Family planning

Question 1

Medical eligibility criteria for birthcontrol

Answer 1

MEC provides guidance on the s
1. no restrictions
2. advantages generally outweight the theoretical or proven risks
3. Theroretical/proven risks outweigh benifits, not reccomended unless more appropriate methods are not available/acceptable
4. Unacceptable health risks

Question 2

Actions of Progestin and Estrogen

Answer 2

Progestin
* ovarian and pituitary inhibition
* thickening of cervical mucus
* endometrial atrophy/transformation (thins lining)
* Cycle control

Estrogen
* ovary and pituitary inhibition
* thinning of/increase in cervical mucous
* endometrial proloferation
* cycle control - allows for period

Question 3

Exams and tests prior to initiation of birth control

Answer 3

• LNG and Cu IUD: bimanual exam
• COC: Blood pressure
• Diaphram or cervical cap: bimanual exam
• if sexually active offer STI test via urine if no pelvic exam
• unnecessary tests can be a barrier to starting effective contraceptive

Question 4

How to be reasonably sure a women is not pregnant

Answer 4

No symptoms of preganacy and:
* <7 days after the statrt of normal menses
* no sexual encouters since LMP
* correctly and consistently using a reliable method of contraception
* <7 days after spontaneous abortion
* within 4 weeks postpartum
* fully or nearly fully breastfeeding, amenorrheic, and <6 months postpardum

For contraceptive methods other than IUDs the benifits of starting to use a contraceptive method likely exceeds any risk, even when healthcare provider is uncertain if the woman is pregnant

Question 5

BC start methods

Answer 5

• Sunday start: start coc, ring, patch on Sunday after menses begin, back up for 7 days
• 1st day of menses start: no back up needed
• Quick start: ascertain pt not pregnant by history, timing of menses. Start COC/patch/ring that day - use back up for 7 days
• Jump start: if unprotected sex since LMP - emergency contraceptive, start coc/ring/patch that day - back up for 7 days

Question 6

Emergency contraception options

Answer 6

copper IUD

emergency cotraceptive pills: Ella ulipristal acetate (UPA) as a single dose (Rx only), Plan B levonogestrel (LNG) 1-2 dose (OTC)
* similar effectiveness when taken within 3 days, UPA more effective if taken 3-5 days after
* common adverse effects: N/V, repeat dose. if vomit within 2 hours of dose.
* next menses occurs within 3 weeks, if menses delayed take pregnancy test

Question 7

Estrogen

Answer 7

too much:
* nausea, bloating, breast tenderness, increased BP, melasma, headache

Too Little
* early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea

Question 8

Progestin

Answer 8

too much
* Breast tenderness, headache, fatigue, changes in mood

Too little
* late breakthrough bleed

Question 9

androgen

Answer 9

too much
* increased appetite, weight gain, acne, oiy skin, hirsutism, decreased libido, increased breast size, breast tenderness, increased LDL, decreasedHDL

Question 10

MEC eligigibility criteria for COC/patch/ring
Cat 3

Answer 10

exercise caution: theoretical/proven risk usually outweigh benefit
* postpardum <21 days
* lactation 6wks-5 months
* Undiagnosed vaginal bleeding
* Age >35 and smoking <15 cigs/day
* interacting drugs phentoin, carbamazaine, valproate
* gallbladder dx
* DM1/2 >20yrs and or vascualr disease
* past hx of breast cancer <5 years ago
* HTN adequately controlled without vascular disease
* untreated HTN 140-159/90-99
* bariatric surgery for COC
* migraine without aura age >35
* rifampicin therapy

Question 11

MEC eligigibility criteria for COC/patch/ring
Cat 4

Answer 11

unnaceptable health risks
* VTE
* CHD, CVA
* Structural heart disease
* >35 and smoking >15cigs/day
* Breast cancer
* pregnancy
* lactation<6wks
* acute hepatitis
* hepatic adenoma
* migraine with aura
* risk for blood clot - prolonged imobilization
* known thrombotic mutations
* BP >160/>100
* vascualr disease