Flashcards in Contraception Deck (45):
What are the estrogenic effects of birth control
Ovulation is inhibited by suppression of FSH/LH
Implantation is inhibited by alteration of the endometrium
Ovum transport is accelerated
Luteolysis may occur as estrogen causes progesterone levels to fall
What are the pro gestational effects of birth control?
Hypothalmis-pituitary- ovarian disturbances
Thick cervical mucus interferes with sperm transport
Capacitation (sperms ability to fertilize the egg) may be inhibited
Ovam transport may be slowed
implantation is hampered by the suppression of endometrium
What are the 3 non-contraceptive benefits of oral contraceptives
Decreased mental cramps and pain
Less menstrual blood flow
Improvement of facial acne
What are the absolute contraindications for oral contraceptives?
History of thromboembolic disorders
Coronary artery disease
Known or suspected breast carcinoma
Known or suspected estrogen-dependent neoplasia (breast, cervical, stomach, brain)
Benign or malignant tumor or impaired liver function
Previous cholelithiasis during pregnancy
Undiagnosed abnormal uterine bleeding (r/o pathology)
When should progestin only pills be used?
hx migraine headaches
contraindication to combination pills
What drugs decrease effectiveness of oral contraceptives?
antibiotics and anticonvulsants
What drugs do oral contraceptives decrease the effectiveness of?
warfarin, insulin, certain hypoglycemics
What are the excessive estrogenic effects
dysmenorrhea, nausea, cholasma, CVA, DVT, PE, thromboembolic disease, telangiectasias (spider vein around the face), hepatic adenoma/adenocarcinoma, cervial changes, breast tenderness (secondary to increased size)
Deficiencies in estrogen effects
no withdrawal bleeding
decreased duration in menstrual bleeding
break through bleeding on DOC 1-9
Excessive pro gestational effects
breast tenderness, HTN, depression, fatigue, decreased libido, decreased duration in menstrual bleeding, increased appetite, weight gain and acne
deficiencies in progesterone
breakthrough bleeding DOC 10 to 21
How would you begin oral contraceptives?
Begin with low dose combined or multi phasic pill (35mcg or less)
Contraindications of the contraceptive ring
Controlled BP but smokes >15 cigarettes/day
Hx of blood clots or any cardioembolic disorder
How long do you have after a ring falls out to replace it?
use back up method of contraceptive must be used if left out for more than 3 hours
How often do you change the patch?
once per week
At what weight does the patch have reduced effectiveness
What medications reduced the effectiveness of the patch
Antibiotics, antifungals, anticonvulsants, st johns wart
What does the patch increase the risk for?
serious cardioembolic events (bc 60% more estrogen than oral contraceptives)
What are the contraindications for the patch?
high BPHx of blood clots or any cardioembolic disorder
When should the first patch be applied
on the first day of menstrual cycle (day 1) or the sunday following
What do you advise if the patch has been off for >24 hours?
restart a new 4 week cycle along with backup method
with is depo-provera's MOA?
suppresses FSH and LH, thus blocking the LH surge which will inhibit ovulation
what are the disadvantages of depo-provera?
menstrual irregularities: Usually amenorrhea
Delayed return of fertility up to 1 year
Injection every 3 months
Lipid changes (decreases in HDL)
Possible reduction in bone density with long-term use
When do you test for pregnancy in a depo patient?
if greater than 2 weeks since 3 month period ended
What do you include in patient education in starting depo?
BAck up method should be used during the first 2 weeks after the injection, unless administered b yDOC 5
What are the kinds of IUDs?
Copper-releasing para-gaurd (10 years) and Progestin-releasing MIrene (5 years)
What are the advantages of IUDs
Progestin releasing IUDs may decrease menstrual loss and dysmenorrhea
Can prevent Asherman's syndrome (making adhesions during bleeding)
What are the IUDs MOA
1) Immobilizes sperm and interferes with migration of sperm from the vagina into the fallopian tubes
2) Speeds transport of the ovum through the fallopian tube
3) inhibits fertilization
4) causes lysis of the blastocyst and/or prevents implantation due to local forge in body inflammatory responses
How long after post partum can you insert IUD
When should a woman have her diaphragm refitted?
Weight gain or loss of 20lbs or more
How long do diaphragms need to stay in after intercourse?
What is the sponge made out of
How long can you leave the sponge in for?
30 hours or less, provides protection for 12 hours
How much space should you leave on the end of a condom?
What is the morning after pill?
levonorgesterel, plan B, high dose progestin
Within how long should the morning after pill be taken?
within 72 hours
What is the "abortion pill"?
How is the copper IUD used for emergency contraception?
inserted within 5-6 days after intercourse
What is the effectiveness of Plan b vs copper releasing IUD
Plan B: 85%
What are the possible undesired effects of Plan B?
N/V- may want to consider antiemetic
Changing in timing or flow of next menses, may increase length of period
MOA of sterilization
Female: tubal ligation
Male: Male vasectomy
How do you: calendar method
Record cycles, fertile phase is -18 days from the shortest cycle and -11 days from the longest cycle (last day of fertility)
How does the basal body temperature graph work
A.m. Body temp for 3-4 months. Temp drops 12-24 hours prior to ovulation, rises following ovulation due to production of progesterone and avoid sex 2-3 days prior to expected drop to 3 days following the rise
What cervical mucus changes do you look for in the billings test/ cervical mucus test?
Mucus changes from scant and thick to thin with increasing Spinnbarkeit