nausea breast tenderness intermenstrual bleeding HA weight gain HTN cholelithiasis benign liver tumors

Schoenwald - Contraceptive Counseling Flashcards by Alice Richards

__% 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

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what test should you perform and document before starting a patient on birth control

pregnancy

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coitus interruptus, postcoital douche, lactational amenorrhea, periodic abstinence

folk methods of contraception

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condoms, diaphragm, cervical cap, vagina sponge, spermicides

barrier methods of contraception

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OCP, patches, ring, injectable

hormonal methods of contraception

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LARC

long acting reversible contraception → IUDs/implantable progestin

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tubal ligation or vasectomy

sterilization

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2 most effective forms of contraception

LARCs

sterilization

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least effective forms of contraception

withdrawal

spermicides

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absolute contraindications for OCP/estrogen-containing contraceptives

DVT

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what form of contraception can increase risk for BV/infxn

douching → disrupts normal vaginal flora

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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

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3 methods of periodic abstinence contraception

calendar

temperature

cervical mucus (Billings)

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major pro of male condoms

protect against STI → esp HIV

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can you use female condoms w. male condoms

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cons of vaginal diaphragm

must be fitted by healthcare provider

need prescription

minimal-no protection against STI

vaginal irritation → increased risk for infxn/STI

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major con of spermicides

may increase risk of STI

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mc used method of oral hormonal contraceptives

combined OCP → both estrogen and progestin

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what has changed regarding oral hormonal contraceptives over the years

reduced estrogen and progestin

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recommendation for timing of OCP

start first sunday after menses

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education for patient using OCP w. abx

need back up method of contraception

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how do abx reduce efficacy of OCP

diminishing gram negative bacteria reduce amt of OCP that gets absorbed

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OCP alter the release of

LH and FSH from pituitary

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common s.e of OCPs

nausea

breast tenderness

intermenstrual bleeding

weight gain

HTN

cholelithiasis

benign liver tumors

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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

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

1. back up birth control 2. pregnancy test 3. transvaginal US 4. 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)