Contraception Flashcards by Alexandra Mull

Age to discuss reproductive health

15-55 YO;

“what are your plans for pregnancy in the next year?”

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Emergency Contraceptives (EC)

2 doses of contraceptive pills w/i 72 hours of unprotected sex

Yuzpe “old school” - estrogen 200 mg
Plan B or Preven - no estrogen

IUD insert w/i 5 days
- Paraguard (copper IUD)

Ulipristal Acetate (Ella)- SPRM effective up to 120 hrs (5 days); hormonal up to 72 hours (3 days)

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Short acting BC

oral contraceptive pills
nuva ring
orthoEvra Patch
Depo Provera

*efficacy irreversibly proportionate to frequency

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Best candidate for short acting BC

women who have short interval prior to wanting pregnancy (excludes depo provera)
not looking for long term prevention
using for non-contraceptive benefits
financial concerns/uninsured

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OCP MOA

suppress ovulation, thicken cervical mucous, thinning of endometrial lining

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Progestin only pill (POP) or “mini pill”

contain only progestin
less likely to consistently suppress ovulation (focus on thickening mucous and thinning lining)
usually used when estrogen contraindicated

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Combination oral contraceptives (COCs)

estrogen + progestin
progestin type differs – important for SE profile
Estrogen helps w/ cycle regulation

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major progestin only SE

irregular, unpredictable bleeding

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Types of combo pills

monophasic
triphasic
continuous pills

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Monophasic pills

single dose of estrogen + prosterone for 21-24 days; + placebo pills for 4-7

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Triphasic pills

not really used anymore

differing dose of estrogen/progesterone throughout course of pack; 7 placebos; lower total dose of estrogen

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Continuous pills

ex. Seasonique
Monophasic; 84 active, 7 placebo

withdrawal bleeding every 3 months

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Continuous pills good for

dysmenorrhea

anemia

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Caution to COCs

well controlled DM, HTN
smoking <35 YO
common migraine h/a
liver disease

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Contra to COCs

uncontrolled HTN
CAD
uncontrolled DM
complex migraine h/a (auras)
hx of thromboembolism
hormone sensitive cancers
smoking >35 YO

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Eligibility criteria for BC

1- no restriction w/ a condition
2- advantages > risks
3- risk > advantages; only used when other methods aren’t available/acceptable
4- unacceptable health risk

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POP

mini pill
breastfeeding, post-partum moms
estrogen contra
more likely to fail if not taken properly (inadequate ovulation suppression due to non-therapeutic levels)

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SE of POP

break through bleeding (lack of estrogen)

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Progestin-only option

Minipill
Depo Provera Shot
Nexplanon implant
Progestin IUD (mirena, skyla, liletta, kyleena)

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Pros/cons of minipill

pro: pregnant right after stoping
con: spotting; depression, hair/skin changes, change in sex drive

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Pros/cons of shot

pro: works for 12 mo; decreases periods, no daly pill
cons: spotting, no period, weight gain, depression, hair/skin changes, change in sex drive; delay in getting pregnant after you stop; SE last up to 6 mo after stopping

Pro/cons of implant

pro: long lasting (up to 4 years); no daily pill; pregnant after removed
cons: irregular bleeding; no period at all after 1 year

Progestin only IUD pro/con

Pro: works 3-7 years; no daily pill; improve cramps/bleeding; prego after removed

Cons: lighter periods, spotting or no period at all

Contra to estrogen

immediate postpartum (increased risk of VTE)
early lactation can be suppressed
hx of thrombophelias
hx of CVD
smokers >35
classic migraines
liver dysfunction

Non-contraceptive benefits of OCPs

cycle regulation tx of heavy menses (progesterone thins lining) tx of acne (suppresses ovarian production of testosterone) - SE vaginal dryness and dysmenorrhea tx of dysmenorrhea (no prostaglandins) prevent functional ovarian cysts prevent ovarian, colon and endometrial CA

CA prevention of BC

endometrial > ovarian > colon

Excluding pregnancy when starting a new method

1. no intercourse since last menstrual 2. consistent/correctly on reliable method of contraception 3. w/i first 7 days after normal menses 4. she is w/i 4 weeks postpartum (non nonlactating) 5. 1st 7 days postabortion or miscarriage 6. fully/nearly fully breastfeeding, amenorrhoeic, and less than 6 mo postpartum

back up/additional contraception not needed

copper-containing IUD

>7 days after menses, use back up BC for 7 days

Progesterone-IUD | injectable

>5 days after start of menses, use back up BC for 7 days

Implant | COCs

>5 days after menses started, back up for 2 days

POP

bimanual exam and cervical inspection needed before BC

copper IUD | progesterone IUD

BP needed before BC

COCs

No exam needed BC

implant shot POP

Depo Provera

``` medroxyprogesterone acetate (progesterone only) Failure: low Contra: none -- caution with DM, HTN, CVD ``` SE: irregular cycle, amenorrhea, bone mineral density loss (reversible) -- don't use for more than 2 years due to bone loss back up if >7 days after menses, use for 7 days

Transdermal options

nuva ring ortho Evra Patch failure: low Estrogen + progesterone Contra: same as COCs

Barrier methods

block fertilization condom, diaphragm, cervical cap/sponge failure: high contra: sensitivity to material non-contraceptive benefit: lower risk of STD

LARCs types

implants | intrauterine devices

sub-dermal implant

hormonal suppression of ovulation Types: implanon/nexplanon, both contain progestin only Failure: very low Contra: allergy to material

IU devices

MOA: unknown formulation: progestin containing vs. copper (worse dysmenorrhea) Failure: very low Contra: active infection, sensitivity to copper, uterine anomaly, untreated cervical disease

SE of IUD

follicular cytsts more common | dysmenorrhea w/ copper

Types of progestin IUD

mirena (FDA approve for menorrhagia) skyla liletta

Non-progestin IUD

Paraguard (copper)

Non-contraceptive benefits of IUDs

treat menorrhagia (Mirena) reduce average menstrual blood flow (not FDA approved)

LARC benefits

``` eliminate user input hormone levels consistent further decreasing ovulation eliminate frequent doc visit one less thing for mom to remember plan pregnancies better ```

Most common sterilization

laparscopic

types of sterilization

laparoscopic postpartum via mini-laparotomy transcervical (essue) - removed from market

Contraindications to sterilization

surgical restrictions | incomplete childbearing

Non contraceptive benefit of sterilization

Ovarian CA?

Laparoscopic sterilization aka

"interval" sterilization

Laparoscopic procedure

requires ventilation and therefore done under general anesthesia requires hospital/surgery center outpatient surgery effective IMMEDIATELY