Week 2- Contraceptives Flashcards
Women use contraceptives for how many years of their life?
30
Percent of pregnancies that are unplanned or unintended?
50
Percent of pregnancies that are unplanned and are voluntarily terminated?
40
Definition of family planning?
The number and timing of pregnancies
Birth control is:
To prevent pregnancy and limit the number of children
What is the IUD made just for adolescents?
Skyler
What is the least effective contraceptive method?
Fertility awareness method
What does the standard day method do?
Looks at the days of your cycle and tells you which days you are fertile
What is the basal body temperature method?
Looks for change in temperature of 0.4F which shows ovulation
Take same time every day
What is the hormone responsible for the rise in your body temperature with ovulation?
Progesterone released by the corpus luteum
What are the risk with the diaphragm and the cap?
If they leave in for longer than 24 hours can get TSS
If they have a history of TSS what contraception do we not recommend?
Diaphragm or the cap
If you leave in the diaphragm or cap in longer than 24 hours what are you at risk for?
Bladder infections
TSS
Infection
What is an advantage to women who use the diaphragm or cap?
Female regulated
Do you have to be fitted for the sponge?
No
What’s the main advantage of barrier methods like condoms?
Conception
Prevent some STDs
Can you use more than one barrier method at a time?
No- breakage
Which male Condom is more effective than the other? Why?
Latex
Non-latex is more brittle and doesn’t stretch like latex
18 year old is not sexually active and wants birth control. Is a pelvic exam necessary?
No
Just need BP- no COC for HTN
When prescribing birth control what is the main subjective family history you need to collect?
History of blood clots, cardiac history, coagulation disorders
What are contraindications to prescribing combined COC?
History of migraine with auras HTN Risk of blood clot Cancers- breast, ovarian Active liver disease Active gallbladder disease Greater than 35 and smokes 4 weeks postpartum
What medications make COCs less effective?
Anti-convulsants
Rifampin
HIV antivirals
If you do a quick start method of birth control what do you need to verify first? What teaching is needed?
Not pregnant and what other birth controls she is using, has she had sex since menses.
She will need to use back-up for first 7 days
If you are not within the first ___ days of your menstrual cycle you have to use backup for 7 days?
5
What is the number one chosen birth control method by women?
COCs
COCs are ___ % effective?
91
Are progesterone or estrogen methods safer?
Progesterone
Do progesterone or estrogen birth control methods cause side effects like HA and nausea?
Estrogen
What do you tell a woman that misses her Sunday pill and it is now Monday?
Take it right away and continue as normal
If a patient forgot to take Saturday and Sunday birth control pills, and it is Monday, so 48 hours without a pill, what do you tell her?
Start on the day you are on, use a back-up method for 7 days
What combines birth control method do we worry about a woman’s weight and it not being effective?
The patch
At what weight may the patch be ineffective?
196
How does the ring work?
Body temperature causes the hormones to release slowly everyday
How long can the ring be left out of the body before you need to use a back up method?
3 hours
What birth control method would you recommend for a woman who is 35 and smokes?
Depo or progestin only pill
What does depo do?
Suppresses ovulation and LH
How does the progesterone only pill work vs combined?
Combines prevents ovulation
Progesterone only creates a cervical mucous plug so spermatogenesis can’t get to the cervix.
Does the progesterone only pill prevent ovulation?
No
Does depo-provera suppress ovulation?
Yes- high does progesterone
What are some non-contraceptive benefits you can get from birth control pills?
Prevent acne
Helps with heavy periods
Protects against anemia
If you are prescribing birth control for dysmenorrhea, how long should you wait to see relief?
2-3 months
What is first line therapy for dysmenorrhea?
NSAIDS
What does LARC stand for?
Long acting reversible contraception
Is LARC hormonal or nonhormonal?
Can be both
What is a non-hormonal LARC?
Copper IUD - Paraguard
Which LARC has progesterone?
Levo something
Which LARC is for adolescents or nulluparous women?
Skylar, kylena
What is the number one downfall of LARCs?
Can cause irregular bleeding
Which LARC can you get pregnant within 6 weeks of removal?
Nextplanon
How long after removal of depo can you get pregnant?
14-36 weeks
What can you do if patient is on a LARC and is having heavy irregular bleeding?
COC if not contraindicated
High dose NSAIDs 800mg TID for 5 days
How long can irregular bleeding last with the initial placement of a LARC?
Up to 12 months
Do you need to test for STIs prior to IUD insertion?
No
Before placing an IUD you need to do a pelvic exam, what are you looking for?
Enlarged uterus- pregnancy
Fibroid of the uterus
IUDs and nexplanon are almost ___% effective?
100
What effect does the copper IUD have on periods?
Can make them heavier
Would you give a woman with dysmenorrhea a copper IUD?
No
What are some non-contraceptive benefits of iuds?
Can prevent endometrial cancer or cervical cancer
Can cause amenorrhea
What IUD can be used as an emergency contraceptive?
Copper iud
How long after unprotected sex can you insert a copper iud?
Up to 5 days
What are the other options for emergency contraception besides a copper iud?
Morning after pill-plan b- 17 or older OTC
Prescription plan B- Ella
How does Ella, the prescription plan B work?
Progesterone antagonist
What is the advantage to Ella?
It’s more effective
Don’t have to worry about weight making ineffective
Plan b is only indicated for up to ___ days after unprotected sex but can be used up to ___ days but will be less effective.
3
5
Ella is effective up to ___ days?
5
A postpartum woman should avoid estrogen containing birth control for at least ____ due to what risk? What
4 weeks
DVT
What risks are associated with placement of IUD directly following birth?
Perforation of the uterus
Expulsion of the IUD
What birth control can women start immediately postpartum?
Progesterone only
What is the lactation amenorrhea method of birth control?
Must be exclusively breastfeeding
Effective up to 6 months
At what week gestation are you unable to have a medical abortion and must do a surgical abortion?
After 9 weeks
Methotrexate may be used up to what week gestation?
7
Mifepristone may be used up to what week gestation?
9
After 9 weeks gestation, what is the most common form of abortion and up to what week can this be done?
Aspiration
12 weeks
What form of abortion can be done up to 13 weeks?
DNC
What form of abortion must be done after 13 weeks?
Dilation and evacuation
With typical use what is the noneffective rate of coitus interruptus?
12%
Due to high levels of prolactin this method inhibits secretion of GnRH that sets off the HPO axis and prevents ovulation.
Lactational amenorrhea method
What conditions must be met for LAM?
Infant must be exclusively breastfed. (No longer then 4 hours between feeds in the day and 6 hours at night)
Infant younger than 6 months.
No return of maternal menses.
What is the lifespan of the ovum?
12-24 hours
How long is sperm viable?
3-5 days
What is the rhythm method?
1st fertile day is shortest cycle - 18
End of fertile days is longest cycle - 11
For standard days method how long does your cycle need to be and what days do you abstain from sex?
26-32 days
Abstain days 8-19
What is the Billings ovulation method?
Uses change in cervical mucous to determine fertile window. Abstain from sex from day 1 of elastic like cervical mucus until 4 hours after gone.
What method do you abstain from sex on days 10-14 of cycle or when you answer yes to:
Did I notice any secretions today?
Did I note any secretions yesterday?
The two day method
With the basal body temperature what rise in temperature indicates ovulation?
At least 0.4 degrees F
What causes the rise in temperature with ovulation?
Occurs as more progesterone is released by the corpus luteum, signaling ovulation has occurred.
This method uses BBT, cervical mucus plug, and cervical observations.
The symptothermal method
Following ovulation, what does the cervix do?
It becomes more firm and lower in the vaginal canal and closed.
Subdermal implants like nexplanon are inserted under the skin and continuously release what which does what?
Progestin (progestin only devices)
Suppresses ovulation
Side effects of nexplanon:
Irregular bleeding, blood pressure (monitor twice a year), acne, increase in weight, nausea, headache.
How long after nexplanon insertion may the patient have irregular bleeding?
Up to 3 months (spotting)
This device the primary contraceptive effect is provided by the reaction of having a foreign body in the reproductive tract- specifically- a sterile inflammatory response that has spermicidal effects.
Copper IUD
What is the PAINS mnemonic for IUD?
Watch for period, abdominal pain, infection, not feeling well, strong missing
These are least effective protection, are meant to be used with a barrier method, and increase risk of STIs due to micro-abrasions in vaginal mucosa.
Spermicidal agents
Estrogen in birth control suppresses the production of what, thereby preventing selection and emergence of a dominant follicle.
FSH
What is the ACHES mnemonic for birth control?
Use to remember adverse events and when patient needs to be see : Abdominal pain Chest pain Headache Eyes/vision Severe leg pain
A medical abortion can not be given to women with:
Coagulopathy
Seizure disorder
Liver/renal disorders
