How do oral contraceptives work (5)?
- All 'work' by manipulation of the preexisting female hormone cycles
--anterior pituitary (follicle stimulating hormone FSH, lutenzing hormone LH)
--Ovarian (estrogen and progesterone)
-Follow insert directions for when to take the 1st pill in the pack (28 pills, 7 are inert)
How many pills is seasonale?
84 pills with 4 withdrawal bleeds a year
What is lybrel oral?
continous dosing 28 pills/pack no bleeding
How does OC prevent conception (5)?
1. Low daily dose of estrogen/progesterone
2. Inhibits ovulation
3. Alters cervical mucous
4. Endometrium unfavorable for implantation
5. Protective effect against ovarian and uterine cancer
What are 7 contraindications for hormonal methods?
1. hx of thromboembolic disoders; CVA, CAD, HTN
2. Any estrogen dependent disorder: Breast ca
3. impaired liver fx, liver tumor
4. Smoking if >35 years/ consider progesterone only OC
5. Undiagnosed vaginal bleeding - uterine cancer
6. suspected pregnancy
7. HA w/ focal neurologic symptoms
OC patient teaching (9)
1. s/e to report
2. take pill same time every day
3. begin pill during 1st 7 days of cycle (use additional protection for 1 week
4. must take in certain order
5. missed dose protocol
6. stop if you think pregnant
7. bottle feeding: wait 3 weeks to start b/c ↑ clot risk
8. BF: don't take. ↓ milk production
9. Antibiotics/anticonvulsants may ↓ effectiveness
OC disadvantages (12)
1. no protection against STDs
2. may change insulin needs
3. slight ↑ risk in breast/cervical cancer (not good if family hx)
4. ↑ vein thrombosis
5. ↑ PE
6. myocardial infarction
10. gall bladder disease
11. benign liver disease
12. chlamydial infection: changes pH in vagina so ↑ risk if exposed
OC advantages (8)
1. unrelated to coitus
2. highly effective
3. ↓ ovarian & endometrial cancer risk
4. regulate cycle
5. improves acne
6. improve endometriosis
7. improves dysmenorrhea (painful periods)
8. ↓ incidence of ovarian cysts, ectopic pregnancies
Warning signs of OC "ACHES"
A = abdominal pain (benign liver disease, GB disease)
C = chest pain (PE, MI)
H = severe HA (stroke)
E = eye problems/blurred double vision (stroke)
S = Severe leg pain (DVT)
Common reasons for changing dose of OC (2)
1. decrease due to N&V, HA & breast tenderness
2. Increase due to breakthrough bleeding
What is the "Patch" Ortho Evra (5)?
1. Transermal delivery of estrogen and progestin
2. Greater risk for s/e, esp. thrombosis
3. One a week application for 3 weeks, 4th week- no patch; then period
4. 99% effective
5. best if wt is <197
Nuvaring- 3 weeks in, 1 week out; withdrawal bleed, ok to remove for 3 hours at a time
What is the Nuva Ring (7)?
1. insert into vagina once a month
2. releases small amounts of hormones
3. held in place by vaginal muscles, exact position not necessary
4. remove after 3 weeks to allow for period. reinsert after 7 days
5. if removed for > 3 hours used another method
6. 92/99% effective
7. no weight requirement
What is Depo-Provera "The shot" (10)?
1. get shot 12-14 weeks
2. Progesterone in oil (depot medrooxyprogesterone acetate) deltoid or dorsal gluteal IM 50 mg
3. works by manipulating hormones
4. breast feeding mothers may use, best after milk established
5. start on day 5 of menses, or before postpartum hospital d/c
6. Forgetful users may remember to get
7. no protection against STD
8. bone loss will occur- do not use longer then 2 years
9. 97/99.3% effective
10. same contradictions as OC = blood clots, strokes
What are some depo-provera s/e (6)?
1. irregular vaginal bleeding and spotting (main reason women d/c)
2. often amenohhea after 3rd dose
3. weight gain (avg. 5 lbs in 2 years)
4. hair loss
5. slightly increase risk of breast ca
6. long term use = permanent bone loss ***
What are some noncontraceptive health benefits of hormonal contraceptions?
Decreases- PID, fibroadenomas, fibrosystic breast changes, less anemia
Emerging Areas- increased bone mass
Decreased- acne, bleeding disorders, endometriosis, RA, uterine fibroids, colorectal Ca
What is an Intrauterine device (IUD)? (8)
1. 97/99% effective
2. Negative cultures for gonorrhea, chlamydia, vaginosis, trichomonas before inserted
3. negative pregnancy test before inserted
4. only use if patient is monogamous b/c string acts as means of infectious enhancement
5. Mirena 5 years, saturated w/hormones
6. works by inflammatory reponse of the endometrium- kills sperm, cervical mucous changes, hostile endometrium
7. conception may occur (in fallopian tubes) - implantation is prevented- may present ethical issues
8. "T" shaped with string at the end
What are 6 contraindications for an IUD?
1. Cervical or uterine ca
2. Pelvic infection
3. Abnormal uterine bleeding
4. Uterine fibroids
5. Nulliparous- never delivered a baby
6. Prior ectopic pregnancy
What are some s/e of an IUD (6)?
1. Menorrhagia = increased amt. & duration of mensus
2. Dysmenorrhea = increased menstral cramping/pain take ibuprofen for pain & iron for anemia
3. increased risk of contracting STDs/Pelvic infections b/c of string
4. possible uterine perforation
5. possible complicated pregnancy
6. possible expulsion
IUD education "PAINS"
P = period late may mean pregnant
A = Abdominal pain
I = infection exposure
N = not feeling well
S = string missing. check weekly for 1st 4 weeks then monthly
What are some barrier methods?
1. Must know latex status
2. Never lubricate w/ vaseline; it destroys the barrier
3. Must use the barrier every time
4. Diaphragm- keep in 6-24 hours after sex
5. prevents sperm from entering cervix
6. may ↓ risk of cervical cancer
1. must be fitted & refitted if gain or loss of 15 lbs
2. empty bladder
3. spread spermicide inside dome & around rim
4. check for placement after insertion
What is a sponge?
Vaginal sponge- 1g nonoxynol-9, moisten w/ water, insert into vagina, leave in place at least 6 hours after intercourse, leave in no more then 30 hours (Increased toxic shock syndrome)
What is a femcap/cervical cap (7)?
1. similar to diaphragm but smaller
2. women w/cervical abnormalities may not be able to use
3. Designed to fit to female anatomy- latex free- Rx
4. Insert prior to intercourse, leave in atleast 6 hours but not .48 houts
5. cap fitting yearly, after abortion, childbirth or surgery
6. pap smear required 3 mo after original fitting
7. 90% in primip, 75-80% in multip
How do women attempt to predict ovulation?
Calender methods, temperature method, cervical mucosa
What is spermicide
1. inserted into vagina prior to intercourse
2. helps prevent condom breakage
3. effective for 1 hour
4. don't douche for 6-8 hours after sex
5. repeat sex, reapply spermicide
6. when used alone 69/74% effective
7. ↑ effectiveness when used with condom or diaphragm
What is sterlization (5)?
1. 99% effective
2. Informed consent critical
3. Insurance may or may no cover it
4. NO insurance pays for reversals
5. Contraindications- age and religious beliefs
What is a vasectomy (6)?
1. Outpatient procedure by urologist/local anesthetic/off work 1-2 days
2. No impact on sexual function
3. S/E: possible bleeding, suture rxn, rxn to anesthetic agent, pain
4. Not immediately sterile, 2 semen samples needed to prove it
5. Different methods to sever the vas deferens
6. reversal difficulty depends on cutting, burning method used
What is a tubal ligation (8)?
1. General anesthesia risk
2. Back to work 2-4 days, may do PP
3. Different types: laparoscopic or incisional
4. During procedure- specimen to lab to confirm
5. PP-1-2 inch incision under umbilicus
6. Abd. gas often the most painful post-op complaint
7. SHARP pain in shoulder
8. Immediately sterile
What is a hysteroscopic tubal occlusion?
Microinsert- inner coil of stainless steel, a nitinol superelastic outer coil, polyethylene fibers, 4 cm long by 0.8 mm diameter- flattened to insert in tube-output-MD office
Not immediately sterile 12 weeks to confirm w/ hystersalipingography
What is the effectiveness % of OC
What is the effectiveness % of the patch (ortho evra)?
What is the effectiveness % of Nuva Ring?
What is the effectiveness % of Depo-Provera?
What is the effectiveness % of an IUD?
Multiphasic OC (3)
1. dose changes throughout cycle, estrogen may increase later in cycle
2. helps reduce side effects
3. must take pills in proper order
Hormone implants (Implanon) (5)
1. thin single rod
2. releases progestin
3. 3 years of contraception
4. inhibits ovulation & thickens cervical mucous to prevent sperm penetration
5. S/E = irregular periods, amenorrhea
What is the effectiveness % of a condom?
85/88% & increased with spermicide
What is the effectiveness % of a diaphragm?
1. pouch inserted into vagina (long tube)
2. only method to allow woman some protection from STDs
3. 79% effective
What is the effectiveness % of a female condom?
What is the effectiveness % of a cervical cap?
90% in primip, 75-80% in multip
What is the effectiveness % of sterilization?
What is the effectiveness % of spermicide?
when used alone 69/74% effective
How to take Morning after pill & % of reduce pregnancy risk (3)
1. no later than 72 hours
2. 2nd dose 12 hours later
3. reduces risk of pregnancy 75%
Natural family planning (5)
1. 75-80% effective
2. both partner highly motivated
3. patient education = calendar method, temperature method, cervical mucous methods
4. no sex during fertile days
5. no contraindications or S/E
What is the effectiveness % of natural family planning?
1. based on ovulation 14 days before period
2. unreliable b/c of factors effecting ovulation
3. record cycle for 6 months
4. subtract 18 from shortest cycle and 11 from longest
ex. 28-18=10 & 32-11=21 so fertile from 10-21 days
5. 91% effective if everything is perfect
What is the effectiveness % of calendar method?
91% effective if everything is perfect
What is the effectiveness % of withdrawal?
81/83% failure rate
Breastfeeding as birth control (7)
2. inhibits ovulation
3, frequency, intensity, duration of sucking influence effectiveness
4. exclusive BF at least 10/day may avoid ovulation
5. add formula & solid food ↓ effectiveness
6. skip night feedings may ↓ effectiveness
7. after 3-6 months periods generally resume
1. sterilization where micro insert is passed through vagina, cervix, uterus & placed in fallopian tubes & body produces scar tissues which occludes fallopian
2. local anesthetic, no incision
3. after 3 months scar tissue forms a barrier
4. use alternate protection for 3 months
5. dye injected to ensure blockage
Most effective method (4)
Very effective (4)
4. depo shot
1. condom w/spermicide
3. fertility awareness
least effective (3)
1. spermicide alone