week 3-BirthControl Flashcards
How long has BC been used for?
When did methods become available?
Since ancient times
mid 19th century
Who is Margaret Sanger?
-leader of family planning
-introduced the diaphragm
-founded the american birth control league
When were IUDs created?
1960’s
1970s
Congress established the national family planning program – Title X
What does title X do?
Provides funding and support for comprehensive family planning services and STD care free or based on income.
What affects BC: and we are behind other countries for which reasons?
-Product liability lawsuits
-Antifamily planning activism
-Feminist pressure
-Religious pressure
-Political groups
-Consumer groups
-Lengthy FDA tape
-Too little knowledge
-Too little money
What is BC defined as?
-Purposeful regulation of conception or childbirth
-Voluntary avoidance or delay of childbirth/pregnancy
-Use of devices, chemicals, abortion or other techniques to prevent or terminate pregnancy
Reasons to use BC?
-Personal convenience
-Economics
-Social values
-Lifestyle
How long is the reproductive lifespan?
40 years
What are the factors that enhance or impair contraceptive behavior?
Age
Maturity
Marital status
Desire
Cultural and religious beliefs
Medical Hx
Presence of medical/physical limitations
Costs
Partner input
Previous experience
Frequency of intercourse
Effectiveness
Safety
Confidence
Lactation status
Costs
Partner input
Previous experience
Frequency of intercourse
Effectiveness
Safety
Confidence
Lactation status
What are some methods of birth control?
COCs
Progestin only
Postcoital methods
Barriers
Vaginal spermicides
IUDs
Fertility awareness method
Coitus interruptus
Lactational amenorrhea method
Sterilization
Abortion
What are some management considerations for BC?
-Client must participate in choosing method
-She must be an informed user
-Informed consent
-Carefully screen for contraindications
-Set aside counseling time
-Be trained in client’s choice
What are some management considerations for BC?
-Presentations in client language
-Be aware of local myths
-Use teaching checklist
-Instruct male/female anatomy
-Provide client with method-specific teaching methods
What are some management considerations for BC?
-Explain factors that could put client at risk for method failures
-IF client chooses a method she is at risk for – recommend another
-If client chooses coitus interruptus – explain high risk days of fertility
-Provide oral and written instructions
-Encourage second method
What are some management considerations for BC?
-Advise client to keep sufficient supplies available
-Teach proper care and storage
-Barrier methods – good hand-washing before
-Ask for client to repeat information
-Inform about the availability of emergency contraception
Combined oral contraceptives
-Been on the market since 1960s
-60 million or more worldwide use this method
-Over 20 million American women
-Pill contains two primary components
**Estrogen and progestin
Estrogens
Ethinyl estradiol
Mestranol
Progestins
Eight different types
Desogestrel
Levonorgestrel
Norgestimate
Norethindrone
Ethynodiol diacetate
Drospirenone
Norgestrel
Norethindrone acetate
The newest progestins have very little
estrogenic or androgenic activity
Minipill (progestin only birth control pill)
MOA
-GNRH is suppressed
-Ovum/tubal transport is altered
-Cervical mucous thickens, inhibiting sperm transport
-99% effective
-Failures
Advantages of the minipill (progestin only birth control pill) MOA
-lighter, shorter, less painful menstrual periods
-take after giving birth even with breastfeeding
-able to get pregnant immediately after stopping the minipill
-does not affect sexual intimacy like barrier forms of BC
-It’s helpful for people who are unable to take estrogen-containing birth control pills
What are disadvantages of the minipill? MOA?
-irregular menstrual bleeding and spotting
-acne
-breast tenderness
-decreased sex drive
-depression
-headaches
-nausea
-ovarian cysts
Benefits of BC? noncontraception
-Improved menstrual characteristics
-Protection against ovarian or endometrial cancer
-Lower incidence of ovarian cysts
-Prevention of ectopic pregnancies
-Low incidence of endometriosis
-Some protection against std
-Low incidence of benign breast and fibroadenomas
-Reduction of acne/treatment of hirsutism/reduce i-ncidence of RA
symptoms of estrogen excess?
-N /V
-Bloating/edema
-HTN
-Migraine HA
-Breast tenderness
-Decreased libido
-Weight gain
-Heavy menstrual flow
-leukorrhea
Side effects of estrogen deficiency?
-Early cycle spotting
-Breakthrough bleeding day 1-9
-Absence of withdrawal bleed
-Amenorrhea
-Vaginal dryness
-Atrophic vaginitis
-Vasomotor symptoms
-Pelvic relaxation
What are the side effects of progestin excess?
-Acne
-Increased appetite/weight gain
-HTN
-Fatigue
-Depression
-Hirsutism
-Vaginal yeast infections
What are the side effects of progestin deficiency?
-Late breakthrough bleeding days 10-21
-Amenorrhea
-Heavy menstrual flow
-Dysmenorrhea
-Menorrhagia and clotting
Adverse effects of estrogenic activity?
-Bloating
-N/V
-Breast fullness
-Irritability
-Headache
-HTN
Adverse effects of progestin activity?
-HA
-Breast pain
-HTN
Adverse effects of androgenic activity?
-Acne
-Oily skin
-Weight gain
-Hirsutism
-Fatigue
-depression
Management considerations for BC?
-Education
-Encourage stop smoking
-Start patient on lowest dose
-Do not start new clients on pills with Desogestrel
-Evaluate new clients at end of three months
-Annual exams
Danger signs slide 40? What to do with danger signs? Maybe acronym page 40
Progestin only pills
-Introduced in 1970s
-Daily with no free periods
-Good for the patient with contraindications to combined pills
-Good for the breast feeding client
-Contain Norethindrone or Norgestrel
Fixed dose
-28 or 42 day packs
What are advantages to progestin only pills?
-No estrogen side effects
-Safer than COCs
-Lactating women and women with HX of DVT
-Good for women with contraindications to COCs
-Minimal effect on CHO
-Rapid reversal
-Noncontraceptive benefits
What are disadvantages to progestin only pills?
-Must be taken with meticulous accuracy
-^ incidence of ectopic pregnancies
-^ incidence of ovarian cysts
-Irregular bleeding
-No protection against STD
-Decreased effectiveness with drug interactions
-Less effective of COCs
-May decrease HDLs and ^ LDLs
-Less widely available
What are contraindications to progestin only pills?
-Must carry same as COCs
-HX of functional ovarian cysts
-HX of ectopic pregnancy
-Inability to take correctly
-Hyperlipidemia
-Undiagnosed abnormal vaginal bleeding during the preceding three months
what are some management considerations for progestin only pills?
Depo- Provera injections
IM injection of 150 mg
Medroxyprogesterone
Approved in 1992
Suppresses ovulation and altering the cervical environment
99% effective
Effective 24 hours after shot
What are some advantages & disadvantages to the depo-provera injection?
What are side effects of the depo-provera injection?
-Weight gain
-Injection sites
-Irregular bleeding
-Loss of bone mineral density
-Delays of return to fertility
Easier to administer than the IM injection
Depo-Provera facts?
-Approved in 1994
-104 mg of Medroxyprogesterone acetate
-Every three months
-Prevents ovulation and causes thinning of endometrium
Transdermal patches
-2002 approved
Ortho-Evra
Combination
-EE/Norgestimate
-MOA similar to COCs
99% effective
Enhanced compliance because weekly administration
Trandermal patches
-Black box warning
-Issued in 2005
-Exposes patients to higher steady state concentrations and lower peak concentrations of EE
-Potential for increased adverse effects related to estrogen
Transdermal patches side effects?
-Associated with higher rates of pregnancies if weigh -more than 198 lbs.
-Increased incidence of breast tenderness
-Poor cycle control
-Application site reactions
How do you use Transdermal patches?
-Buttock, abdomen, upper outer arm or upper torso on 1st day
-Apply new patch weekly/3 weeks
-Location of patch rotated
IUDS?
-Came under some scrutiny in 1970s related to PID and the Dalkon shield
Two types
Copper containing
Hormone releasing
Copper containing IUD?
Copper Paragard T- 380 A
More commonly used
Function by decreasing sperm’s ability to reach the uterus and fallopian tubes for fertilization and create cellular changes to the sperm that cause it to be nonviable
No hormonal side effects
Safe for 10 years
Has a white string
Hormonal IUD?
Progestasert (progesterone)
-First one
-Functions as a contraceptive by releasing progesterone and alters the cervical environment
-Inserted by the clinician
-Left in place for 1 year
-Efficacy rate 98%
Copper IUD was approved in?
1984
Progesterone T was approved in?
1976
Adverse effects of Hormonal IUD?
-Intermenstrual spotting
-Severe but rare effects
-PID
-Fragmentation of device
-Cervical perforation
