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89 Cards in this Set
- Front
- Back
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Oral Contraceptives block ovarian stimulation by
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preventing the release of FSH from the anterior pituatary gland
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In the absence of FSH, a follicle does not ripen
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and ovulation does not occur.
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Progestins (synthetic forms of progesterone)
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suppress the LH surge
prevent ovulation render the cervical mucus impenetrable to sperm |
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Hormonal contraceptive agents may be
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oral, transdermal, vaginal, or injectible
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Combined oral contraceptives that contain both estrogen and progesterins are
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currently used by many women to prevent pregnancy
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Benefits of combined hormonal contraceptive use include a reduction in the incidence of
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benign breast disease,
improvement in acne reduced risk of uterine and ovarian cancers, anemia, and pelvic infection |
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Prolonged hormonal contraceptive use has resulted in no definite long-term undesirable effects, although there is an increased risk of
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gallbladder problems (cholestasis)
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In about 20% of hormonal contraceptive users, resumption of normal menses is delayed
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2 to 3 months or longer
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Risks of hormonal contraceptive use include
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venous thromboembolism (incidence decreased due to the less estrogen concentration
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Venous thromboembolism is less than half as likely with hormonal contraceptives than with
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pregnancy
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Fetal anomolies are not an issue with
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hormonal contraception use
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Normal reproductive tract function and fertility resume after
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hormonal contraceptive use is discontinued
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After stopping hormonal contraceptive use....WAIT TWO OR THREE MONTHS before attempting to
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become pregnant to permit a normal period for accurate dating of pregnancy
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Adverse reactions when using hormonal contraceptives include:
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nausea
depression headache leg cramps breast soreness usually these symptoms subside after 3-4 months |
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Symptoms may be related to sodium and water retention caused by estrogen,
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a smaller dose of the hormone or a different hormonal combination may alleviate
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Many patients experience spotting in the first month of use or if they use it irregularly, caution the patient to
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use it as prescribed
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Absolute contraindications to hormonal contraceptives include
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current or past thromboembolic disorder
cerebrovascular accident artery disease migraine headaches with visual auras known or suspected breast cancer known or suspected current or past benign or malignant liver tumors liver dysfunction clotting disorders congenital hyperlipidemia abnormal vaginal bleeding |
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Relative contraindications include
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hypertension
bile-induced jaundice acute phase of mononucleosis sickle cell disease |
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Controlled hypertension in otherwise healthy young nonsmokers is generally not a
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contraindication to use of combination agents but does require a LOW dose and careful blood pressure monitoring
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Women older than 35 years of age who smoke are at risk for
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cardiac problems and should not use hormonal contraceptives
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Occasionally, d/t hormonal contraceptives,
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neuro-ocular complication arise, but a cause and effect has not been established
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If visual disturbances occur,
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hormonal contraceptives should be discontinued
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Combined prep (pills, transdermal, patches, vaginal rings)
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(combined) monophasic preps supply the same dose of estrogen and progestin for 21 days
Biphasic preps and Triphasic preps vary the amount of hormonal components during the cycle Usually leads to a lighter than normal menstrual flow, which results from withdrawal |
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Progestin only "mini" preps
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"mini"
less protection than combined 40% of women have ovulatory cycles useful for women than have had estrogen related side effects (headaches, hypertension, leg pain, chloasma, or skin discoloration) weight gain or nausea on combined Useful for LACTATING women who need a hormonal contracteptive method DEPO-PROVERA (progestin only injection) last for 3 months IMPLANAN, subdermal implant, last 3 years |
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Coexisting medical disorders that may make contraception a complex issue include:
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Chronic hypertesnion
lipid disorders diabetes migraines fibroids obesity lupus depression seizures HIV or AIDS PHYSICIAN MAY PRESCRIBE DEPO-PROVERA OR IUDS |
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US FDA COMBINATION
ORAL CONTRACEPTIVE PILLS VAGINAL RING (NUVARING) TRANSDERMAL PATCH (ORTHO EVRA |
US FDA PROGESTIN-ONLY
progestin only pills or mini pills progestin-only emergency contraception (plan B) once-every 3 month injection (Depo-Provera) Levonorgestrel-releasing intrauterine system (Mirena) single-rod subdermal implant (Implanon) |
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Hormonal contraceptives protect the patient from pregnancy not from
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STDs or HIV
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Many women currently use oral contraceptive preps
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of synthetic estrogens and progestins....extended regimes are an option for women who have heavy or uncomfortable menstrual bleeding or who wish to have fewer periods
Risks: increased occurrence of breakthrough bleeding, the blood may be dark brown rather than red, may be more difficult to tell if a pregnancy occurs with this method, although pregnancy is unlikely if pills taken as prescribed |
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BENEFITS OF COMBINATION
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Decreased cramps and bleeding
regular bleeding cycle decreased incidence of anemia decrease in acne with some formulations protection from uterine and ovarian cancer decreased incidence of ectopic pregnancy protection from benign breast disease decreased incidence of pelvic infection |
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RISKS OF COMBINATION
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rare in healthy women
bothersome side effects (breakthrough bleeding, breast tenderness) nausea, weight gain, mood changes Small increased risk of developing blood clots, stroke or heart attack (related more to smoking) RISK OF BENIGN LIVER TUMORS/GALLBLADDER DISORDERS NO PROTECTION FROM STDs/STIs (possible increased risk with unsafe sex) |
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Transdermal Contraceptives
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Ortho Evra (thin, beigne, matchbook size skin patch that release an estrogen and a progestin continuously
Changed every 3 weeks, no patch during the 4th week, resulting in withdrawal bleeding Effectiveness comparable to that of oral contracpetives, risks similar to oral and include increased risk of blood clots. Patch may be applied to the torso, chest, arms, or thighs DO NOT APPLY TO THE BREASTS Remembered more easily than a daily pill NOT AS EFFECTIVE FOR WOMEN WHO WEIGH MORE THAN 198 |
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Vaginal Contraceptives
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NuvaRing (etonogestrel/ethinyl estradiol vaginal ring) is a combination hormonal contraceptive that releases estrogen and progestin
Inserted in the vagina for 3 weeks and then removed, resulting in withdrawal bleeding. As effective as oral contraceptives and results in lower hormone blood levels than oral Nuva Ring is flexible, does not require sizine or fitting, effective when placed anywhere in the vagina Women may fear uncomfortable or noticed by partner, the nurse can be helpful in dispelling misconceptions Some women notice a slight increase in vaginal discharge but increases the vaginal health promoting LACTOBACILLUS Scared ring will migrate |
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Injectable contraceptives
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An I.M. injection of Depo-Provera (long acting PROGESTIN) EVERY THREE MONTHS...inhibits ovulation, provides a reliable, private, convenient contraceptive method. Sub Q form also available. Can be used by LACTATING women and those with HTN, LIVER DISEASE, MIGRAINES, HEART DISEASE AND HEMOGLOBINOPATHIES.
MAY HAVE IRREGULAR BLEEDING EPISODES AND SPOTTING DECREASE DECREASE OR AMENORRHEA Advantages: reduced menorrhagia, dysmenorrhea and anemia d/t heavy menstrual bleeding may reduce the risk of pelvic infection, improved hematologic status of women with SICKLE CELL....does not interfere with ANTISEIZURE AGENTS DECREASES RISK OF ENDOMETRIAL CANCER, PID, ENDOMETRIOSIS AND UTERINE FIBROIDS |
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SIDE EFFECTS OF DEPO-PROVERA
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irregular mentstrual bleeding
bloating headaches hair loss decreased sex drive bone loss weight loss weight gain |
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DEPO-PROVERA DOES NOT
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protect against STDs
Fertility may be delayed when discontinuing Depo-Provera, therefore, a different contraceptive should be considered for women that wish to conceive within a year of discontinuing Depo |
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When Depo-Provera is used
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bone density decreases....risk factor future osteoporosis
allergic response rare....possible following injection |
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Depo Provera is contraindicated in women
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that are pregnant
abnormal vaginal bleeding of unknown cause breast or pelvic cancer sensitivity to progestin no long term effects on infants of nursing mothers using depo |
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Implanon
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single rod subdermal implant usually placed inside the upper arm via small incision
effective for THREE YEARS may cause irregular bleeding but may improve dysmenorrhea Implanon DOES NOT effect bone mineral density Implanon CAN be used by lactating women |
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IUD is a small
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plastic device (T-shaped) inserted into the uterine cavity
A string attached to the IUD is visible and palpable at the CERVICAL OS prevents pregnancy by causing a local inflammatory reaction that is toxic to spermatozoa and blastocysts, preventing fertilization THE IUD DOES NOT WORK BY CAUSING ABORTION |
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IUD ADVANTAGES
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Effectiveness over a long period of time
Few systemic effects Reduction of patient error This reversible method of BC is as effective as sterilization More effective than barrier methods |
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IUD DISADVANTAGES
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possible excessive bleeding
cramps backaches slight risk of tubal pregnancy slight risk of pelvic infection at insertion displacement of the device RARE - perforation of cervix/uterus IF PREGNANCY OCCURS - device removed immediately to avoid infection Spontaneous abortion may occur upon removal |
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An IUD is not used in women
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that have not had children d/t a small nulliparous uterus may not tolerate it
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IUD, women with
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multiple partners
heavy or crampy periods history of ectopic pregnancy pelvic infection USE OTHER METHODS OF CONTRACEPTION. SOME CLINICIANS TEST FOR CHLAMYDIA AND GONORRHEA PRIOR TO INSERTION OF IUD TO PREVENT PID |
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PARAGARD T 380A (IUD)
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has been available for 15 years, effective for 10 years
prevents fertilization by impairing sperm function as COPPER has an antispermatic effect |
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The LEVONORGESTREL INTRAUTERINE SYSTEM (LNG-IUS; Mirena), another IUD
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releases LEVONORGESTREL, a synthetic progestin used in oral contraceptives and is effective for FIVE years
impairs sperm function thickens cervical mucus suppresses the endometrium reduces heavy bleeding (therapeutic) may prevent need for hysterectomy women with heavy vaginal bleeding also helps women with menorrhagia, dysmenorrhea, endometriosis and fibroids |
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Mechanical Barriers (Diaphragm) consists of a
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round, flexible spring (50 to 90 mm wide) covered with a domelike latex rubber cup
Spermicidal jelly or cream is used to coat the concave side of the diaphragm before it is inserted deep into the vagina (covering the cervix completely) Stops spermatozoa from entering the cervical canal! Not felt by user or partner Must be sized/fitted by an experienced clinician (because women vary in size) Women instructed in using/caring for the device A return demonstration ensures that the woman can insert the diaphragm correctly and that it covers the cervix |
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Each time the women uses the diaphragm, she should
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examine it carefully....
hold up to a bright light, no pinpoint holes, cracks, or tears then she applies spermicidal jelly or cream and inserts the diaphragm remains in place 6 hours after coitus (no more than 12 hours) Addt'l spermicide is necessary if more than 6 hours has passed before intercourse and before each act of repeated intercourse Upon removal, cleanse with mild soap and water and dry before storing in container |
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Disadvantages (Diaphragm)
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allergic reactions to latex
increased incidence of UTIs Toxic shock - some but rare |
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Diaphragm (Alert)
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Assess the woman for possible latex allergy (diaphragm, cervical cap, male condoms) may cause anaphylaxis
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Cervical Cap is
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much smaller (22 to 35 mm) than the diaphragm and covers only the cervix
If woman can feel her cervix, can learn to use cervical cap Advantage: can be left in place for 2 days following sex Convenient but may cause cervical irritation, therefore, before fitting a cap most clinicians obtain a Pap smear and repeat the smear after 3 months Cap is used with a spermicide and DOES NOT require addt'l spermicide for repeat sex |
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Contraceptive Sponge is made of
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soft, disposable polurethane foam that is moistened with water and inserted into the vagina before intercourse
contains and releases a spermicide (nonoxynol-9) continuously released into the vagina in small amounts through a 24 hour wear time Sponge is left in vagina for at least 6 hours after intercourse and can be kept in place for 24 addt'l hours without the need to replace it with repeated acts of sex during that period Sponge is OTC; does not require a prescription or special fitting Do not use if allergic to polyurethane Do not use during your period Hx of Toxic Shock - do not use sponge |
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Female condom developed to give
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women control of barrier protection
PROTECTION FROM STDs/HIV/Pregnancy Female condom (Reality) consists of a cylinder of polyurethane enclosed at one end by a closed ring that covers the cervix and at the other end by an open ring that covers the perineum |
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Advantages Female Condom
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Some degree of protection from STDs (HPV, herpes simplex virus, and HIV)
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Disadvantages Female Condom
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inability to use while standing (positions)
Noisy/slippery |
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Spermicides are made from a
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nonoxynol-9 or octoxynol and are available
OTC as foams, gels, films, and suppositories and also on condoms Spermicides do not protect women from HIV or other STDs |
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Spermicides (Nonoxynol-9) has been found to be associated with
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minor tears in vaginal tissue with frequent use (daily)
possibly increase the possibility of HIV |
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Male Condom is an
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impermeable, snug-fitting cover applied to the erect penis
Tip of condom is pinched while being applied to leave space to ejaculate, if no space, ejaculation may cause a tear or hole in the condom The penis, with condom in place, is removed from the vagina while still erect to prevent ejaculate from leaking Creates a barrier agains STDs (gonorrhea, chlamydial infection, HIV) and may reduce risk of herpes transmission |
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Natural (male) condoms
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(made from animal tissue) do not protect against HIV
Condoms do not provide complete protection from STDs because HPV may be transmitted by skin-to-skin contact LATEX ALLERGY Swelling and itching may occur, possible warning of latex allergy include oral itching after blowing up a balloon, eating kiwis, bananas, pineapples, passion fruit, avocados, chestnuts If burning, itching; see your primary |
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Alternatives to latex condoms include
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Reality (female)
Avanti (male) Made of polyurethane |
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Coitus interruptus or Withdrawal
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UNRELIABLE FORM OF CONTRACEPTION
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Rhythm or Natural Methods of conception regulation based on
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awareness of signs and symptoms of fertility during menstrual cycle
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Advantages of Natural contraceptive methods include:
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not hazardous to health
Inexpensive approved by some religions |
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Disadvantage of Natural contraceptive methods:
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Require discipline by the couple
Must monitor the menstrual cycle Abstain from sex during the fertile phase |
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Current methods (natural):
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calendar method
basal body temperature method ovulation method symptothermal method Combinations of these methods are often used |
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Fertile phase (abstinence required)
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is estimated to occur about 14 days before menstruation
may occur between the 10th and 17th days |
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Spermatozoa can fertilize an ovum up to
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72 hours after sex
ovum can be fertilized for 24 hours after leaving the ovary |
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Pregnancy rate with the Rhythm (calendar) method is about
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40% yearly
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Women who determine their "safe period" based on
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precise recording of menstrual dates for at least one year
carefully follow a worked-out formula may achieve very effective protection Long abstinence period during each cycle required - require more time and control than many couples have |
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Symptothermal method based on
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changes in cervical mucus and body temp d/t hormonal changes relation to ovulation (scientific basis)
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Courses in natural family planning are offered
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AT MANY CATHOLIC hospitals and some family planning clinics
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Ovulation detection methods (clearblue easy fertility monitor) are available
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in most pharmacies....PRESENCE OF enzyme guaiacol peroxidase in cervical mucus signals ovulation 6 days beforehand and affects mucosal viscocity.
OTC kits are easy to use and reliable but expensive More effect for planning pregnancy than for avoiding |
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Ovulation detection methods plus cervical mucus changes and calendar method may
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prove effective
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Emergency contraception may arise after an episode of
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unprotected sexual intercourse
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Emergency contraception (hormonal methods)
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A properly time adequate dose of estrogen and progestin or progestin-only medication after sex without effective contraception or when a method has failed can prevent pregnancy by stopping or delaying ovulation
Does not stop pregnancy or cause abortion With prescription - not OTC May be dispensed without prescription by some pharmacists in some states Safe and effective by the FDA (Plan B) (progestin only) of emergency contraception with literature....can also be prescribed as a specific number of pills, depending on med and dose used |
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Emergency method must be used not more than
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5 days following sex.
Nausea may be minimized by taking with food and with antiemetic Breast soreness and irregular bleeding but is transient Advise of potential failure rate and other contraceptive methods No known contradictions except an established pregnancy If breastfeeding - progestin only prescribed To avoid exposing infants to synthetic hormones - express milk and bottle feed for 24 hours Next menstrual period may be a few days earlier/later than normal Return for pregnancy test if no period in 3 weeks and offered another visit to provide a regular method of contraception if not one in place |
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Postcoital Intrauterine Device Insertion (Emergency!)
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Insertion of a COPPER bearing IUD within 5 days of sex; may be inappropriate for some women or if contraindications exist
IUD interferes with fertilization Discomfort on insertion, heavier menstrual periods and increased cramping CONTRA: Confirmed or suspected pregnancy or contraindication to regular copper IUD use Advise patient risk that insertion may disrupt a pregnancy already present |
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Emergency contraceptions (nursing management)
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Patients may be anxious, embarrassed and lack information about birth control
If repeatedly using emergency, inform patient of failure rate higher with this method than with regular method 1-888-NOT-2-LATE operates 24 hours a day in English and Spanish and provides info and referrals to health care providers |
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Barrier Methods
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Male condom - 15% - protects against STIs
Female condom - 21% - protects against STIs - difficult to insert Contraceptive sponge - 17-24% - 24 hours before sex - No STI protection Spermicide - 29% (varies if used with other methods - unpleasant taste - film and suppositories 15 minutes to be effective - spermicidal allergy |
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Hormonal Methods
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Combined-Oral - 8% - lower risk ovarian endometrial cancer, acne and dysmenorrhea - contraindications: breast cancer/DVT, migraines with focal aura, neuro changes, CAD
Patch - 8% - changed weekly, teen "cannot remember" to take the pill - Breast cancer/DVT, migraines Progestion Only (Implanon) - 1% - Decreased dysmenorrhea - Breast Cancer/Liver Disease Vaginal Ring - 8% - Removal 21 days - new ring 7 - Breast Cancer/DVT |
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Behavioral Methods
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Abstinence
Withdrawal LAM (Lactational Amenorrhea), facilitates post pregnancy weight loss, decreased risk breast cancer....contra: infant less than 6 months, return of menses, blood borne disease, taking drugs, breast feeding |
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Surgical sterilization
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.1%
Female: Decreased risk for ovarian cancer Male: easier, less expensive Surgical risks less for females Possible regret No STI protection Contra: If unsure |
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Progestin only contraceptives risk of
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ectopic pregnancy
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Nursing approach
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psychological
physiological stresses substance abuse domestic violence |
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Cultural Beliefs
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primary goal of Healthy People 2010
eliminate disparities among different cultures did not happen - new number 2020 |
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Socioeconomic factors/cultural beliefs
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affects behaviors of women
access to and use of health services Confidence in their practitioners Recommend prevention guidelines |
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Comparison among womenSame
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Racial and ethnic minority
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4 leading causes of death for AA and Hispanic/Latina women
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heart disease
cancer cerebrovascular disease (stroke) diabetes encourage early screening African American women higher mortality rate of breast cancer b/c cancer is more advanced at dx |
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Latina women view illnesses
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as a punishment for sins they committed
or illness is caused by the will of their God cultural/religious beliefs - Latina women affect use of health care industry revert to folk medicine and home remedies Healthy promotion is major issue diabetes/HTN/obesity/heart disease/stroke/kidney/arthritis/HIV, lupus and advanced cervical/breast |
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Native American/Alaskan Native Women
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Higher mortality rates for chronic liver disease, cirrhosis, kidney disease, suicide
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