Women's Health, Contraceptive Counseling- Schoenwald Flashcards
Decision Making
-For many people, personal and sensitive issue–> Religious or philosophical
- High rate of unintended or unplanned pregnancy, 2009 ~49.2%
- Oral contraceptives: Side effects, access, methods difficult to use correctly
Approximately __% of unintended pregnancies occur in women who do not desire pregnancy yet do not use a method of contraception
40%
Approximately ___% of unintended pregnancies occur in women using some form of birth control
60%
Teenage pregnancy has dropped, 2009 study found rate dropped ___% from 1990 to 2005
40%
Why use birth control?
- Family Planning – limit family size, space children
- Avoid child bearing – personal, medical condition
- Provider to discuss information on both benefits and risks of both contraception and pregnancy – so the patient can make an informed choice
- Most states have laws that permit access to contraception for minors (under 18yo)- confidential visits
- Signed consent forms (IUD, injections, Nexplanon, sterilization)
- Pregnancy test – documented negative
Methods of contraception:
- Folk methods – coitus interruptus, postcoital douche, lactational amenorrhea, and periodic abstinence (rhythm or natural family planning)
- Barrier methods
- Hormonal methods
- LARC – Long acting reversible contraception (IUDs and implantable progestin)
- Sterilization
List Ex’s of barrier methods
condoms (male and female), diaphragm, cervical cap, vaginal sponge, and spermicides
List Ex’s of Hormonal methods
oral contraceptives, patches, ring, and injectable
Describe Sterilization Procedures
tubal ligation or vasectomy
(BOTH are reversible, tubal ligation is more difficult to reverse due to scarring. Vasectomy is 1 procedure, and if it was decided to be reversed later on–> then you can do a reversible but it’s another procedure)
Comparing Effectiveness of Family Planning Methods:
Least effective: withdrawal methods, spermicide usage,
Next: condoms
Next: Injectables, Pills (OCPs), Patch, ring
Most effective: implants, IUD, sterilization
CDC Medical Eligibility criteria (for initiating contraception)
1- method can be used without restriction
2- Advantages of use generally outweigh theoretical or proved risk
3- Method usually not recommended unless other, more appropriate methods are NOT available or acceptable
4-Absolute contraindication, method NOT to be used
Coitus Interruptus
- One of the oldest contraceptive methods= pullout method
- Withdrawal of penis before ejaculation
- **Failure rate higher than most methods
Postcoital Douche=
- Plain water, vinegar, and a number of feminine hygiene products used
- Theoretically, douche flushes semen out of vagina
- Ineffective and unreliable
- Contributes to lack of normal vaginal flora>increased risk of infection
CDC chart on Contraceptive use:
know for exam
takeaways:
- Pts on OCPs are at a HIGHER risk for DVTs, OCPs in the setting of clotting history= 3,4 (if you can use something else you should, (ie a woman with Factor 5 may opt for an IUD in place of OCPs)
- -add in smoking in a Pt with clotting risk–> BAD
-any Pt with a clotting history SHOULD NOT be prescribed an OCP. safest to have another method
Lactational Amenorrhea=
Efficient method for breastfeeding women
Lactational Amenorrhea:
-suckling results in decreased ____
GnRH, LH, and FSH
Lactational Amenorrhea: results in ________ and anovulation
amenorrhea
anovulation (dont ovulate)
Lactational Amenorrhea:
During first 6 months, if breast feeding exclusively, menses are mostly anovulatory and fertility remains ____
low (0.9 – 1.2%)
Lactational amenorrhea:
-after 12 months, pregnancy rates ____
rose (7.4%)
Lactational Amenorrhea:
Must use breastfeeding as the ____ ____ of infant nutrition
only form
Periodic Abstinence=
-Women fertile for only a few days of menstrual cycle (so menstrual cycles are then mapped out)
- Rhythm or natural family planning method
- -Avoid coitus during the time of the cycle when woman most fertile
- -Fertile period=ovulation to 2-3 days after
What is the pregnancy rate for Pts using the periodic abstinence method?
Pregnancy rate 10-25%
Periodic Abstinence:
-Methods?
- Calendar method - failure rate up to 35%
- Temperature method – record upon wakening basal body temperature – temperature has slight drop 24-36 hours after ovulation. The temperature then rises abruptly (0.5-0.7 degrees F)for remainder of cycle.
- Cervical mucus method (Billings) – uses changes in cervical mucus to predict ovulation – starting several days before until just after ovulation, mucus becomes thin and watery, at other times mucus thick and opaque
Male Condom:
- Cover for the penis during coitus–> prevents deposition of semen into vagina
- Reduce transmission of infectious agents
Material: -Latex (most common) -Polyurethane (vinyl) -lamb intestine (lamb skin) effective and inexpensive contraception protection from STIs including HIV - no prescription needed -Some condoms contain spermicide
- Failure rate 10-30% in first year of use-technique?
- More effective if used in conjunction with other birth control method
- Still may have skin contact of scrotal-labial
Female Condom:
- material?
- describe this method
- disadvantages?
- Failure rate?
- Made of thin polyurethane material with 2 flexible rings on either end
- One ring fits inside vagina and other ring sits outside near the introitus
- Under control of female and offer some protection against STIs
- Disadvantages – cost and bulkiness
- 6 month failure rate with perfect use 2.6%
- Reduces annual risk of HIV by more than 90%
Can you use a female condom with a male condom?
NO -Do not use with male condom
Vaginal Diaphragm
=Mechanical barrier between vagina and cervical canal
- Designed to fit in vaginal canal and cover cervix
- Contraceptive jelly or cream should be placed on the cervical side of the diaphragm(insert with dome facing down)
- Can be inserted up to 6 hours before intercourse
- Should be left in place for at least 6-24 hours after intercourse
- Perfect use failure rate 6%,
- Normal use 15-20%
- Must be fitted by a healthcare provider, prescription needed
- May need size adjustment
- May protect against STIs-(minimal to none)
- May cause vaginal wall irritation or increased risk of UTIs
Cervical Cap
=Small cuplike diaphragms placed on cervix and held in place by suction
- Most be fitted tightly over cervix to provide barrier for sperm
- Must be measured by healthcare provider
- Difficulty placing cap
- May remain in place for 1-2 days at a time
- Cap should be left in place for 8-48 hours after intercourse
- Foul discharge may develop after this
- Proper placement over cervix confirmed by digital self exam after each sexual act
- Failure rate similar to that of diaphragm
Spermicides: list Ex’s
Spermicidal vaginal jellies, creams, gels, suppositories, vaginal sponge, and foams
Spermicides: effect?
- Toxic effect on sperm also act as mechanical barrier
- Can be used alone or in conjunction with diaphragm or condom
Spermicides: Failure rate?
15% per year with perfect use but double with typical use
Spermicides: irritation S/E
Chemicals may irritate vaginal mucosa/genitalia
T/F: spermicides are not effective in preventing gonorrhea, chlamydia, or HIV
true
Genital lesions from frequent use of spermicides may be linked to increased risk _____
HIV infection
Oral Hormonal Contraceptives
- General use started in 1960s
- MC used method is combined method – pills containing both estrogen and progestin are taken for 21 days followed by 7 days of placebo during which time most women have withdrawal bleeding
- Estrogen dose has been reduced over past decades, usually 15-35 micrograms
- Progestin dose has also been reduced
- Studies show reduced risk of endometrial and ovarian cancers, ectopic pregnancy, PID, menstrual disorders, benign breast disease, and acne
OCP:
-timing?
- In general start with onset of menstrual cycle
- -First Sunday after menses began
- -Quick start – start immediately regardless of menses
- -Recommend backup contraception for at least *7 days after
-Administer pills for prolonged period of time to cause extended periods of amenorrhea (reduce number of periods) significant amount of women experience irregular bleeding
