Family Planning Flashcards
(34 cards)
Abstinence
o Cost- zero
o Advantages – inexpensive, intimacy
o Disadvantages – not followed
Coitus interuptus
o Cost – zero
o Failure rate – Typical 27%, Perfect 4%
o Advantages – free, no side effects, no chemicals, backup for any other method
o Disadvantages – decrease pleasure, pregnancy and no protection for STD/HIV
Male condoms
o Cost – $0.5-1
o Failure rate – Typical %6-30, Perfect %2
o Advantages – inexpensive, accessible, hygienic, STD/HIV prevention, sperm allergies, erectile enhancement
o Disadvantages – latex allergy, decrease sensation, interrupt erection, breakage
o SE – irritation to spermicide, latex
o CI – latex allergy
• Yeast, BV, and oil based products breakdown condom integrity
• Sheepskin more mpermeable to HIV/STDs but equally effective in preventing pregnancy
Female condoms
o Cost – $2.50-3
o Failure rate – Typical 21%, Perfect 5%
o Advantages – no allergy, accessible, packaged with lube
o Disadvantages – need to learn correct insertion, cost
o SE – none
o CI – allergy to polyurethrane
• Can be placed 8 hours before intercourse
Diaphragm
o Cost – $25-30
o Failure rate – Typical 16%, Perfect 6%
o Advantages – good for 3 years, can use w/ condoms, no hormones, decrease cervical neoplasia
o Disadvantages – increase UTI, BV, VVC, decrease spontaneity, TSS
o SE – none
o CI – allergy to latex, rubber, spermicide, abnormal anatomy, inability to insert and remove, Hx of TSS or recurrent UTIs
• Insert 6 hours b4 sex, leave in 6 hrs post sex
• Refit for weight change >10lbs, post partum, post abortion or SAB
Cervical cap
o Cost – $24-30
o Failure rate – N: Typical 20%, Perfect 9% M: Typical 40%, Perfect 26%
o Advantages – use w/ condoms, no hormones, long term
o Disadvantages – TSS, increased BV, VVC, decrease spontaneity, abnormal paps, only few sizes
o SE – none
o CI – latex, rubber, spermicide allergy, hx abnormal pap, cervical infection, vaginal bleeding (inc menses)
• Must leave in place for 6 hrs post sex, up to 48 hours
Spermicide
o Cost – $12/canister or tube, suppositories or sheets more exp
o Failure rate – Typical %21-40, Perfect %4
o Advantages – good back up method, accessible, OTV, inexpensive, STD/HIV protection, lubrication
o Disadvantages – irritation, increase VVC, must use w/I time frame, messy
o SE – irritation
o CI –allergy, sensitivity, inability to insert, abnormal anatomy
• Foam – alone or w/ condom or diaphragm, effective 1 hour after insertion
• Creams/gels – alone, diaphragm, cap, condom, effective 1 hour after insertion
• Suppositories – alone or w/ condom, wait 15 min before sex, effective 1 hour, posterior vagina
• Film – wait 15 min b4 sex, one hour effective, dry fingers to insert into posterior vagina
Progesterone Only
inhibits ovulation, increases cervical mucus, premature luteolysis gets rid of corpus luteum, atrophic endometrium so egg cant implant
o Advantages – no estrogen side effects, decrease menses, amenorrhea, decrease anemia, ok in lactatin mothers, decreases PID, endometriosis, ovarian ca, okay when estrogen CI (hx dvts, >35, smoker, inactive, overweight
o Disadvantages – irregular menses, amenorrhea, weight gain, breast tenderness, mood changes, HA, same time daily
Depo-Provera
o Cost – $35-50/injection
o Failure rate – Typical/Perfect 0.3%
o Advantages – easy, immediate efficacy, post partum, spontaneity, amenorrhea
o Disadvantages – weight gain, decreased bone density, not immediately reversible, apt q3 mo, increase in breast ca, menstrual changes
o SE – menstrual changes, HA, weight gain
o CI – suspected pregnancy, undiagnosed irregular vaginal bleeding, contemplating pregnancy, concern for weight/mood changes
• Given within first 5 days of mesnies, repeat q12w, 150mg IM
• Black label warning after 2 years – bone density → Ca+vitD daily
• Can take 12-18 months to get out of system – not good if want pregnancy soon
Progesterone only pills
- Progesterone only pills
o Cost – $25
o Failure rate – Typical %5, Perfect %0.5
o Advantages – immediately reversible, no weight gain, amenorrhea (maybe after a year)
o Disadvantages – irregular bleeding, ovarian cysts, ectopic pregnancies
• One pill daily, no placebos, use backup for first month
• Can use w/ breast ca patients
Nexplanon
o Cost – $400-800/insertion, $75-100 removal
o Failure rate – Typical/perfect % 0.5
o Advantages – 3 years, no estrogen, breast feeding ok, immediately reversible, amenorrhea 2%
o Disadvantages – irregular bleeding 6-12mo, cost, pain/scarring at insertion site, small weight gain, HA, acne, ovarian cysts, mood changes
o SE – N, breast tenderness, bloating, decreased libido
o CI – pregnancy, allergy to etonogestrel, breast cancer, liver tumors, undiagnosed vaginal bleeding, severe liver dx, NOT before 6 wk postpartum
• No age restriction
• Local anesthetic to inner upper arm between bicep and tricep, insertion into subdermal tissue w/ needle like applicator, bandage for 24hrs, removal after 3 years w/ small incision and forceps
- IUD
o Cost – $200/IUD, $200-300/insertion
o Types – copper v progesterone vs. levonorgestrel
o Mechanism of action – immobilizes sperm, interferes with migration, speeds ovum transport, endometrial effects
o Advantages – safe, highly effective, Rx ashermans (increased scarring in uterine lining which thins)
o Disadvantages – PID, dysmenorrhea, menorrhagia, expulsion, pregnancy complications, uterine rupture
o SE –
o CI – multiple partners, hx PID, ectopic endometriosis, post abortion sepsis, pregnancy, anatomical abnormalities, heart/valve dx
- Copper IUD
– Copper T 380A Paraguard – copper T w/ single filament string
o Failure rate – Typical 0.8%, Perfect 0.6%
o Efficacy 10 years
o Advantage – long term, immediately reversible
- Levonorgestrel 20mg – Mirena– releases 20mcg levo daily
– releases 20mcg levo daily
o Failure rate – Typical/Perfect 0.1%
o Efficacy 5 years
o Advantages – decrease flow and pain, ease of use, amenorrhea
o Disadvantages – increase ectopic, PID, perforation, sepsis
• Good w/ transitioning into menopause and need bleeding control
- Levonogestrel 13.5mg – Skyla – releases 13.5mcg levo daily
- Levonogestrel 13.5mg – Skyla – releases 13.5mcg levo daily
o Failure: Typical/perfect 0.1%
o Efficacy 3 years
o Adv/disadv same as mirena
- Combined estrogen/progesterol products –
- Combined estrogen/progesterol products – screen out if smoker +35, CV risk, bleeding, migraines w/ aura, diabetes, liver, smoke
Combined oral contraceptives
o Cost – $24-30
o Failure rate – Typical %5, Perfect 0.1%
o Advantages – safe, effective, cycle control, dysmenorrhea, ovarian cysts, acne, mittelschmerz (painful ovulation), PID, anemia, reversible, prevents ovarian and endometrial ca, BMD, lipid profile, PMDD
o Disadvantages – expensive, daily, BTB, glucose intolerance, gall bladder dx
o SE – BTB, N, V, HA, breast tenderness, mood changes
o CI – pregnancy, undx irregular bleeding, vag bleeding, breast ca, >1ppd, >35 and smoker, hx PE, CVD, thrombophlebitis, CVA, liver dx, >50yo
o Inhibits ovulation, decrease ovum transport, early lutelysis, thickens cervical mucus, alters capacitation, alters endometrium
o Complications – thrombophlebitis, PE, CVD, cancer, hepatocellular adenoma
o Drug to drug: rifampin, vit C, anticonvulsants, antibiotics
Combined oral contraceptives- types
Types – monophasic (good for ovarian cysts), biphasic, triphasic (orthotricyclen good for acne)
• Seasonale, loestrin 24 – good for migraines – 4 menses/yr
Combined oral contraceptives- Education
Education – first day or Sunday start
• Missed pills – miss one take 2 next day, miss 2, take 2 next 2 days, miss 3
• Fu 3-6 months at least w/ call
o BTB – 1st half of cycle, change estrogen, 2nd half, change progesterone
o ACHES – abd pain, chest pain, HA, eye visual changes, swelling
Combined injection– lunelle – medroxyprogesterone and estradiol cypionate
o Cost – $30-35
o Failure rate – Typical/Perfect 0-0.2%
o Advantages – immediate coverage, given q 28-33 days, as effective as pill, no daily pill, less BP elevation, return of ovulation in 2-4mo
o Disadvantages – monthly apt, monthly menses, pill SE
o SE – same as pill
Combined transdermal patch – Ortho evra – Norelgestomin/norgestimate 150ug and EE 20ug
Failure rate – 0.8%
o CI – >198lbs
• Apply 2 week for 3 weeks, off for 1 wk, constant serum concentration – abd, butt, uppoer outer arm, torso, not near breast – 1st day or Sunday start
• Blackbox – higher estrogen dose compared to pill – higher risk stroke, MI, DVT – ONLY in young, active, healthy ppl
Combined Vaginal Ring – nuvaring – etonogestrel 120ug, EE15ug, 2” flexible ring, in for 3 weeks, out for 1
o Failure rate – 0.7% o Advantages – no daily pill o Disadvantages – backup for 1st month o CI – poor vaginal tone/hx vaginal prolapse, chronic constipation • Insert between 1st and 5th day of LMP • If falls out, rinse and put back in
Emergency contraception
o Cost – $20-30
o Failure rate – 25%
o Advantages – effective, alternative to pregnancy and abortion, low cost, safe
o Disadvantages – failure, exposure to meds, N, V
o SE – N, V, breast tenderness, dizzy, abd pain
o CI – anyone where OCPs are contraindicated or if sex >72 hours ago, not for >35+smoker
• 1st dose w/I 72 hours sex, 2nd dose 12 hr later – cant take as one pill too – if N after 1st dose, retake
• Make sure not pregnant first
• Generally get period w/I 3 weeks of taking
- Mefeprestone - (mifeprestone/misoprostone) RU486 – progesterone receptor antagonist
o Failure rate – 8%
o SE – N, V, D, HAs
o CI – allergy to med, hemorrhagic d/o, adnexal mass, chronic adrenal failure, suspected ectopic, unk vag bleed
• 600 mifeprestone followed by 400mg misoprostol 2 days later
• f/u 14 days after 1st dose to confirm termination and evaluate bleeding
• Give w/I 49 days of LMP
