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86 Cards in this Set

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Describe the ethical, pragmatic, and legal bases for informed choice and consent in family planning and reproductive health care.
1. Ethically - Clients have the right to thorough information about products or procedures that can affect their health and the right to decide what is done to their bodies.
2. Pragmatically – People are more likely to use a contraceptive method consistently and appropriately or undergo a medical procedure when they understand it thoroughly and choose it freely.
3. Legally – The provider must provide adequate information to help patients reach a reasonable and informed decision about contraceptive options, medications, procedures and devices.
Identify the components of the BRAIDED mnemonic for informed consent.
1. Benefits of the method
2. Risks of the method (all major risks, all common minor risks, and related uncertainties and unanswered questions), be sure to include consequences of method failure.
3. Alternatives to the method (including abstinence and no method)
4. Inquiries about the method are the patient’s right and responsibility
5. Decision to withdraw from the method without penalty is the patient’s right at any time.
6. Explanation of the method is owed the patient, in a format that is understandable to the patient.
7. Documentation that the caregiver has ensured understanding of each of the preceding six points, usually by use of a consent form.
Factors that influence contraceptive efficacy
inherent efficacy, user characteristics, and competence and honesty of the investigator.
What is inherent efficacy?
Depends a lot on the ability of the user to use it consistently or not. Sterilization, implants, and IUDs have high inherent efficacy and the reported pregnancy rates are quite low. For pills and injectables the inherent efficacy is still high but the likelihood that a client misses a pill or is late for an injection drives up the unintended pregnancy rates. In general the studies on barrier methods give a very wide range of possibilities because the odds of misuse are so high.
What User Characteristics affect contraceptive efficacy?
most importantly – imperfect use, age, frequency of intercourse, and regularity of cycles.
What does Influence of the investigator have to do with contraceptive efficacy?
– There are financial incentives for companies to provide studies demonstrating a very low pregnancy rate for their method or brand of contraception. Some are downright fraudulent and others are just sloppy. For example some investigators might drop a woman from a study after becoming pregnant because they decided she did not meet the profile after all. Another example is that the rate of unintended pregnancies for all methods is much higher in the first year than in subsequent years for a given population. Those who will fail due to user error usually will become pregnant within the first year. So some investigators can drive their numbers down by continuing the trial forever.
How do reproductive stages affect contraceptive method choice?
Reproductive Stages – A woman’s reproductive years can be generalized into 4 stages.
1. First menarche to intercourse - Her reproductive goals during this period are generally to postpone her first birth while preserving her fertility.
2. First Intercourse to first birth - Her reproductive goals during this period are generally to postpone her first birth while preserving her fertility. She may have one or many partners during this era with periods of high coital frequency. She may be equally concerned about STI and pregnancy prevention.
3. First birth to intention to have no more children - Her reproductive goals during this phase are generally aimed at child spacing. Usually more concerned with pregnancy prevention than STI prevention as more likely to be with one partner.
4. Intending to have no more children to menopause – Her reproductive goals at this point are to prevent pregnancy. Most common form here is sterilization as she is no longer concerned with preserving fertility. Typically less concerned with STI prevention.
How does cost and cost effectiveness affect contraceptive method choice?
Important to tell the woman up front what her ongoing costs will be – generally not covered or poorly covered by insurance. However, when compared to the cost of an unintended pregnancy all methods are more cost effective, particularly the ones that are longer lasting due to duration of use. Providing emergency contraception can be particularly cost saving, especially if provided in advance to women using barrier method or other prone to failure by saving money on unintentional pregnancy.
How does pattern of sexual activity affect contraceptive method choice?
It is the norm to have more than one sexual partner throughout a lifespan, number of partners affects STI risk. Less obvious are women who practice serial monogamy – having only one partner at a time but then moving on to another. They may perceive their STI risk to be lower than it is. Frequency of intercourse also has a bearing on contraceptive choice. A woman who infrequently has intercourse may not want to take a daily medication or deal with side effects for little benefit.
How does access to medical care affect contraceptive method choice?
Not everyone has easy access to medical care and one should take this into consideration when recommending or prescribing a method. It is usual to Rx 13 cycles of pills but generally won’t give out a year’s supply of condoms.
How does intimate partner violence affect contraceptive method choice?
A woman at risk for IPV probably can’t rely on her partner to withdraw or use a condom. She may be better off with a method she is solely responsible for.
Describe traditional surgical methods of female sterilization versus newer transcervical approaches.
Transcervical approach techniques are new and still considered experimental. Since 2002 Essure has been available in the US. It s a soft spring coil that is introduced through the cervix and placed into the proximal portion of the tube. The outer coil anchors the device in the lumen while the inner coil’s polyester fibers stimulate growth of fibrous tissue, which over the course of a few months occludes the tubes. In one study 96% of women had 2 occluded tubes at 3 months and 100% did by 6 months. Since it is new and special training isrequired to insert it it may not be available everywhere. However, when available it can be done as a 30 minute office procedure. Long term studies have not been completed but 2 year long studies have reported zero pregnancies in that time period. Long term safety has not been established.
Dora is a 34 year-old whose husband has just gotten a vasectomy. When can she stop using her diaphragm?
Sterility usually takes at least 3 months to achieve. Her husband should schedule an appointment with his surgeon to look at his sperm under a microscope after 3 months to see if it is clear of sperm. She should continue to use her diaphragm until his surgeon gives the all clear.
3. Ellen is a 19 year-old using spermicides as her only method of contraception. She has the following questions: How effective are spermicides in protecting against pregnancy? Do spermicides affect her risk of acquiring HIV and other sexually transmitted infections? What other nonhormonal method(s) would you suggest for her?
1. Spermicides are 75-90% effective in preventing pregnancy if used correctly. (Contraceptive technology p 356)
2. Spermicides do not protect against STI and may increase transmission of HIV if used frequently due to possible disruption of vaginal epithelium. (Contraceptive technology p 358)
3. Condoms would be a good addition to spermicides. They would increase her effectiveness as well as offer protection against STIs. (Contraceptive technology p 358)
4. Frances is a 16 year-old who was told by her boyfriend that the withdrawal method of birth control is just as effective as not having sex at all. What can you advise her about the effectiveness of the withdrawal method for contraception? For what else would she be at risk?
1. Contraceptive technology p 312 – 313 – The withdrawal method is not as effective as abstinence. With perfect use the effectiveness can be as high as 96%, however typical use effectiveness is really more like 73%. Another consideration is that younger, less experienced men may find it more difficult to predict when ejaculation is going to occur and also may find it more difficult to have the self discipline necessary to pull out when in the throes of sex.
2. Contraceptive technology p 313 – She may also be at risk for STIs including HIV.
5. Gail is a 36 year-old is using a latex diaphragm for birth control as well as a lubricant for vaginal dryness. What lubricants or creams should she avoid? What other birth control methods can be affected by lubricants and creams?
1. Gail should avoid oil based lubricants and medications such as baby oil, mineral oil, suntan oil, vegetable oil, butter, monistat cream, estrogen cream, and vagisil (Contraceptive technology p 377)
2. Anything made of latex can be affected by oil based lubricants and creams such as male latex condoms, and cervical cap (Contraceptive technology p 377)
In what ways is the cap different from the diaphragm?
1. smaller than diaphragm, fits snugly over the cervix rather than being held in place by the vaginal walls. (Contraceptive technology p 368).
2. Provides continuous contraceptive protection for up to 48 hours no matter how many times intercourse occurs. (Contraceptive technology p 369).
3. It is recommended but not required to reapply spermicide with each additional act of intercourse (Contraceptive technology p 369).
4. The cap is less effective than the diaphragm with typical use in parous women (Contraceptive technology p 371).
5. The diaphragm may provide protection against cervical dysplasia and some STIs, the cap has not been shown to do this. (Contraceptive technology p 373).
6. The cap cannot be used during menses (Contraceptive technology p 376).
In what ways is the cap similar to the diaphragm?
1. The cap has the same effectiveness as the diaphragm with typical use for nulliparous women. (Contraceptive technology p 371).
2. They both have the same mechanism of action – a physical barrier that shields the cervix along with a spermicide (Contraceptive technology p 366).
3. They both require the use of spermicides to increase effectiveness. (Contraceptive technology p 376).
4. They both come in multiple sizes, though 6-10% of women can not be fitted with a cap (Contraceptive technology p 380).
5. They both can increase risk of TSS and UTIs (Contraceptive technology p 374).
What three conditions are necessary for the Lactational Amenorrhea Method to be an effective contraceptive method?
1. Full or nearly full breastfeeding
2. Has not had first postpartum menses
3. baby less than 6 months old
How do monophasic and multiphasic COCs differ?
1. Monophasic pills – each active pill contains the same doses of the estrogen and progesterone
2. multiphasic pills – The amount of hormones in the active pills vary throughout the cycle. Can be biphasic which has 2 different combos of estrogen and progestin or triphasic which has three different combos.
In what other general ways do the various brands of COCs differ?
3. CT 397-398 – Most pills come in either 21 or 28 day packs with 21 days of active pills and either no placebos or 7 days of placebos. One, seasonale, has 84 active pills followed by 7 placebo pills which reduces bleeding to 4x year.
4. CT p 400 – pills can be grouped into categories based on their estrogen content. There are 20, 30, 35 and 50 mcg pills plus no estrogen and phasic pills.
5. CT p 423 - Basically if a woman doesn’t have any contraindications she can be started on any sub-50 mcg pills. Choose which pill based on patient desire, availability, side effects, non-contraceptive benefits, cost and prior experience of the woman or clinician.
What therapeutic uses do COCs have in addition to providing contraception?
2. Dysmenorrhea, menorrhagia
3. dysfunctional uterine bleeding
4. recurrent luteal phase ovarian cysts
5. family history of ovarian cancer
6. personal risk for endometrial cancer
7. acne or hirtuism
8. PCOS
9. PMS (extended use in particular)
10. suppression of endometriosis (extended use in particular)
11. mentally challenged women whose bleeding may scare them or make caring for them challenging (extended use in particular)
12. Anemia due to menorrhagia (extended use in particular)
13. dysmenorrhea (extended use in particular)
14. emergency contraception
the ACHES acronym that is used to teach combined contraceptive method users about warning signs
2. Abdominal pain (blood clot in pelvis or liver, benign liver tumor, gall bladder disease)
3. Chest pain (PE, MI, Angina, Breast lumps)
4. Headaches (stroke, migraine, headache, Htn)
5. Eye problems (stroke, blurred or double vision, migraine, blood clots in eyes, change in shape of cornea
6. Severe leg pain (DVT)
In what circumstances would progestin-only contraceptives be more appropriate hormonal methods than combined contraceptives?
1. CT p 461. Women who can not take combined contraceptives due to estrogen content. This is especially important for lactating women.
2. They are also a safer alternative for:
1. Smokers, especially over the age of 35 (p 472)
2. Women with family history or personal history of clotting issues (still a level 3 or risk probably outweighs the benefits for a current DVT) (p. 437)
3. Women with prolonged immobilization (p 473)
4. Stroke (p 474)
5. Heart disease (p 474)
6. Headaches (474)
7. Diabetes (476)
8. Gallbladder disease (477)
3. Still not recommended for women with breast cancer, current or past history (p 475)
What are the noncontraceptive health benefits of combined and progestin-only contraceptives?
2. Scanty or no menses; less anemia
3. Decreased cyclic menstrual cramps, pain, mood changes, headaches, breast tenderness, and/or nausea
4. Suppression of mittelschmerz
5. Decreased risk of endometrial cancer, ovarian cancer, and PID
6. Management of pain associated with endometriosis
Ashley is a 25 year-old who would like to begin COCs. What history would you obtain? How would you select a COC?
2. Does she smoke? If she is a heavy smoker it may not be a good idea, though at her age if she is a light smoker it would not be contraindicated.
3. Does she have moderate to severe hypertension? The pill is contraindicated with BP > 160/100
4. Any undiagnosed abnormal vaginal bleeding? The bleeding needs to be diagnosed to rule out CA but if it is fibroids or endometriosis the pill can actually be helpful in these cases. This is a WHO level 2 consideration which means it may trigger potential concerns but the benefits generally outweigh the risks.
5. Does she have diabetes with vascular complications or has she been diabetic more than 20 years? Contraindicated if so.
6. Does she have a history of DVT or PE or current history of ischemic heart disease? Contraindicated if so.
7. Does she get headaches with focal neurological symptoms or have a personal history of stroke? Contraindicated if so.
8. Is there a strong family history of thrombosis? This is a WHO level 2 consideration which means it may trigger potential concerns but the benefits generally outweigh the risks.
9. Is there a current or personal history of breast cancer? Current BC is a contraindication and past history with no evidence of current disease is a WHO level 3 category which means the risks probably outweigh the benefits.
10. Does she have active viral hepatitis or mild or severe cirrhosis? Active viral hepatitis is contraindicated but carrier status is OK. Severe cirrhosis is contraindicated and mild is level 3 so the risk probably outweighs the benefits.
11. Is she exclusively breastfeeding right now? If she is less than 6 weeks postpartum combo pill is contraindicated, if she is less than months the risk probably outweighs the benefit (level 3), if she is > six months it is a level 2 recommendation so the benefits probably outweigh the risks.
12. Is she planning on major surgery with immobilization within 1 month? Contraindicated if so.
13. Does she have a personal history of cholestasis with pill use? This is a level 3 recommendation so the risks probably outweight the benefits.
14. Assuming she meets the above criteria (or doesn’t really) she can be prescribed any sub 50 pill based on her preference, availability, cost, my preference, etc.
Liz is a 17 year-old who calls you while taking her second package of COCs concerned about spotting she is experiencing. What questions would you ask? What physical examination and/or diagnostic testing would you perform? What are the differential diagnoses? What are the management options?
1. CT p 434 – Spotting is common (30-50%) in the first few months of COCs and generally resolve by 3-4 months of use. Progestins administered early in the cycle reduce estrogen’s proliferative effect and cause thinning of the endometrium which is usually the cause of spotting. I would want to rule out other more common causes of spotting including pregnancy, infection, medications that block hormone absorption (olestin) or increase their metabolism by the liver (anticonvulsants, smoking, St. Johns Wort, rifampin, griseofulvin), and GI problems such as vomiting or diarrhea. One of the most common causes of spotting is missed pills, s I would want to ask her about that as well as if she is taking them at the same time every day.
2. CT 434 - PE / dx tests would include pregnancy testing, cultures for infectious diseases.
3. CT 434 - Since she is only on her second month the most likely cause is that her body has not had time to adjust to her pills yet. Other differential dx include pregnancy, infection, GI problems.
4. CT 434 - Once other causes are rules out I would probably advise her to stick with it another 2 months and see if the problem resolves on it’s own. Reinforce that it is important to take her pill every day at the same time. I would advise her to use a back up method of BC as spotting can indicate that the pill is not effective. Another option would be to piggyback her pills or shorten the pill free interval by having her start her new pack on the first day of bleeding rather than waiting the full 7 days. If the problem persists I would change pills. If the spotting is right before her bleeding she probably needs more progesterone so I would choose one with the same estrogen content but up her progestin dose. If the spotting is at the beginning of her cycle she probably needs more estrogen so I would choose one with a higher estrogen content but a similar progestin dose. If the spotting is in the middle of the cycle the cause may be unclear and I should try a phasic pill.
The PAINS acronym can be used to remember the early IUD warning signs:
• P - Period late (pregnancy); abnormal spotting or bleeding
• A - Abdominal pain, pain with intercourse
• I - Infection exposure (STI); abnormal vaginal discharge
• N- Not feeling well, fever, chills
• S - String missing, shorter or longer
What are the noncontraceptive health benefits of intrauterine devices?
• possible protection against endometrial cancer
• Decreased menstrual blood loss
• To decrease menopause symptoms
How do combined and progestin-only ECPs differ?
2. Progestin only ECPs – the only one available and marketed for emergency contraception is “Plan B” – levonorgestrel 0.75 mg. It is more effective and has less side effects than combined ECPs. Plan B reduces the likelihood of pregnancy by 89%. It can still cause side effects such as nausea, vomiting, breast tenderness, HA, abdominal pain and dizziness, but causes these 50% less than the combo pils. Estrogen containing ECPs are regular birth control pills containing ethinyl estradiol and either norgestrel or levonorgestrel. They can be provided with specific dosing information for ECP if plan B is unavailable. This is an off label use.
Faith is a 15 year-old who are you educating about emergency contraception. She wants to know how Plan B works. What would you tell her?
2. I would tell her that it depends largely on when in her cycle she has unprotected intercourse and when in relation to that she takes plan B. If used early in the cycle it works by suppressing the LH surge and inhibiting ovulation. It also thickens cervical mucous and makes the uterus unfavorable for capacitation, though these effects probably are negligible since it is typically taken after the sperm are in the upper genital tract. If it is taken really close to ovulation it dampens but does not suppress the LH surge and ovulation may have already or still occur. In this case the released ova is generally less open to fertilization. It does not appear to have any affect on the travel down the tubes. It is possible that it disrupts implantation by thinning the endometrium but this has not been proven and actually much of the data refutes that. But until this part of the mechanism of action is more certain people need to know that it may disrupt implantation and therefore work post fertilization. If this is an important factor for the woman she should probably not use plan B.
Differentiate options and abortion counseling.
* Options counseling is for women who know they are pregnant and need to clarify her thoughts and feelings about her alternatives
* Abortion counseling is for a woman who knows she wants an abortion
Identify key components of options counseling
2. Explore how a woman feels about her pregnancy and her options. Use open ended questions to start to get a sense about how she is feeling and where she is coming from. Ask her if she understands what her options are and if she has any questions about them.
3. Help the woman identify support systems and assess risk. Ask her who she has told she is pregnant and what their reaction has been. Help her to identify people she could confide in if she has not told anyone. Assess her risk for interpersonal violence either from her partner or her parents if she is a teen. Assess her potential for coercion regarding about the decision about her pregnancy. Help her figure out how to talk to her partner or parents or whoever she decides to confide in. Arrange for additional follow up, especially if she feels like she can’t tell anyone.
4. Help the woman reach a decision or discuss a timetable to make one. Make sure she knows what her estimated gestational age is and understands that this decision is time sensitive.
5. Refer or provide appropriate services. Depending on what she decides to do she may or may not be able to receive services at that setting. Make sure you know your community resources and that she understands how to access them.
Compare surgical and medical abortion
2. Surgical abortion is the most common type of abortion in the US, followed by medical. Labor induction methods are not generally used or recommended due to higher rates of morbidity and mortality.
3. MVA or EVA is most common in the first trimester. Manual or Electrical vacuum aspiration. A cannula attached to suction is introduced through the cervical os and products of conception (POC) are removed.
4. D&C or dilation and curettage is used in conjunction with vacuum aspiration sometimes depending on the practitioner and they use a curette to scrape the walls of the uterus to assure there are no POC left. This has been associated with a higher rate of uterine perforation but is used frequently.
5. D&E or dilation and evacuation is generally used after the first trimester and forceps are used to help remove the POC.
6. D&X or dilation and extraction is used infrequently in the US and is for later abortions and involves reducing the fetal head prior to removal.
7. Medical abortion is relatively new and not used as frequently. You can use either a combo of mefipristone or methtrexate and misoprostol.
8. Mefipristone works by competing with progesterone which causes the endometrium to slough and the cervix to soften. Typically pts are given mifepristone (200-600 mg) on site with instructions to take miso 1-3 days later. Typically bleeding and passage of pregnancy ensues within 4-5 hours of miso administration but may take 24 hours or longer.
9. Methotrexate is an IM injection. It is older and is less commonly used now that mefipristone is available. The big difference is that is can take several weeks for passage of POC with methotrexate
10. In cases of failed medical abortion, surgical abortion must be done as misoprostol is teratogenic and the pregnancy should not be continued after failed abortion.
Mechanism of action of COCs
-Progesterone’s Effects:
-thicken cervical mucous so sperm can’t swim in
-Block the LH surge thus inhibiting ovulation
-Inhibit capacitation of sperm thus limiting the sperm’s ability to penetrate egg.
-Slow tubal motility ths delaying transport of ova
Some progestins also:
-disrupt transport of fertilized ovum
-induce endometrial atrophy thus making implantation less likely.
Estrogen’s Effects:
-Provide better cycle control
-Boost efficacy
Mechanism of action of vaginal ring
Progesterone’s Effects:
-thicken cervical mucous so sperm can’t swim in
-Block the LH surge thus inhibiting ovulation
-Inhibit capacitation of sperm thus limiting the sperm’s ability to penetrate egg.
-Slow tubal motility ths delaying transport of ova
Some progestins also:
-disrupt transport of fertilized ovum
-induce endometrial atrophy thus making implantation less likely.
Estrogen’s Effects:
-Provide better cycle control
-Boost efficacy
Mechanism of action of the patch
-Progesterone’s Effects:
-thicken cervical mucous so sperm can’t swim in
-Block the LH surge thus inhibiting ovulation
-Inhibit capacitation of sperm thus limiting the sperm’s ability to penetrate egg.
-Slow tubal motility ths delaying transport of ova
Some progestins also:
-disrupt transport of fertilized ovum
-induce endometrial atrophy thus making implantation less likely.
Estrogen’s Effects:
-Provide better cycle control
-Boost efficacy
Mechanism of action of POPs
-Decreases ovulation somewhat by decreased GnRH pulse frequency and inhibition of positive feedback of estradiol on LH and FSH
-Suppresses midcycle peaks of LH and FSH
-Thickens cervical mucous so sperm can’t swim
-Decreases endometrial receptivity to blastocyst
Mechanism of action of Depo-Provera
-Decreases ovulation a lot by decreased GnRH pulse frequency and inhibition of positive feedback of estradiol on LH and FSH
-Suppresses midcycle peaks of LH and FSH
-Thickens cervical mucous so sperm can’t swim
-Decreases endometrial receptivity to blastocyst
Effectiveness of COCs
Typical use 92%
Perfect Use 99.7%

COCs can be made more effective by shortening or eliminating the pill free interval.
Effectiveness of the vaginal ring
Typical use – data not available – assume same as the pill – 92%
Perfect Use 99.7%
Effectiveness of the patch
Typical use – data not available – assume same as the pill – 92%
Perfect Use 99.7%

Caution in women over 198 lbs – higher failure rate observed.
Effectiveness of POPs
Perfect use – 99.5%
Typical use – 92%

Nearly 100% effective during lactation due to the added contraceptive effects of lactation
Effectiveness of Depo-Provera
Perfect use – 99.7%
Typical use – 97%
Advantages of COCs
CT begin p 398
-safe and effective
-Noncontraceptive uses including decreased dysmenorrhea, PMS, menorrhagia, acne, menopausal symptoms
-mittelschmerz relief
-fewer ovarian cysts
-improvement in menstrual migraines
-rapidly reversible
-decreases perinatal mortality by decreasing the number of unintended pregnancies
-decreases the risk of ectopic pregnancies
-decreased risk of breast and ovarian cancer
-decreased risk of benign breast conditions.
-decreased risk of gonorrheal PID
-Suppression of endometriosis
-decreased risk of iron deficiency anemia
Advantages of the vaginal ring
CT p 449
-has local effect so there is less systemic hormone
-once a month self administered
-provides better cycle control than the pill
Advantages of the patch
CT p 448
-safe, effective an rapidly reversible
-once a week dosing
Easier to remember and use than the pill
-it is assumed it will offer the same non contraceptive and long term protective benefits as the pill but it has not been around long enough to be studied long term.
Advantages of POPs
No estrogen – a good choice for women who cannot take estrogen
-Noncontraceptive benefits – scanty or no menses, decreased menstrual cramps, pain, mood changes, headaches, breast tenderness or nausea
-immediately reversible
-Not confusing – there are no pill free days
-decreased risk of PID due to thick cervical mucous
Advantages of Depo-Provera
CT 466-467
-No estrogen – a good choice for women who cannot take estrogen
-Noncontraceptive benefits – scanty or no menses, decreased menstrual cramps, pain, mood changes, headaches, breast tenderness or nausea
-reduces risk of ectopic pregnancy
-culturally acceptable – preferable in many cultures
-minimal drug interactions
-decreases frequency of grand mal seizures
-fewer sickle cell crises
Disadvantages of COCs
CT p 404
-Can be expensive generally not covered by insurance
-daily administration
-need for storage and ready access
-No protection against STIs
Disadvantages of vaginal rings
CT 449
-some women may not like to have to touch their genitals
-privacy issues as it is recommended they remain refrigerated
Disadvantages of the patch
CT p 445-446
-Difficult to conceal so privacy is sub optimal.
-cost, storage and access issues are still present.
-No protection STIs
-risk of local skin irritation
-decreased effectiveness in women > 198 lbs
Disadvantages of POPs
CT p 469 & 471
-no protection of STIs – may increase risk for HIV due to vaginal thinning
-menstrual irregularity, may have many days of light bleeding or amenorrhea
-weight gain
-breast tenderness
-depression
-vulnerability efficacy
-certain meds decrease the effectiveness
-less availability
Disadvantages of Depo-Provera
-no protection of STIs – may increase risk for HIV due to vaginal thinning
-menstrual irregularity, may have many days of light bleeding or amenorrhea
-weight gain
-breast tenderness
-depression
-no possible to discontinue immediately
-return visits required every 11-13 weeks
-increased LDL and decreased HDL
-allergic rxn possible
-decreased bone density
Effectiveness of Copper T (Paragard) IUD
98.9%
Effectiveness of Mirena
98.6%
Mechanisms of Action Paragard
Causes an increase in uterine and tubal fluids containing copper ions, enzymes, prostaglandins, and white blood cells that impair sperm function and prevent fertilization.
Mechanism of action mirena
-Thickens cervical mucous
-Inhibits capacitation
-Suppresses the endometrium
-May suppress ovulation
Advantages of Paragard
-highly effective
-protective against ectopic
-long lasting
-convenient
-well-liked by users
-low risk side effects
-cost-effective
-may decrease risk of endometrial cancer
Advantages of Mirena
-highly effective
-protective against ectopic
-long lasting
-convenient
-well-liked by users
-low risk side effects
-cost-effective
-may decrease risk of endometrial cancer
-decreases menstrual bleeding by 90%, and 20% of women stop bleeding altogether.
Disadvantages of IUDs
-menstrual irregularity, especially in the first several months.
-cramping and pain lasting 10-15 min post insertion
-between 2-10% of IUDs are spontaneously expelled in the first year, and can occur without the woman being aware of it.
What is the effectiveness of coitus interruptus?
Typical use 73%
Perfect use 96%
What are the different types of Fertility Awareness-Based Methods
Ovulation method-observation of fertile signs such as cervical mucous changes
Symptothermal method – same as above plus monitoring basal metabolic temp.
Standard days method – assume fertility between days 8 – 19 of cycle
Calendar rhythm method – standard days plus awareness of cycle length and how that affects ovulation
Effectiveness of Fertility Awareness-Based Methods?
Ovulation method-
Typical 78%
Perfect 97%

Symptothermal method –
Typical 80-87
Perfect 98%

Standard days method –
Typical 88%
Perfect 95%
Effectiveness of male condoms?
Perfect use 98%
Typical use 75%
Advantages of male condoms?
-OTC
-Low cost
-Protection against STIs
-Prevention of infertility
-Less messy
-Prevention of sperm allergy
-Portable
-Minimal side effects
Disadvantages of male condoms?
- Latex sensitivity
- May decrease spontaneity
-May cause problems with erections
- Embarrassment
- Inconvenient
- Lack of cooperation from male partner
- May reduce sensitivity of penis
Effectiveness of vaginal spermicides?
Studies vary widely from < 50% to 95%. Pregnancy rates. More recent controlled studies show 72% - 90%
Advantages of vaginal spermicides?
OTC
Male partner does not have to be involved
Long shelf life
Simple back up option waiting for ID or pill or if missed doses of pills, can augment natural family planning
Disadvantages of vaginal spermicides?
-Allergies
-No STI protection, may increase susc to HIV by disrupting vaginal epithelium if used frequently
-Abn vaginal anatomy can interfere with proper placement
-Increased rates of UTI
-messy, must be used every time, must wait 10-15 min for film to dissolve, only good for 1 hour
Effectiveness of female condom?
Typical use 79%
Perfect use 95%
Advantages of female condoms?
-no systemic side effects
-do not alter hormonal patterns
-good for women who need only intermittent contraception
-protects against STI including HIV
Disadvantages of female condoms?
May be uncomfortable.
Effectiveness of diaphragm?
Typical use 80%
Perfect use 94%
Advantages of diaphragm?
-no systemic side effects
-do not alter hormonal patterns
-good for women who need only intermittent contraception
-do not require male partner cooperation
-may decrease risk of gonorrhea, Chlamydia & trich (obser studies only no controlled so be cautious about this advise)
-possible proection of cervical dysplasia
Disadvantages of diaphragms?
-with spermicide may increase risk of UTIs, BV and yeast infections
-risk of TSS rare
-irritation from spermicide
-may have cramps, bladder pain, or rectal pain
-avoid oil based lubes
-latex
Effectiveness of cervical cap?
Nulliparous – typical use 80%
Perfect use 91%
Parous –
Typical use 60%
Perfect use 74%
Advantages of cervical cap?
-no systemic side effects
-do not alter hormonal patterns
-good for women who need only intermittent contraception
-do not require male partner cooperation
Disadvantages of cervical cap?
-with spermicide may increase risk of UTIs, BV and yeast infections
-risk of TSS rare
-irritation from spermicide
-may have cramps, bladder pain, or rectal pain
Effectiveness of female sterilization?
99.5%
Effectiveness of vasectomy?
99.9%
Advantages of female sterilization?
-permanence
-Highly effective
-safe
-quick recovery
- no LT side effects
-Cost effective
-no need to buy anything
-no need for partner compliance
-no need to interrupt sex
-privacy of choice
Disadvantages of female sterilization?
-Permanence
-Regret for decision
-technically difficult
-need for surgeon, OR, etc.
-High initial cost
-Increased chance of ectopic should it fail
-No protection against STIs
Advantages of vasectomy?
-permanence
-Highly effective
-safe
-quick recovery
- no LT side effects
-Cost effective
-no need to buy anything
-no need for partner compliance
-no need to interrupt sex
-privacy of choice
-removes burden from woman
Disadvantages of vasectomy?
-Permanence
-Regret for decision
-need for surgeon
-High initial cost
-No protection against STIs
Effectiveness of lactational amenorrhea method of birth control?
If exclusively breastfeeding and has not had first postpartum menses, BF is 98% effective for the first 6 months.