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Contraception

Terms in this set (12)

Emergency Contraception
Oral levonorgestrel (Plan B) works by delaying ovulation, but is ineffective post-fertilization

Ulipristal is effective for 5 days as opposed to 3 and also interferes with ovulation

Most states: adolescents can get this without parental consent
OCPs
combination of both estrogen and progesterone
-inhibit FSH/LH, suppresses ovulation, thickens cervical mucus, decidualize endometrium
-pill taken for 21 days and placebo for 7 days (in which experiences menstruation
↓ risk of endometrial, ovarian cancer and ↓ risk ectopic pregnancy
↑ risk of thromboembolism (ethinyl estradiol dose determines risk, but ↓ dose leads to more breakthrough bleeding)
-Women who use oral contraceptive pills have a slightly higher risk of developing cervical intraepithelial neoplasia
-progesterone leads to decreased androgenicity (desogestrel, drospirenone)
-Rifampin, anticonvulsants ↓ OCP efficacy
Contraindications to combined hormonal contraceptives
-migraine with aura
>15 cigarettes/day and age>35
Stage 2 HTN (>160/100)
History of venous thromboembolism disease
history of stroke or ischemic heart disease
breast cancer
-estrogen and progesterone may have proliferative effect on breast tissue (concerning with hormone receptor positive cancer
-Copper IUD good option in these patients
cirrhosis and liver cancer
major surgery with prolonged immobilization
<3 weeks postpartum
Vaginal Ring
AKA NuvaRing
flexible vaginal ring that releases both estrogen and progesterone for 3 weeks
-when ring is removed, breakthrough bleeding occurs
-similar side effects and efficacy to OCPs
-may ↑ vaginal discharge and lead to spotting
Transdermal Patch
AKA OrthoEvra
-Transdermal patch with a combination of estrogen and progesterone placed on the skin for 7 days
-each week the previous patch is removed and new patch is placed
-3 weeks of patches are followed by patch free week (withdrawal bleeding)
-Side effects/efficacy same as OCPs, thromboembolism risk in smokers and those>35
-Does not work as well in women>198 lbs
Depo-Provera (medroxyprogesterone)
IM injection effective contraception for 3 months
-lighter or no periods, safe with breastfeeding
-Disadvantages: irregular bleeding, weight gain, delayed fertility after discontinuation (up to 10 months)
IUD
Placed into uterus and provides contraception for 10 years
-2 types: copper IUD and levonorgestrel device
-devices a/w PID when they are place.
-Mirena thins lining of uterus (↓ dose of progesterone)
-Skyla ↓ dose and smaller, for nuliparois women
-immediate fertility once removed, safe with breastfeeding, lighter periods and less cramping
CI to Copper IUD is Wilson's Disease
Implanon
progestin only implant
-inhibits ovulation and ↑ cervical mucous viscosity
-effective for up to 3 years, immediate fertility once removed, safe with breastfeeding
-AE: weight gain, depression, irregular periods
Progestin only minipills
thicken cervical mucus
-safe with breastfeeding
-requires strict compliance with daily timing
Contraindications to estrogen
pregnancy
history stroke or DVT
breast cancer
undiagnosed abnormal vaginal bleeding
estrogen dependent cancer
benign or malignant liver neoplasm
current tobacco use and age>35
Contraindications to IUDs
known or suspected pregnancy
unexplained vaginal bleeding
current purulent cervicitis
acute or recurrent PID
conformed symptomatic actinomycosis
bicornuate or septet uterus
cervical or uterine cancer
Atypical pap smears
Hx heart valve replacement or artificial joints
Sterilization
Hysteroscopic tubal occlusion (Essure®) can be performed in the office and places coils into the fallopian tubes that cause scarring that blocks the tubes.
-Patients are required to use a back up method of contraception for three months following the procedure until a hysterosalpingogram is performed confirming complete occlusion of the tubes.
-While tubal ligation, either by laparoscopy or mini-laparotomy, are common and effective forms of permanent sterilization, for this patient with her BMI and previous surgeries, this would carry more surgical risks.
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