Women's health lecture 2 Flashcards
How many pregnancies in US are unplanned?
More than 50%
Two general MOA for contraception
- Inhibit the development and release of egg
- imposing a mechanical, chemical or temporal barrier between the sperm and egg
What is considered a barrier between sperm and egg (not expected)
intrauterine contraception
Secondary mechanism
alter the ability of the fertilized egg to implant and grow
What is provider’s obligation?
Knowledge of all agents and ability to explain to patient in language they can understand
Pearl Index of contraception
the measure of unintended pregnancies from 100 women during 1 year of contraceptive use
The most effective contraceptive
implant at 0.05 then IUS at 0.2-0.8
Contraindications to hormonal contraceptives in general
- known or suspected pregnancy
- thrombosis disorder
-hepatic tumor or active liver disease
-undiagnosed abnormal genital bleeding
-breast cancer
-allergy
What are considered LARC
Nexplanon, IUD, injectable Depro
When to switch out the Nexplanon?
3 years
MOA of Nexplanon
thickening of the cervical mucus and inhibiting ovulation
what hormone is in Nexplanon?
Progestin (etonogestrel)
Can Nexplanon be inserted after delivery?
Yes
SE of Nexaplanon
Irregular bleeding, weight gain, HA, mood swing, acne
does NOT affect bone mineral density
Risk of Nexaplanon
complications associated with implantation and removal, can travel, be careful of the neural vascular bundle
Hormonal IUD for bigger diameter
Mirena and Liletta
Hormonal IUD with smaller diameter
Kyleena and Skyla
Non hormonal IUD
Copper T IUD
How long does the copper IUD last for
10 years
How long does the copper IUD last for
10 years
MOA for copper IUD
acts as a spermicide
SE of copper IUD
heavier, longer periods, spotting in between, cramping
Risk of copper IUD
Pelvic inflammatory disease, ectopic pregnancy, uterine perforation, expulsion
Contraindication for copper IUD
Wilson’s disease
IUD with progestin MOA
may thicken the mucus of the cervix, thinking of the uterine lining
Which IUD can be used for 8 years
Mirena and Liletta
Which IUD can be used for 5 years
Kyleena
Which IUD can be used for 3 years
Skyla
SE of hormonal IUD
Irregular bleeding, amenorrhea, abdominal/pelvic pain
Risk of hormonal IUD
PID, severe infection, ectopic pregnancy, uterine perforation, expulsion, ovarian cyst
Benefits associated with hormonal IUD
decrease menstrual blood loss and severity of dysmenorrhea
When is the best time for IUD insertion
when the patient is menstruating
What do you need to confirm before IUD insertion?
Pregnancy and negative STD
Can IUD be inserted immediately postpartum?
Yes, 10 minutes of placenta delivery
When is the expulsion rate highest for IUD
done immediately postpartum
How to remove IUD if it is imbedded in the uterine wall?
Hysteroscopy
How to remove the IUD if it perforates
laparoscopic removal
Risks associated with IUD
Infection is likely in the first 20 days after insertion
Do you need to remove the IUD if the patient acquires STD while it is in place?
No, as long as there aren’t any signs of spreading to the endometrium or fallopian tube
Do you need to remove the IUD if the patient acquires STD while it is in place?
No, as long as there aren’t any signs of spreading to the endometrium or fallopian tube
When is expulsion the greatest with IUD
first few months of use
How long does injectable hormonal contraceptive last
13 weeks up to 15 weeks
When do you give the injectable
within first 5 days of the current menstrual period
Is the injectable a sustained release of progestin?
No, higher peaks and then sustained levels of progestin
MOA for injectable
inhibits the secretion of LH which prevents follicular maturation and ovulation cause cervical mucus to thicken
the concern about injectable effectiveness
not as effective with ovulation suppression as OCP since it cannot suppress the FSH
indication for injectables
breastfeeding, smokers, HTN, >35 y/o, seizure disorders
contraindication of injectables
unevaluated vaginal bleeding, suspected pregnancy, malignancy of the breast, sensitivity to DMPA ingredients
SE of injectables
Measurable weight gain, irregular bleeding, amenorrhea, BONE LOSS due to suppression of estradiol
Benefits of injectables
decrease the risk of endometrial carcinoma and IDA, improves pain associated with endometriosis
COC of hormonal contraceptive
ethinyl estradiol or estradiol valerate with 19-nortesterones or spironolactone derivative
Monophasic
The same goes in each pill each day of the month
Monophasic
The same does in each pill each day of the month
Biphasic
deliver the same amount of estrogen each day while progestin does is increased halfway
Triphasic
Three varying doses of hormones in the pill pack
Which physic regimen is associated with breakthrough bleeding
triphasic
Continuous regimens benefits
shorter and less frequent menses
Continuous regimens SE
higher rate of breakthrough bleeding
- worse the first 12 weeks cycle
estrogen specific side effect
bloating and weight gain, breast tenderness, nausea, fatigue, headache, HTN
COC contraindication
-35 y/o who smokes >15 cigarettes/day
-history of CAD, CHF, or cerebral vascular disease
- history of thromboembolic disease
- undiagnosed abnormal vaginal bleeding
- known breast cancer
POP MOA
makes the mucus thick and relatively impermeable, thins endometrium
who are ideal patient for POP
lactating women, women over age 40, women with contraindication to estrogen component
Disadvantage of POP
-> 3 hours late, need backup method
- start on the first day of menus
-poor cycle control
-continuous regimen
Oral contraceptive SE
- breakthrough bleeding
- amenorrhea and post pill amenorrhea
-venus thrombosis
-PE
-stroke
Advantages of oral contraceptive
*predictable, shorter and less painful periods
* reduce the risk of iron deficiency
* lower incidences of endometrial and ovarian cancer
* lower incidence of benign breast and ovarian disease
* decrease the risk of ectopic pregnancy
Oral contraceptive disadvantages
- may interact with other medications
- antibiotics may alter the intestinal flora and thought to interfere with absorption, but efficacy is not reduced
First day start with OCP
*provides maximum contraceptive effect
* no back up form is needed
Sunday start with OCP
*use secondary form for first 7 days
Quick start with OCP
*back up is needed for the first 7 days
Transdermal patch usage
*Start during the first 5 days of period
* replace every 3 weeks
*4th week is patch free
* place on the buttocks, upper outer arm, or lower abdomen
What hormones does transdermal patch contains?
Estrogen and progestin (xulane)
Do not used ________ if BMI is >30
transdermal patch
What hormones does contraceptive vaginal ring contains?
Estrogen and progestin
When to change the vaginal ring
change once a month, 3 weeks in and 1 week out
How long can you take out the vaginal ring for without altering the efficacy
up to 3 hours
Advantage of thing ring
*less breakthrough bleeding than OCP
* Less GI SE and medication interactions
Is the ring temperature sensitive?
Yes, store at room temp
Condoms is __________
Only reliable, nonpermanent method of contraception available to men
concerns with natural membrane condom
*Does not block HIV and other STDs
*damaged by oil based lubricants
When to seek emergency contraceptive if there was breakage or slippage of the condom
Within 120 hours
Slippage and breakage rate of male condom
5-8%
Slippage and breakage rate of female condoms
3%
What is placed on the diaphragm?
Spermicide
What does the diaphragm covers?
Anterior vaginal wall and cervix
How to tell if the diaphragm is placed correctly?
If the cervix can be felt through the dome of the diagphragm
When to insert the diaphragm
up to 6 hours before intercourse
How long do you leave the diaphragm in for?
6-8 hours after, max is 24 hours
What to do if additional intercourse is desired during the 6-8 hour window?
Apply additional spermicide without removing the diaphragm
Oil lubricants can damage _______
Diaphragm, cervical cap, condom
What is the common size of the diaphragm?
75mm
Diaphragm usage is twice likely to have_____
UTI
How long is the cervical cap left in place for?
6 hours after, max 48 hours
______is not necessary for repeated intercourse when using cervical cap
additional spermicide
How long can the contraceptive sponge used for repeated intercourse
24 hour period
How long is the contraceptive sponge left in for?
6 hours after intercourse, up to 30 hours
What is the most common ingredient in spermicides
Nonoxynol- 9
When do you place the spermicide?
10-30 minutes before each act of intercourse
How long is the spermicide effective for?
no more than 1 hour
How long do you need to chart when using the calendar methods
6 months
How is the fertile period determined
subtracting 18 days from the total length of the shortest cycle
How to determine the last day of fertile period
subtract 11 days from the total length of the longest cycle
When do you check the basal body temperature
immediately upon awakening
What temperature and pattern determines ovulation
Biphasic pattern with rise of 0.5-1F
When looking at the mucus, when are you most fertile?
watery, thin, “stretchy” (EWCM - egg white cervical mucus)
Lactational amenorrhea MOA
suckling = elevated prolactin level which suppresses GnRH from hypothalamus
Does emergency contraceptive cause abortion?
No, it only prevents the fertilized egg from implantation
Which emergency contraception can be used regardless of weight or BMI?
IUD
When is the copper EC inserted?
Within 5 days of unprotected intercourse
Liletta and Mirene use in EC (off label)
- inserted within 5 days
- reduces menstrual bleeding and discomfort
Antiprogestin commercial names
Ella, ellaOne, fibristal
MOA of antiprogestin
selective progestin receptor modulator
more effective than progestins
When can you take Ella?
within 5 days of UPI
Levonoregestrel or plan B contains what hormone?
Progestin
When to take the plan B?
within 72 hours of UPI
What is Yuzpe
EC pill that contains combined estrogen and LNG contraceptive pill
When do you need to take Yuzpe?
within 72 hours
SE of Yuzpe
severe nausea and vomiting
What can interfere with Ella?
progestin contraceptive
When can you take progestin contraceptive after taking Ella?
5 days after UPA administration
Concern with oral EC pills
efficacy decrease with increasing BMI
Are there contraindication with taking a second dose if you vomited 3 hours after taking it?
No
Which EC pill can you start contraceptive immediately?
LNG, levonoregestrel, also called Plan B
Risk indicator for regret about sterilization
*younger than 25
*minority status
*less access to information or support from other procedure
Is vasectomy immediate sterilization?
No
*multiple ejaculations are required before the collecting system is emptied of sperm
how is azoospermia confirmed?
Semen analysis
*may be checked at 8-10 weeks
Laparoscopy conducted
occlusion of Fallopian tube
is the most common surgical approach for tubal ligation in the world
Minilaparotomy
Essure
titanium-Dacron spring device places into the tubal Ostia bilaterally
Complication with essure
ectopic pregnancy, persistent pain, uterine perforation, prolonged heavy bleeding, migration of device
