Contraceptive Options Added

Front 1

General conciserations

Back 1

1. Begin with low-dose combined or multiphasic pills (35 mcg or less)
2. Progestin only pills may be used in women with history of migraine headache, breast feeding, have some contraindications to combine pills

Hint 1

2 points

Front 2

Adverse effects: abnormal menstrual bleeding: breakthrough bleeding or spotting

Back 2

MAY NEED HIGHER DOSE

Front 3

Amenorrhea, or hypermenorrhea

Back 3

Cause by low amount of progestin, may need dose increase

Front 4

Birth defects

Back 4

Estrogen=pregnancy category X
Immediately discontinue oral contraceptives if pregnant

Front 5

Cancer: estrogen promote certain type of breast cancer

Back 5

Patient with +family history of breast cancer

Front 6

Hypertention

Back 6

Risk is increased with age ,dose , and length of therapy

Front 7

Weight gain, increased appetite, fatigue, depression, acne, and hirsutism

Back 7

Height amount progestin, may need lower dose

Front 8

Nausea, edema, and breast tenderness

Back 8

Caused by hight amount of estrogen, need lower dose

Front 9

Thromboembolic disorder

Back 9

History of thromboembolic disorder, CVA, CAD, or heavy smoker are contraindicated to OCs

Front 10

Nausea, edema, and breast tenderness

Back 10

Caused by hight amount of estrogen, need lower dose

Front 11

Thromboembolic disorder

Back 11

History of thromboembolic disorder, CVA, CAD, or heavy smoker are contraindicated to OCs

Front 12

NuvaRing

Back 12

Synthetic estrogen and progestin;
provide one month protection; left in for 21 days;
must be inserted on the same day of the week as it was inserted in last cycle;
if out, must to be inserted in 3 hours;
Lbackup method must be used if left out more than 3 hours.

Front 13

The patch

Back 13

1. Transdermal contraceptive release synthetic estrogen (ethinyl estradiol) and progestin (norelgestromin)
2. One per week
3. Can be worn for three weeks
4. Reduce effectiveness in worn over 90 kg
5. Increase risk for serious cardioembolic events: 60% more estrogen released than with oral contraceptives
6. If stay off over 24 hours, restart a new four week cycle is necessary along with backup method

Front 14

Drug drug interaction

Back 14

Certain antibiotics, anticonvulsants decrease effectiveness of OCs;
OCs decrease effectiveness of warfarin, insulin, and certain oral hypoglycaemic a

Front 15

Injected contraception

Back 15

Depo-Provera (DMPA)
1. Long acting progestin
2. Intramuscular injection every three months
3. 1 year failure rate less than 1%
4. Delayed return of fertility (up to 1 year)
5. Side effects: menstrual irregularity; decrease in HDL; rare anaphylactic reaction
6. Backup method should be used during the first two week after the injection unless was administered by Day Of Cycle (DOC) 5

Front 16

Injected contraception

Back 16

Depo-Provera (DMPA)
1. Long acting progestin
2. Intramuscular injection every three months
3. 1 year failure rate less than 1%
4. Delayed return of fertility (up to 1 year)
5. Side effects: menstrual irregularity; decrease in HDL; rare anaphylactic reaction
6. Backup method should be used during the first two week after the injection unless was administered by Day Of Cycle (DOC) 5

Front 17

Implant contraception

Back 17

1. Contains etonogestrel: a low diffusion of progestin
2. Continue protection for 3 years
3. Need consent

Front 18

Injected contraception

Back 18

Depo-Provera (DMPA)
1. Long acting progestin
2. Intramuscular injection every three months
3. 1 year failure rate less than 1%
4. Delayed return of fertility (up to 1 year)
5. Side effects: menstrual irregularity; decrease in HDL; rare anaphylactic reaction
6. Backup method should be used during the first two week after the injection unless was administered by Day Of Cycle (DOC) 5

Front 19

Implant contraception

Back 19

1. Contains etonogestrel: a low diffusion of progestin
2. Continue protection for 3 years
3. Need consent

Front 20

Mechanism of IUD

Back 20

1. Immobilizes sperm and interferes with migration
2. Speeds transport of the ovum through the Fallopian tube
3. Inhibit fertilization
4. Cause lysis of blastocyst and/or prevents implantation due to local foreign body inflammatory responses

Front 21

IUD

Back 21

Copper- releasing (ParaGard)
Progestin releasing (Mirena): levonorgestrel releasing intrauterine system (LNG-IUS)

Front 22

IUD advantages

Back 22

Progestin-releasing IUD may decrease menstrual loss and dysmenorrhea;
Can prevent Asherman's Syndrome

Front 23

IUD advantages

Back 23

Progestin-releasing IUD may decrease menstrual loss and dysmenorrhea;
Can prevent Asherman's Syndrome

Front 24

IUD disadvantages

Back 24

1. Pain and cramping may accompany use: up to 40% of removal related to pain
2. Increase in menstrual bleeding result in anemia
3. Pregnancy:
Spontaneous abortion in up to 50% case if IUD left in uterus
Ectopic pregnancies occur in 50% of users

Front 25

IUD advantages

Back 25

Progestin-releasing IUD may decrease menstrual loss and dysmenorrhea;
Can prevent Asherman's Syndrome

Front 26

Advantage of condoms

Back 26

1. Provide immediate protection against pregnancy and transmission of most STD
.2. Purchased over counter
3. Relatively safe

Front 27

Disadvantage of condoms

Back 27

1. Nature skin condoms have no protection against STDs
2. Provide less sensation
3. Condoms break or slip
4. Fore play is interrupted

Front 28

Management of condoms

Back 28

1. Latex provides greater degree of protection against STDs
2. Avoid use oil- based lubricants
3. Lubricants increase sensation
4. Leave 1/2 inch of empty at the end of condom to reduce risk of condom breakage
5. Effective increase if used with spermicide

Front 29

Two types of emergency contraception

Back 29

1. Oral: levonorgestrel ( Plan B)
2. IUD insertion

Front 30

Plan B

Back 30

1. Over counter, no need for prescription for women over 17 years of age
2. Take within 72 hours of unprotected intercourse
3. Not. Abortion pill

Front 31

Effective rate for Plan B

Back 31

85%

Front 32

Side effect of Plan B

Back 32

Like side effect of progestin
Nausea, vomiting, dizziness, headache, breast tenderness, diarrhea, fluids retention, change the timing or flow for next menstrual ( may increase the length)

Front 33

Failure rate for sterilization in male and female

Back 33

Female 1:400
Male1:600

Front 34

Typical first year failure rate for nature family planning

Back 34

20%

Front 35

How to determination fertile phase

Back 35

1. Identify the longest and shortest cycle
2. Subtracting 18 days from the shortest cycle to determine the earliest day of fertility
3. Subtracting 11 days from the longest cycle wot determine the latest day of fertility

Front 36

IUD disadvantages

Back 36

1. Pain and cramping may accompany use: up to 40% of removal related to pain
2. Increase in menstrual bleeding result in anemia
3. Pregnancy:
Spontaneous abortion in up to 50% case if IUD left in uterus
Ectopic pregnancies occur in 50% of users
4. Expulsion up to 10% in the first year
5. PID rate is highest in the first 6 weeks after insertion

Front 37

Basal Body Temperature graph

Back 37

1. Record daily BBT prior rising in am over 3-4 months
2. Temperature drop 12-24 hours prior overlay ion, rises following ovulation due to the production of progesterone
3. Avoid intercourse 2-3 days prior expected drop and 3 days following the rise

Front 38

Billings test

Back 38

1. Record change in cervical mucus ( Spinnbarkeit) over 3-4 month
2. Notice change from scant thick to thin and Spinnbarkeit
3. Abstain from time of mucus change until 4 days after change ( mucus will resume thickness)

Front 39

What is symptothermal method?

Back 39

BBT with cervical mucus technique together

Front 40

Lactational amenorrhea method

Back 40

Breast feeding usually delay onset of ovulation and menstration for approximately 6 months

Front 41

Diaphragm /cervical Cap

Back 41

1. Typical 1st year failure rate 18%
2. May provide some protection against STDS when Used with spermicidal cream ( those with monozygotic -9)
3. Possible increase risk of UTI
4. Contraindications to latex or rubber allergy
5. Refit if weight gain exceeds 20 lbs
6. Avoid oil- based lubricants
7. Must stay 6 hours following intercourse, do not remove if repeat sex

Front 42

Spermicides 1st year failure rate

Back 42

21%

Front 43

The sponge typical failure rate

Back 43

10%

Front 44

Does Spermicides affects transmission of STDs

Back 44

Possible

Front 45

Sponge insertion time

Back 45

Insert up to 6 hours before intercourse

Front 46

True or false
Sponge may provide some protection against gonorrhea and chlamydia?

Back 46

Disadvantage of sponge

Hint 46

1. Risk of toxic shock
2. Increase risk for candidiasis
3. Contraindicated in those allergy to spermicides

Front 47

Management of sponge

Back 47

1. Insert into vaginal using a cord loop attachment
2. Can be inserted up to 6 hours before intercourse
3. Should be left in place at least 6 hours following intercourse
4. Provide protection for up to 12 hours
5. Should not be left in the vagina more than 30 hours

Front 48

Condoms typical 1st year failure rate

Back 48

Male 12%, female 21%