Pc 615 Module 3 Contraception Fsmfn

Front 1

Describe the ethical, pragmatic, and legal bases for informed choice and consent in family planning and reproductive health care.

Back 1

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.

Front 2

Identify the components of the BRAIDED mnemonic for informed consent.

Back 2

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.

Front 3

Factors that influence contraceptive efficacy

Back 3

inherent efficacy, user characteristics, and competence and honesty of the investigator.

Front 4

What is inherent efficacy?

Back 4

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.

Front 5

What User Characteristics affect contraceptive efficacy?

Back 5

most importantly – imperfect use, age, frequency of intercourse, and regularity of cycles.

Front 6

What does Influence of the investigator have to do with contraceptive efficacy?

Back 6

– 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.

Front 7

How do reproductive stages affect contraceptive method choice?

Back 7

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.

Front 8

How does cost and cost effectiveness affect contraceptive method choice?

Back 8

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.

Front 9

How does pattern of sexual activity affect contraceptive method choice?

Back 9

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.

Front 10

How does access to medical care affect contraceptive method choice?

Back 10

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.

Front 11

How does intimate partner violence affect contraceptive method choice?

Back 11

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.

Front 12

Describe traditional surgical methods of female sterilization versus newer transcervical approaches.

Back 12

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.

Front 13

Dora is a 34 year-old whose husband has just gotten a vasectomy. When can she stop using her diaphragm?

Back 13

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.

Front 14

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?

Back 14

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)

Front 15

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?

Back 15

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.

Front 16

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?

Back 16

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)

Front 17

In what ways is the cap different from the diaphragm?

Back 17

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).

Front 18

In what ways is the cap similar to the diaphragm?

Back 18

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).

Front 19

What three conditions are necessary for the Lactational Amenorrhea Method to be an effective contraceptive method?

Back 19

1. Full or nearly full breastfeeding
2. Has not had first postpartum menses
3. baby less than 6 months old

Front 20

How do monophasic and multiphasic COCs differ?

Back 20

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.

Front 21

In what other general ways do the various brands of COCs differ?

Back 21

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.

Front 22

What therapeutic uses do COCs have in addition to providing contraception?

Back 22

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

Front 23

the ACHES acronym that is used to teach combined contraceptive method users about warning signs

Back 23

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)

Front 24

In what circumstances would progestin-only contraceptives be more appropriate hormonal methods than combined contraceptives?

Back 24

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)

Front 25

What are the noncontraceptive health benefits of combined and progestin-only contraceptives?

Back 25

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

Front 26

Ashley is a 25 year-old who would like to begin COCs. What history would you obtain? How would you select a COC?

Back 26

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.

Front 27

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?

Back 27

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.

Front 28

The PAINS acronym can be used to remember the early IUD warning signs:

Back 28

• 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

Front 29

What are the noncontraceptive health benefits of intrauterine devices?

Back 29

• possible protection against endometrial cancer
• Decreased menstrual blood loss
• To decrease menopause symptoms

Front 30

How do combined and progestin-only ECPs differ?

Back 30

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.

Front 31

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?

Back 31

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.

Front 32

Differentiate options and abortion counseling.

Back 32

* 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

Front 33

Identify key components of options counseling

Back 33

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.

Front 34

Compare surgical and medical abortion

Back 34

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.

Front 35

Mechanism of action of COCs

Back 35

-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

Front 36

Mechanism of action of vaginal ring

Back 36

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

Front 37

Mechanism of action of the patch

Back 37

-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

Front 38

Mechanism of action of POPs

Back 38

-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

Front 39

Mechanism of action of Depo-Provera

Back 39

-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

Front 40

Effectiveness of COCs

Back 40

Typical use 92%
Perfect Use 99.7%

COCs can be made more effective by shortening or eliminating the pill free interval.

Front 41

Effectiveness of the vaginal ring

Back 41

Typical use – data not available – assume same as the pill – 92%
Perfect Use 99.7%

Front 42

Effectiveness of the patch

Back 42

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.

Front 43

Effectiveness of POPs

Back 43

Perfect use – 99.5%
Typical use – 92%

Nearly 100% effective during lactation due to the added contraceptive effects of lactation

Front 44

Effectiveness of Depo-Provera

Back 44

Perfect use – 99.7%
Typical use – 97%

Front 45

Advantages of COCs

Back 45

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

Front 46

Advantages of the vaginal ring

Back 46

CT p 449
-has local effect so there is less systemic hormone
-once a month self administered
-provides better cycle control than the pill

Front 47

Advantages of the patch

Back 47

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.

Front 48

Advantages of POPs

Back 48

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

Front 49

Advantages of Depo-Provera

Back 49

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

Front 50

Disadvantages of COCs

Back 50

CT p 404
-Can be expensive generally not covered by insurance
-daily administration
-need for storage and ready access
-No protection against STIs

Front 51

Disadvantages of vaginal rings

Back 51

CT 449
-some women may not like to have to touch their genitals
-privacy issues as it is recommended they remain refrigerated

Front 52

Disadvantages of the patch

Back 52

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

Front 53

Disadvantages of POPs

Back 53

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

Front 54

Disadvantages of Depo-Provera

Back 54

-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

Front 55

Effectiveness of Copper T (Paragard) IUD

Back 55

98.9%

Front 56

Effectiveness of Mirena

Back 56

98.6%

Front 57

Mechanisms of Action Paragard

Back 57

Causes an increase in uterine and tubal fluids containing copper ions, enzymes, prostaglandins, and white blood cells that impair sperm function and prevent fertilization.

Front 58

Mechanism of action mirena

Back 58

-Thickens cervical mucous
-Inhibits capacitation
-Suppresses the endometrium
-May suppress ovulation

Front 59

Advantages of Paragard

Back 59

-highly effective
-protective against ectopic
-long lasting
-convenient
-well-liked by users
-low risk side effects
-cost-effective
-may decrease risk of endometrial cancer

Front 60

Advantages of Mirena

Back 60

-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.

Front 61

Disadvantages of IUDs

Back 61

-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.

Front 62

What is the effectiveness of coitus interruptus?

Back 62

Typical use 73%
Perfect use 96%

Front 63

What are the different types of Fertility Awareness-Based Methods

Back 63

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

Front 64

Effectiveness of Fertility Awareness-Based Methods?

Back 64

Ovulation method-
Typical 78%
Perfect 97%

Symptothermal method –
Typical 80-87
Perfect 98%

Standard days method –
Typical 88%
Perfect 95%

Front 65

Effectiveness of male condoms?

Back 65

Perfect use 98%
Typical use 75%

Front 66

Advantages of male condoms?

Back 66

-OTC
-Low cost
-Protection against STIs
-Prevention of infertility
-Less messy
-Prevention of sperm allergy
-Portable
-Minimal side effects

Front 67

Disadvantages of male condoms?

Back 67

- Latex sensitivity
- May decrease spontaneity
-May cause problems with erections
- Embarrassment
- Inconvenient
- Lack of cooperation from male partner
- May reduce sensitivity of penis

Front 68

Effectiveness of vaginal spermicides?

Back 68

Studies vary widely from < 50% to 95%. Pregnancy rates. More recent controlled studies show 72% - 90%

Front 69

Advantages of vaginal spermicides?

Back 69

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

Front 70

Disadvantages of vaginal spermicides?

Back 70

-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

Front 71

Effectiveness of female condom?

Back 71

Typical use 79%
Perfect use 95%

Front 72

Advantages of female condoms?

Back 72

-no systemic side effects
-do not alter hormonal patterns
-good for women who need only intermittent contraception
-protects against STI including HIV

Front 73

Disadvantages of female condoms?

Back 73

May be uncomfortable.

Front 74

Effectiveness of diaphragm?

Back 74

Typical use 80%
Perfect use 94%

Front 75

Advantages of diaphragm?

Back 75

-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

Front 76

Disadvantages of diaphragms?

Back 76

-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

Front 77

Effectiveness of cervical cap?

Back 77

Nulliparous – typical use 80%
Perfect use 91%
Parous –
Typical use 60%
Perfect use 74%

Front 78

Advantages of cervical cap?

Back 78

-no systemic side effects
-do not alter hormonal patterns
-good for women who need only intermittent contraception
-do not require male partner cooperation

Front 79

Disadvantages of cervical cap?

Back 79

-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

Front 80

Effectiveness of female sterilization?

Back 80

99.5%

Front 81

Effectiveness of vasectomy?

Back 81

99.9%

Front 82

Advantages of female sterilization?

Back 82

-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

Front 83

Disadvantages of female sterilization?

Back 83

-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

Front 84

Advantages of vasectomy?

Back 84

-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

Front 85

Disadvantages of vasectomy?

Back 85

-Permanence
-Regret for decision
-need for surgeon
-High initial cost
-No protection against STIs

Front 86

Effectiveness of lactational amenorrhea method of birth control?

Back 86

If exclusively breastfeeding and has not had first postpartum menses, BF is 98% effective for the first 6 months.