Schoenwald - Contraceptive Counseling Flashcards
__% of unintended pregnancies occur in women who do not use a method of contraception
and __% of unintended pregnancies occur in women who are on birth control
40
60
what test should you perform and document before starting a patient on birth control
pregnancy
coitus interruptus, postcoital douche, lactational amenorrhea, periodic abstinence
folk methods of contraception
condoms, diaphragm, cervical cap, vagina sponge, spermicides
barrier methods of contraception
OCP, patches, ring, injectable
hormonal methods of contraception
LARC
long acting reversible contraception → IUDs/implantable progestin
tubal ligation or vasectomy
sterilization
2 most effective forms of contraception
LARCs
sterilization
least effective forms of contraception
withdrawal
spermicides
absolute contraindications for OCP/estrogen-containing contraceptives
DVT
PE
what form of contraception can increase risk for BV/infxn
douching → disrupts normal vaginal flora
is lactational amenorrhea an effective method of contraception for breastfeeding women
yes →
BUT
only for first 6 months and breastfeeding must be only form of nutrition
3 methods of periodic abstinence contraception
calendar
temperature
cervical mucus (Billings)
major pro of male condoms
protect against STI → esp HIV
can you use female condoms w. male condoms
no
cons of vaginal diaphragm
must be fitted by healthcare provider
need prescription
minimal-no protection against STI
vaginal irritation → increased risk for infxn/STI
major con of spermicides
may increase risk of STI
mc used method of oral hormonal contraceptives
combined OCP → both estrogen and progestin
what has changed regarding oral hormonal contraceptives over the years
reduced estrogen and progestin
recommendation for timing of OCP
start first sunday after menses
education for patient using OCP w. abx
need back up method of contraception
how do abx reduce efficacy of OCP
diminishing gram negative bacteria reduce amt of OCP that gets absorbed
OCP alter the release of
LH and FSH from pituitary
common s.e of OCPs
nausea
breast tenderness
intermenstrual bleeding
HA
weight gain
HTN
cholelithiasis
benign liver tumors
do OCPs pose a high risk for complications
lower dose estrogen pills are safe for most women
contraindications for OCPs (6)
pregnancy
undiagnosed vaginal bleeding
prior hx VTE, MI. stroke
cigarettes + > 35 yo
current or hx breast ca
active liver dz
the patch is applied
weekly x 3 weeks
followed by placebo
3 brand names for the patch
ortho evra
xulane
the ring is inserted
every 3 weeks
then left out for one week
s.e associated w. the ring
discomfort
leukorrhea → discharge
vaginitis
foreign body sensation
problems w. intercourse
the mini pill contains only
progestin → norethindrone 0.35 mg
does the mini pill suppress ovulation
no
pt education for mini pill
MUST be taken at the same time every day!!
DMPA
medroxyprogesterone acetate → DEPO
DEPO is administered via
injection into gluteus or deltoid
con of DEPO
10 months to be able to conceive after discontinuing
significant s.e of DEPO
reduction in bone mineral density during use
not linked to increase in fx risk
3 types of emergency contraception
Plan B
ellaOne
copper IUD
Plan B doesn’t work well for what pt population
BMI > 26
ellaOne doesn’t work well for what pt population
BMI > 35
Levonorgestrel - single dose w.in 72 hr
Plan B
Ulipristal 30 mg x 1 dose
Ella
w. Plan B you should resume OCPs
asap
w. ella you should resume OCPs
after 5 days
which type of IUD can be used for emergency contraception
copper
3 types of LARC
levonorgestrel IUD
copper IUD
etonogestrel (Nexplanon)
2 types of IUD
copper
levonorgestrel
which IUD is non hormonal
copper
s.e of copper IUD
cramping
abnormal bleeding
4 types of levonorgestrel IUD
mirena
liletta
skyla
kyleena
complications of IUD
ectopic pregnancy
spontaneous abortion
expulsion
uterine perforation
infxn
irregular bleeding
f.u for IUD pt’s
4-6 weeks after implantation
yearly after
pt needs to check for strings
management of missing strings
- back up birth control
- pregnancy test
- transvaginal US
- refer to gyn for removal
etonogesterel - nexplanon
implant similar to action of Depo
who can insert/remove nexplanon
only certified providers
4 types of sterilization
tubal ligation
essure
vasectomy
hysterectomy
implant into fallopian tubes that encourages scar build up
essure
what might be a good option for young patients
DEPO → less worried about 10 months to return to fertilization
pt’s can return to fertility soon after d,c of conception w.
OCP
IUD
Nexplanon
what method of contraception might be good for a pt. w. contraindications for estrogen (like PE/DVT)
mini pill → progestin only
what 3 types of birth control contain progesterone only
mini pill → norethindrone
Depo
etonogestrel (Nexplanon)