Saude sexual e reprodutiva Flashcards
Planeamento familiar
- planning of when to have children and the use of birth control and other techniques to implement such plans
o Avaliação de eficácia
- Indice de Pearl- common measure used to summarize contraceptive effectiveness
. Number of pregnancies per 100 women a usar o metodo/years
Metodos mais eficazes
- Implante é o melhor (uso perfeito e uso tipico)
- também bom o Depo provera, e DIU
Escolha do metodo
- Age
- Culture
- Socio economic conditions
- Objectives
- Chronic diseases (alt hepatica nao deve fazer contraceção oral combinada)
- Mechanism of action
- Adverse events
- Noncontraceptive benefits
Eligibilidade medica para utilizar metodo contracetivo
- ACOG e WHO
- Cat 1 : sem restrição
- Cat2: beneficio > risco
- cat 3: Risco > beneficio
- Cat4: CI
- Ex: LES com SAFF ->unico metodo cat 1 - DIU cobre, Contraceção oral combinada Cat 4
Class de metodos contracetivos
- Não hormonais o Fertily awareness methods . Calendar method . Cervical mucus method (Billings) . Basal body temperture (BBT) . Symptothermal Method . Fertility Monitoring Devices
o Withdrawal (coito interrompido)
o Barrier methods
o Lactational amenorrhea
o Intrauterine device
o Sterilisation (female/male)
- Hormonais o Combined hormonal contraceptives (estrogenio e progestativos) . Oral . Transdermal (Patch) . Vaginal (ring) . Injectable (não há em PT)
o Progestin-only contraceptives
. Oral
. Injectable (acetato de medroxiprogesterona)
. Subdermal (implante com etanogesterel)
. Levonorgestrel IUD (3 tipos com duração e quantidade de hormona diferente)
Metodo de calendario (Ogino e Knaus)
- Evaluation six months (6 ciclos), ovulation occurs 14 days before next cycle
- Periodo fertil:
o First day = subtract 18 days from the shortest cycle experienced
o Last day = subtract 11 from the longest cycle experienced - pressupost que a mulher so tem 1 ovulação por mês
Metodo do muco Billings
- Evaluation of cervical mucus and
sensations at vaginal introitus. - Periodo fertil: : Final day of stretchy,
transparent mucus →3 days after
cervical mucus is no longer detected - Após a menstruação o muco aumenta de volume e de filância, o 1- dia do periodo fertil inicia-se no 1º dia de muco filante e termina 3 dias após a filância máxima
Metodo de T basal
- measured on waking and before any activity - Aum progesterone following ovulation → small increase in BBT (0,3 -0,8ºC), which remains until the beginning of next menstruation - The couple avoids vaginal sex or uses a barrier method from the first day of a menstrual period until 3 days after the woman's temperature has risen above her regular temperature. - T basal (oral, vaginal, rectal) the temperature rise identifies the end, rather than the onset of the fertile period
Metodo sintotermico
- Observation of more than one indicator of fertility (BBT, cervical secretions, calendar)
- More effective than using a single indicator
- muito dificil de praticar
Amenorreia de lactação
- Amamentação pos parto
o Baby ≤ 6 months
o Mother still amenorrhea
o Practices exclusive breastfeeding on demand, day and night
o Efficacy ≥ 98%- 6 meses - Hormonas na amamentação: chupar aum prolactina -> dim LH e beta-endorfina-> dim GnRH -> dim LH
- Inibição da ovulação
Metodos de barreira
- Mechanical o Condom (male, female), diaphragm, capuz cervical
- Spermicides: (nonoxinol-9)
o Creams, foams, films, vaginal suppositories - Mixed
o Contraceptive sponge - Advantages:
o Accessibility, easy to use, male contraception, provide protection STIs - Disadvantages:
o Irritability/allergy, interferes with sexual intercourse,
effectiveness variable
Contracetivo hormonal combinado
- Estrogen component: Ethinyl estradiol (EE), estradiol valerate, 17 ß estradiol (2 ultimos mais parecidos com o estrogenio nativo)
- Progestin component:
o Derived from testosterone
Levonogestrel, gestodene, desogestrel, etonogestrel, norelgestromin,
norgestimate,dienogeste
o Derived from progesterone
Cyproterone acetate, chlormadinone acetate, nomegestrol
o Derived from spironolactone
Drosperinone
- VIA:oral, vaginal,transdermal, injectable
- Formulações: 21, 24 ou 28 pills/monophasic (todas a mesma dose), biphasic (2 doses), triphasic
- Def em estudos epidemiologicos:
o First generation oral contraceptives- ≥ 50 µg EtinilEstradiol
o Low dose oral contraceptives- ˂ 50 µg EE
o Second generation- 20,30, 35 µg EE + levonorgestrel, norgestrel, norgestimate (- risco trombose que 3 gen)
o Third generation- 15, 20,25,30 µg EE+ desogestrel/ gestodene
o Fourth generation- drosperinone/dienogest (bom para acne e hemorragias)/ normegestrol acetate (mais natural mas as mesma CI)
Mecanismo de ação de CHC
- Estrogen:
o Stability to the endometrium (menos spotting)
o Inibition FSH (prevents the emergence of a dominant follicle)- Os estrogenios por inibicao da libertacao de fsh- inibem a emergencia do foliculo domimante
o Aum intracellular progestational receptors
- Progestogen: o Inibition LH (inibition ovulation) o Decidualized endometrium o Thick cervical mucus o Alteration of motility of fallopian tubes
CI Cat4 CHC
- Venous/pulmonar thromboembolism
- Ischemic heart disease, stroke
- Known thrombogenic mutations
- Age ≥35 years + smoking ≥15 cigarettes per day
- Postpartum ˂ 21 days + other factors for VTE
- Breastfeeding ≤ 6 weeks postpartum
- Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
- Complicated valvular heart disease
- Major surgery + prolonged immobilization
- Multiple risk factors for arterial cardiovascular disease
- Systemic lupus erythematosus (positive antiphospholipid antibodies)
- Breast cancer
- Cirrhosis, Hepatocellular adenoma or malignant hepatoma
Migraine with aura
Beneficios não contraceção dos CHC
- Menstrual cycle disorders o Menorrhagia o Dysmenorrhea o PMS and premenstrual dysphoric disorder o Prevention of menstrual migraine
- Cancer risk reduction: endometrial, ovarian and colon cancer
- Hyperandrogenism: acne,hirsutism
- Others: pelvic inflamatory disease, fibrocystic breast disease, endometriosis, ectopic pregnancy, leiomyomas
