week 3 Birth Control-part 2 Flashcards
Mirena (levonorgestrel – 52 mg)
May prevent ovulation in 20% of cycles but works by altering cervical environment and thinning of endometrium
99% effective
Good for five years
Effects:
Irregular bleeding
PID
dysmenorrhea
Skyla (levonorgestrel – 13.5 mg)
how does it work?
What is the effectiveness of skyla?
length of time?
small
What are the side effects of skyla?
Liletta (Levonorgestrel) 52 mg
How does it work?
What is the effectiveness of liletta?
length of time?
What are the side effects of liletta?
Vaginal contraceptive ring
-EE/etonogestrel
-98-99% effective
-Flexible ring inserted into the vagina by the 5th day of the menstrual cycle
-Left in place for three weeks
-MOA similar to COCs
What are the side effects of the contraceptive ring?
What patients should not have the contraceptive ring?
Not recommended for patients with a cystocele, rectocele, or uterine prolapse
Management for the contraceptive ring?
How to take
Insertion
-If out of vagina for more than 3 hours must rinse off and reinsert – no need to use backup method
-Out of vagina more than 3 hours backup method for next seven days
-New ring inserted at same time as old one was removed
Implant contraception?
-Single rod subdermal implant
-Releases 60-70 mcg of etonogestrel initially then decreasing
-Became available 2006
-Provides effective contraception for 3 years
MOA?
Ovulation suppressed by inhibition of LH
Change in cervical mucous
Thin endometrium
98-99% effective
Same advantages and disadvantages as Depo
See pages 190-191
Postcoital Contraceptive method
-Morning after or emergency contraception
-Used to prevent pregnancy after 1 night of unprotected intercourse
-Indications
Postcoital contraceptive method
-Must be used within 72 hours if pills, have up to five days with IUDs
Available in following:
COCs
POPS
Copper-T IUD
COC? (combined oral contraceptives?
Timing?
Pregnancies?
Advantage?
Disadvantage?
Side effects?
Avoid?
Timing= up to 72 hrs
Pregnancies= 3.2%
Advantage= many available
Disadvantage- N/V
Side effects- N/V
Avoid- pregnancy
POPs (progesterone only pill)
Time= up to 72 hrs
Pregnancies= 1.1%
Advantage- less N/V
Disadvantage: N/V but lower rates
Avoid: pregnancy
IUD?
TIme: up to 5 days
Pregnancies: 0.1%
Advantage: most effective
Disadvantage: pain, bleeding, risk of infection
Avoid Pregnancy
combined oral contraceptives (COCS)
-preven or ovral
-Loveral
-Nordette
-Levlen
-Levora
-Triphasil
-Trilevlan
-Trivora
-Alesse
-Levlite
progesterone only pills (POPs)
ovrette
20 yellow pills
Barrier methods
Male condoms
Female condoms
Spermicides
All are over the counter
Barrier methods: diaphragm
-Must be fitted by a health care provider
-Must have a prescription
-Must change if gain or loss ten pounds
Fertility Awareness methods
-Client must be diligent in charting the menstrual cycle
-Must be diligent the body basal temperature
-Must be diligent in recording the change in cervical mucous
Fertility Awareness methods: Calendar
-Client knows and understands her cycle, the life of the sperm, and the life of the ova
-Charts cycle for 8 months
-Uses longest and shortest to decide when she should refrain from sexual activity
Body basal temperature: Fertility Awareness method
Uses changes in body temperature when ovulation occurs to predict the safe period of sexual activity
Cervical mucous: Fertility Awareness method
-Assessment of mucous characteristics
-If resembles egg whites, ovulation is near
-Safe period is dry days and 4th night after peak mucous day to menses
Cervical Position: Fertility Awareness method
-Assessment of position of the cervix
-If fertile – the cervix is high in the vagina, soft, open, and wet.
Cervical Position: Fertility Awareness method
Effectiveness
-Must be done correctly
-Unforgiving of imperfect use
-72% effective
Elective Abortion
-1973 won the right to have a legal abortion
-Death rate has decreased from 300 deaths/year in 1961 to 6 deaths/year in 1987
-There has also been a decrease in other complications
Methods of Induced Abortion
Vacuum curettage:
Most common
Done before 14 weeks
Can be done under local
Cervix must be dilated either by metal dilators or osmotic dilators
Suction D&C:
Complications
IAB, cervix laceration, seizure, cardiac arrest, uterine perforation, bleeding, infection, uterine atony
Methods of Induced Abortion
Dilatation and evacuation
-Completed after 14 weeks
-Involves dilation of cervix
Laminaria
Metal dilators
-Products removed by forceps followed by curettage and suction
-Safer than medical methods
Medical methods of induced abortion (mostly medication for abortion)
-Prostaglandin E2 suppository
-Prostaglandin F2 IM
-Hypertonic intra-amniotic infusion
-Intra-amniotic prostaglandin infusion
-Hypertonic urea intra-amniotic infusion
-Cervical dilation
-Oxytocin IV
-Completed in hospital
Medical methods of induced abortion (mostly medication for abortion)
- Methotrexate/Misoprostol
Given IM at 50mg/sq. meter of body surface - Misoprostol in 800 mcg by suppository or orally 3-7days later.
- Methotrexate
Toxicity to the tissue
SE minimal - Misoprostol
For uterine contractions
N, V, D
Medical methods of induced abortion (mostly medication for abortion)
RU486
Mifiprex and Cytotec
Mifiprex
Potent antiprogestogen and blocks the action of progesterone
- First visit
Counseled, given 3 pills and observed - Second visit
Given 2 200 mcg and observed for 4 hours - Third visit
Evaluation – after 12 days
What is the NPS role in a well women visit?
*Counseling and client preparation
*Menstrual HX
*Contraceptive HX
*OB HX
*Reproductive disease
*Drug/anesthesia allergies
*Illness
*Current medications
What is the NPS role in a well women visit?
What labs would you order?
Physical Exam
Labs
*Pregnancy test
*Sono
*HCT/HGB
*Blood type
*STD testing
