergency contraception options (2)
-
Plan B (OTC): levonorgestral
1. Begun within 72 hours of unprotected intercourse
2. DEC pregnancy rate from 8/100 to 2/100 women - Copper IUD the most effective EC metho; prevents implantation, but have to put in within 72 hours
What should you recommend to all women seeking contraceptive recommendations?
CONDOMS
17-y/o. Counsel about safe sex. Condoms every time. Screen for STIs. Mom is there
Healthy. Worried about acne, weight, and complains of dysmenorrhea.
What is her best contraceptive option?
- Oral contraceptives: will help with acne, and keep periods regular
- Also a candidate for depo, although this may cause weight gain
- IUD a possibility, but not Cu because this will make cramps worse
- See back in 2 months to check on adherence, comfort, side effects
42-y/o with history of HTN and menorrhagia. What is her best contraceptive option?
- Depo, IUD
- OC’s or patch would be fine, but you want her to be off the pill by 45 to prevent INC risk of breast cancer
1. If she had heparin in the past for DVT, you would rule out the pill - IUD copper would also be fine
How is estrogen prothrombotic?
- DEC anti-thrombin III, affecting factor ratio
- INC thromboembolic effect
- REMEMBER: risk of thromboembolism is HIGHEST during pregnancy
Is there a contraindication to being on birth control pill if you are a smoker under 35?
- NO
- Over 35 and a smoker a contraindication
Woman had tubal ligation, and presents with no period and abdominal pain. What next?
- Pregnancy test for ectopic pregnancy