Contraception: Behavior, Barrier, Hormones Flashcards Preview

Q4 Women's Health > Contraception: Behavior, Barrier, Hormones > Flashcards

Flashcards in Contraception: Behavior, Barrier, Hormones Deck (41):
1

Methods of contraception? (6)

1) behavioral
2) barrier
3) hormonal
4) IUD
5) sterilization
6) emergency

2

Failure Rate is?

% of preggos per yr on particular method

3

Typical Use vs Expected Rate?

Typical Use = actual fail rate due to human error

Expected = fail rate when used correctly

4

Most effective REVERSIBLE methods?

Implants
IUD

5

Most effective IRREVERSIBLE methods?

sterilization

6

Next most effective methods?

Hormones
Diaphragm

7

Behavioral Methods: Abstinence

Benefits?

Risks/Disadv?

Benefits:
↓ STI risks (NOT no risk)
No s/e
100% effective

Risks:
Difficult
Leaves situation open to NO contraception or STI prevention

8

Behavioral Methods: Fertility Awareness Based (FAB)

Includes? (5)

1) Basal temp
2) Calendar
3) Cervical mucus
4) Symptothermal (all 3 above)
5) Lactational amenorrhea

9

Behavioral Methods: FAB

Benefits?

Risks/Disadv?

Benefits:
no hormones or s/e

Risks:
Difficult
High failure ~24%

10

Behavioral Methods: Withdrawal

Benefits?

Risks/Disadv?

Benefits:
No hormones

Risks:
Difficult
High failure

11

Barrier methods action?

prevent sperm from contacting egg

12

Barrier Methods: Spermicides action?

Block entrance
Immobilized sperm

13

Barrier Methods: Spermicides

Use? (2)

Benefits? (3)

Risks/Disadv? (5)

10 min wait post insertion
leave in 8 hrs post intercourse

Benefits:
most W can use
convenient
easy to get/cheap

Risks:
easy to use wrong
irritation
Not for HIV+ W
↑ HIV/STDs
high fail

14

Barrier Methods: Sponges

Use? (4)

Benefits? (3)

Risks/Disadv? (4)

Use:
cover cervix
up to 24 hrs prior to action
leave in 6 hrs post
max placement 30 hrs

Benefits:
most W can use
immediate use
easy to get/cheap

Risks:
can break apart
sulfite allergy
toxic shock
high fail

15

Barrier Methods: Male Condom

Benefits? (5)

Risks/Disadv? (3)

Benefits:
most effective barrier method w/ correct use,
convenient,
best STI protection (o/t abstinence),
easy to get/cheap

Risks:
↓ sensation
irritation
(P) breakage

16

Barrier Methods:Female Condom

Benefits? (2)

Risks/Disadv? (3)

Benefits:
some STI protection
easy to get/cheap

Risks:
slippage
↓ sensation
irritation

17

Barrier Methods: Diaphragms/Caps

Use? (5)

Benefits? (3)

Risks/Disadv? (6)

Use:
Must be fitted
covers cervix
use w/ spermicide
leave in 6 hrs post
max placement 24 hrs (diaph), 48 hrs (cap)

Benefits:
immediate use
not felt
good for 2 yrs

Risks:
need pelvic exam
Rx only
BLADDER INFECTIONS
allergy/irrit
↑ toxic shock
high fail (esp caps)

18

Hormonal contraception action?

prevent ovulation

19

Hormonal Methods: Combined Oral Contraceptives Action? (6)

Estrogen (inhibit FSH)
Progesterone (inhibits LH)
Prevents ovulation
Thickens cervical mucus (barrier)
Alter endometrium (unreceptive)
DOES NOT interrupt already implanted egg

20

Hormonal Methods: COC Types? (3)

1) Monophasic (constant E2/Prog thru entire cycle)

2) Biphasic (2 prog doses -> ↑ 1/2 way thru cycle)

3) Triphasic (3 E2 doses -> ↑ thru cycle)

21

Hormonal Methods: COC start options? (3)

1) Quick Start (begin immediately but need 7 days of backup method)

2) Sunday Start (start 1st Sunday after 1st day of bleed)

3) First Day of Start

22

Hormonal Methods: COC use? (3)

Pregnancy may happen if? (3)

R/O pregnancy first
Take daily
Works best if same time ea day

start pills too late in cycle
miss >1 pill in a row
take in wrong order

23

Hormonal Methods: COC

Contraindicated for? (14)

1) ≥ 35 and smokes
2) Hx MI or embolic CVA
3) Hx heart valvulopathy
4) Hx uncontrolled HTN
5) Controlled HTN and smokes
6) Hx thromboembolism
7) Hx blood coagulopathy
8) Unexplained vag bleeding
9) Hx breast/uterine CA
10) Liver dz
11) DM assoc'd vascular conditions
12) Pregnant
13) Prolonged bedrest post surgery
14) Migraine HA w/ Aura

24

Hormonal Methods: COC

Benefits? (10)

Reg/short/lighter periods
↓ cramps
↓ PMS/depression
↓ ectopics
↓ ovarian cysts/ovarian CA
↓ acne
↓ bone loss
↓ body hair
↓ vag dryness/painful intercourse
Quick return of fertility

25

Hormonal Methods: COC

Risk/Disadv? (7)

Rx
Daily
Nausea, bloating, tender breasts
(P) spotting
No STI protection
↑ MI/Stroke/Clots esp if smoker
Meds ↓ effectiveness: TB abx, anti-seizure, anti-fung, HIV meds

26

Factors that ↑ VTE w/ oral contraceptive?

1) ≥ 35 and smokes
2) < 21 days postpartum
3) Prolonged bedrest post surgery
4) Hx of DVT or PE
5) Hereditary thrombophilia
6) IBD
7) Corticosteroids
8) SLE

27

Hormonal Methods: Extended Cycle OC use?

E2/Prog combo
91 day: 12 wks active pills, one wk inactive

28

Hormonal Methods: ECOC

Benefits?

Risk/Disadv?

Benefits:
same as COC
fewer periods

Risks:
same of COC
(P) unrealized pregnancy
(P) unplanned spotting

29

Hormonal Methods: Patch

Use?

Benefits?

Risk/Disadv? (4)

Use:
weekly for 3 wks, 1 wk off

Benefits:
same COC
easier compliance

Risks:
Rx and exam
Weight max = 190#
Irritation
↑ VTE than other COC (more E2)

30

Hormonal Methods: Ring

Action?

Use?

Action:
same as COC
E2/prog

Use:
in place 3 wks, out 1 wk,
loses effectiveness if out > 3hrs during "in" wks

31

Hormonal Methods: Ring

Benefits?

Risk/Disadv? (6)

Benefits:
convenient
no fitting necess
no spermicide necess

Risks:
same COC
Rx
VAGINAL D/C
Irritation
(P) felt during action
higher cost

32

Hormonal Methods: Progestin Only Pills

Action?

Use?

Action:
Less inhib of ovulation than COC
Thins endometrium
Thicken cervical mucus

Use:
MOST USED by breastfeeding
Continuous active pills (no placebo interval)
Do have to take at same time ea day

33

Hormonal Methods: POP

Benefits?

Risk/Disadv? (6)

Benefits:
E2 contraindication alternate
Safe for breastfeeding

Risks:
Menstrual ∆s
Depression
↓ libido
Acne
Breast tenderness
↑ follicular ovarian cysts

34

Hormonal Methods: Injections

Action?

Use?

Prevents ovulation
(P) thickening of cervical mucus

Use:
Q 3 monts (IM or SQ)
Preg test every time
Immediate protection if given during 1st 5 days of bleed

35

Hormonal Methods: Injections

Benefits? (5)

Risk/Disadv? (4)

Benefits:
VERY EFFECTIVE (better than tubal ligation),
No E2 so few s/e,
Safe in lactation,
PREVENTS endometrial CA (thins membrane),
Safer for >35yo, overweight, smokers w/ clot hx and high BP

Risks:
(P) spotting or amennorhea
↓ BMD
Weight gain
HA/dizzy/fatigue
Long lead time to returned fertility

36

Hormonal Methods: Implants

Action?

Benefits?

Progestin

Benefits:
MOST EFFECTIVE
lasts 3 yrs
rapid return to fertility

Risks:
same as injection
UNSCHEDULED bleeding

37

IUD: Copper

Action?

Imobilizes sperm in uterus
Prevents implantation by ∆ing uterine lining
Good for 10 yrs

38

IUD: Hormonal

Action?

Low progestin
Thickens mucus
Prevents implantation by ∆ing uterine lining
Good for 5 yrs

39

IUD insertion?

Complete H&P to r/o STIs and abnormalities
Insert at any time but heaviest day is best
MUST ensure not pregnant
Post delivery or abortion -> wait 4 wks

40

IUD Benefits?

Best for non-compliant pts
Works immediately
Remove any time
Not felt

41

IUD Risks/Disadv?

Cramping after placement
Spotting
Dysmennorhea
Menorrhaiga
Miscarriage
Punctured uterus