Women's Health- Contraception

Question 1

what are the two methods of contraception?

Answer 1

1: Preventing the sperm and egg from uniting
a: Preventing ovulation ( BCP)
b: Creating a barrier ( condom)

2: Prevention of implantation and growth of the embryo.

Question 2

what factors affect choosing contraception?

Answer 2

1: Efficiency
2. Safety
3. Availability
4. Cost
5. Protection against STD
6. Age
7. Religious
8. Desire for Future Fertility
9. Side Effects
10. Co-existing medical conditions

Question 3

what affect does efficacy have on contraception choices?

Answer 3

a: perfect use failure rate: Number of conceptions that occur when the individual uses the method consistently and correctly (perfectly) for one year.

B. Typical Use Failure Rate – The number of conceptions that occur when the individual routinely uses a method in an inconsistent or incorrect manner.

Question 4

what what is Natural Family Planning

Answer 4

Calendar Method – Avoid having unprotected vaginal intercourse during the most fertile period of a woman’s cycle. (Fertile period begins 3 – 5 days prior to ovulation and ends the day after ovulation.)

Question 5

how do you mark out natural family planning?

Answer 5

Method – Monitor menses for 6 – 12 months.

Earliest fertile day = Shortest Menstrual Cycle – 18 days

Latest fertile day = Longest Menstrual Cycle – 11 days

Short MC = 26 days - 18= 8
Longest= 31-11=20

this means you can not have sex from days 8-20

Question 6

what are the failure rates of Natural Family Planning

Answer 6

Failure Rate –Perfect Use: 4%; Typical Use: 25%

Question 7

what are the pros and cons of natural family planning?

Answer 7

. Pros – Does not require any prescription or device, inexpensive

Cons – 1 in 4 couples will get pregnant during the course of a year;
Must have REGULAR cycles;
Does not prevent against STD’s;
Some couples find the time and attention needed to be successful too bothersome;
can have an abnormal cycle which puts a couple at increased risk for pregnancy

Question 8

what is the Withdrawal method?

Answer 8

AKA coitus interruptus – Male partner withdraws his penis completely outside the vagina before ejaculation

Question 9

what is the proper method of the withdraw method?
a:
b:

Answer 9

a. Wipe off any preejaculatory penile discharge prior to inserting penis into vagina.
b. Use a coital position that will allow the male partner to withdraw easily.

Question 10

what is the failure rates of the withdrawal method?

Answer 10

Failure Rate – Perfect Use: 4%; Typical Use: 27%

Question 11

what are the pros and cons of the with drawl method?

Answer 11

pros: – Does not require any prescription or device, inexpensive

Cons – 1 in 4 couples will get pregnant during the course of a year; Requires the male partner to be aware when ejaculation will occur; Does not prevent against STD’s

Question 12

what is the Symptothermic Method

Answer 12

Utilization of the changes in basal body temperatures and cervical mucous to detect ovulation

Question 13

what is the proper method of using the Symptothermic Method

Answer 13

.Proper Method – Abstain from intercourse from the start of menses until a suitable period after ovulation occurs.

a. Basal Body temperature – A rise in BBT of 0.5 – 1 degreeF indicates ovulation: Then wait 2 – 3 days.
b. Cervical Mucous Changes – Thin, stretchy clear cervical mucous indicates ovulation: Then wait 4 – 5 days until the milky, opaque mucous returns

Question 14

what is the failure rate of the Symptothermic method?

Answer 14

Perfect Use: 2%; Typical Use: 20%

Question 15

what are the pros and cons of the Symptothermic method?

Answer 15

Pros - Does not require any prescription, only a thermometer; inexpensive

4. Cons - Does not prevent against STD’s;
   Some couples find the time and attention needed to be successful too bothersome;
   Patient needs to be aware of normal cervical mucous changes and feel comfortable examining them;
   Having intercourse prior to ovulation will change the mucous and make it difficult to determine ovulation

Question 16

Barrier Methods

Answer 16

Barrier Methods

Question 17

what are Spermicides?

Answer 17

Almost all available contain nonoxynol-9 (N-9) which damages the sperm cell membrane.

Question 18

what forms of spermicides are avb?

Answer 18

a. foam
b. gel
c. jelly
d. bioadhesive gel
e. suppositories
f. Vaginal Contraceptive film
g. Foaming tablets

Question 19

what is the failure rate of spermicides

Answer 19

Perfect Use: 18%; Typical Use: 29%

Question 20

what are the pros and cons of spermicides?

Answer 20

Pros – If pregnancy occurs it is not affected by it; easy to buy OTC

Cons – May cause vaginal burning sensation or irritation; N-9 may increase risk of HIV transmission and other STD’s (messes with the barrier of body wall)

Question 21

Male Condom
what is it:

forms available:
a:
b:
c:
d:

Answer 21

Barriers worn over the penis to prevent semen and STD’s from coming into contact with a partner’s orifice.

1. Forms available:
   a. latex
   b. polyurethane
   c. natural animal membrane
   d. with or without spermicide

Question 22

what is the failure rate of male condoms?

Answer 22

failure rate (without spermicide) –
 Perfect Use:  2%;  Typical Use: 15%

Question 23

what are the Pros and cons of male condoms?

Answer 23

Pros – Decrease risk of STD’s; offered for free at some public health clinics; does not require office visit; allows men to take some responsibility

Cons – Must be used at every act of intercourse; can break, tear, or slip off; may cause an allergic reaction to latex; Over time may become expensive; may decrease penile sensation; Need to protect from heat; have a shelf life

Question 24

Female Condom

what is it:

Answer 24

Female Condom – Female initiated barrier device for contraception and STD protection

Polyurethane sheath with a flexible ring at each end of the sheath. The condom is prelubricated with a silicone-based, nonspermicidal lubricant to facilitate insertion

Question 25

what is the failure rate of female condoms?

Answer 25

Perfect Use: 5%; Typical Use: 21%

Question 26

what are the pros and cons of female condoms?

Answer 26

3. Pros – Helps prevent against STD’s; non-latex; can be inserted up to 8 hours prior to intercourse; may use choice of lubricants; stays in place even after the man loses his erection Cons – May be difficult for the female to insert; movement in the vagina during intercourse can be noisy; Can NOT be used with a male condom; outer ring may slip into the vagina during intercourse; rings may cause irritation

Question 27

what is a Diaphragm ? what is it MOA?

Answer 27

A latex rubber or silicone device designed to fit over the cervix and keep spermicide in close contact with the cervical mucous. Mechanism of Action – Acts as a barrier to sperm and the spermicide acts as a vaginal microbicide to kill sperm.

Question 28

what is a diaphragms failure rate?

Answer 28

Perfect Use: 6%; Typical Use – 16%

Question 29

what are the pros and cons of diaphragms?

Answer 29

Pros – Is a reusable product; may place prior to intercourse Cons – Requires an office visit to determine sizing; Does not protect against STD’s; Increased risk of UTI’s; Rubber diaphragms need to be replaced every 2 years, may cause allergy, or absorb odors; Requires resizing of the diaphragm if a patient has had a 10 pound weight change, been using it for a year, or had a pregnancy or an abortion; Must stay in the vagina for at least 6 hours after ejaculation, but not more than 24 hours; Requires patient to feel comfortable touching vulva and vagina

Question 30

what is a Cervical Cap | what is its MOA?

Answer 30

Similar device to the diaphragm, but smaller size and less compression of the bladder decreases the incidence of UTI’s. Mechanism of Action – Acts as a barrier to sperm and the spermicide acts as a vaginal microbicide to kill sperm.

Question 31

what are the failure rates of cervical caps? Nulliparous Parois

Answer 31

``` Nulliparous = Perfect Use: 9%; Typical Use – 16% Parous = Perfect Use: 26%; Typical Use – 32% ```

Question 32

what are the pros and cons of cervical caps?

Answer 32

. Pros – It is easy to carry around; may be inserted up to six hours prior to intercourse; no hormones; and not usually felt by the partner Cons – Can be difficult for a woman to insert; may be pushed out of place during intercourse; can not be used during menses; requires spermicide which may cause vaginal irritation; needs to be kept in place for 6 hours after intercourse, but not more than 48 hours; may cause discomfort for male or female; Requires patient to feel comfortable touching vulva and vagina

Question 33

what is the Sponge: | MOA:

Answer 33

The Sponge – A soft, round foam device containing spermicide that is inserted deep into the vagina to prevent pregnancy. A nylon loop is on the bottom for removal. Mechanism of Action – The sponge prevents pregnancy by preventing a sperm from meeting with an egg. This occurs by blocking the cervix and preventing entry into the uterus, and by the continual release of a spermicide which damages the sperm cell membrane.

Question 34

what is the failure rate of a sponge? Nulliparous: Parous:

Answer 34

``` Nulliparous = Perfect Use: 9%; Typical Use – 16% Parous = Perfect Use: 20%; Typical Use – 32% ```

Question 35

what are the pros and cons of sponges?

Answer 35

3. Pros – It can be inserted hours ahead of time; Intercourse may be performed multiple times during the first 24 hours without having to reinsert or reapply; it does not require a prescription or a visit to a physician Cons – It may cause vaginal irritation and therefore increase risk of HIV or STD transmission; It may make intercourse too messy or dry; It may break into pieces; Expensive – costs $9 – $15 for a package of three; Must be worn for at least 6 hours after the last intercourse; Requires patient to feel comfortable touching vulva and vagina; Can increase risk of TSS therefore should not be used during any form of vaginal bleeding, following childbirth, abortion, or miscarriage, or with a pelvic infection

Question 36

III. Hormonal Contraception

Answer 36

III. Hormonal Contraception

Question 37

Combined Oral Contraceptives

Answer 37

AKA Birth control pills. Various combinations of estrogen and progesterone designed to prevent pregnancy. 1. Method of Action – a) Inhibits ovulation- Progesterone inhibits LH b) Thickens cervical mucous-Estrogen supresses FSH c) Atrophies endometrium- Progesterone thins.

Question 38

what is the role of estrogen?

Answer 38

Estrogen keeps the endometrial wall intact to prevent break through bleeding It also suppresses FSH- follicle can't grow

Question 39

what is progesterones role?

Answer 39

It thins the endometrial lining, | inhibits the LH surge

Question 40

what is a mono phasic v a triphasic?

Answer 40

mono: same hormone through out the mo triphasic: three hormones through out the mo

Question 41

what is the failure rate of COC?

Answer 41

Perfect Use: 0.3%; Typical Use – 8%

Question 42

what are the pros of COC?

Answer 42

Regulate menses; shortens and lightens menses; decreases dysmenorrhea; many options to choose from; easily reversible; decreased risk of endometrial and ovarian cancer; decreases acne; decreased risk of ovarian cysts; no effect on breast cancer

Question 43

what are the cons of COC?

Answer 43

Increases risk of blood clot; Increased metabolism with certain anti-infectives and anti-convulsants; irregular bleeding; nausea and vomiting; need to remember to take pill at same time daily; can not use during breast feeding; may increase migraines; almost all contain lactose.

Question 44

progesterone only pills define MOA

Answer 44

Contains only progesterone at a lower dose than the combined oral contraceptive pills Method of Action – Prevents conception by creating thick, hostile cervical mucous and by thinning the endometrium

Question 45

what is the failure rate of progesterone only pills

Answer 45

same as COC erfect Use: 0.3%; Typical Use – 8%

Question 46

what are the pros of progesterone only pills

Answer 46

utilized when estrogen is contraindicated (patients with a history or risk of thromboembolic disease, systemic lupus erythematosus with or without vascular disease, cigarette smoking in women over 35, breastfeeding, or migraines from combined OCP’s);

Question 47

what are the cons of progesterone only pills?

Answer 47

Must be taken at the same time every day; no placebo pills; causes irregular vaginal bleeding; increased risk of ovarian cyst formation; smaller progesterone dose susceptible to increased liver metabolism by certain anticonvulsants and antiinfectives; does not protect against STD’s.

Question 48

``` Progesterone Injection – Depo Provera MOA a: b: c: ```

Answer 48

Methods of Action a. Inhibits ovulation b. Thickens cervical mucous c. Atrophy of the uterine lining to prevent the fertilized egg from implanting

Question 49

what is the failure rate of progesterone injections?

Answer 49

LOW! Perfect Use: 0.3%; Typical Use – 0.3%

Question 50

what are the pros of progesterone injections?

Answer 50

atient does not need to remember to take a daily medication; Can be used by women who cannot take estrogen or who require medication for seizures; Reduces menstrual cramps and anemia; Helps prevent endometrial cancer; treatment for endometriosis

Question 51

what are the cons of progesterone injections?

Answer 51

equires repeat injection every 3 months; Irregular bleeding; Increased appetite and weight gain (a lot!); Depression; Bone loss; It is not possible to stop the side effects until the shot wears off; does not protect against STD’s and may increase risk of HIV transmission

Question 52

Progesterone Implant what is it MOA?

Answer 52

Nexplanon (Implanon) – A thin, flexible implant about the size of a cardboard matchstick. It is inserted under the skin of the upper arm. It protects against pregnancy for up to 3 years. 1. Method of Action – Nexplanon releases a progestin which may inhibit ovulation, Thickens cervical mucous, and thins the endometrial lining to prevent implantation of a fertilized egg.

Question 53

what are the failure rates of progesterone implants?

Answer 53

Perfect Use: <1 %

Question 54

what are the pros of progesterone implants?

Answer 54

It gives continuous long lasting birth control without have to remember to take a pill, insert something prior to intercourse, or return for frequent office visits; fertility returns quickly after removal of the rod; it can be used by women who are unable to take estrogen or are breastfeeding; outer membrane appears to react less with surrounding tissue creating a lower risk (than Norplant) for fibrosis

Question 55

what are the cons of progesterone implants?

Answer 55

Requires an appointment with a health care provider for placement and removal; Removal requires a small incision; may cause discoloration or scarring at the site; Very common to have irregular bleeding or spotting; May stop bleeding altogether; Menses may become longer and heavier; Does not protect against STD’s

Question 56

Nuvaring what is it MOA?

Answer 56

Combination estrogen and progesterone flexible vaginal ring that releases 15 mg of ethinyl estradiol and 0.120 mg of etonogestrel per day. Ring is worn for 3 weeks, removed for one week during which time withdrawl bleeding occurs. 1. Method of Action - Same as for combination OCP’s

Question 57

what are the failure rates of nuva ring?

Answer 57

Perfect Use: 0.3%; Typical Use – 8%

Question 58

what are the pros of nuva ring?

Answer 58

– Easy to use; only needs to be placed once a month; causes less GI disturbance than oral medications; recommended it is worn during intercourse, however may be removed for up to 3 hours without loss of efficacy;

Question 59

what are the cons of nuva ring?

Answer 59

. Cons – Patient must be comfortable touching vulva and vagina; vaginal discharge; foreign body sensation in vagina; may be expelled from vagina without patient awareness; irregular bleeding, breast tenderness, nausea; does not protect against STD’s

Question 60

what are Ortho Evra? | what is its MOA?

Answer 60

4. 5 cm square transdermal patch that delivers 20 mcg of ethinyl estradiol and 0.150 mg of norelgestromin (the active metabolite of norgestimate) daily 1. Method of Action – same as for combination OCP’s

Question 61

what is the failure rate of Ortho Evra?

Answer 61

Perfect Use: 0.3%; Typical Use – 8%

Question 62

what are the pros for Ortho Evra?

Answer 62

Pros – It is a visual reminder that the patient is using birth control; Only needs to be placed once a week; Does not require insertion before intercourse; Results in less fluctuation in hormone levels than with daily medication

Question 63

what are the cons of Ortho Evra?

Answer 63

Less effective in women weighing over 198 pounds; The manufacturer states: "You will be exposed to about 60% more estrogen if you use ORTHO EVRA than if you use a typical birth control pill containing 35 micrograms of estrogen."; application site reactions; Does not protect against STD’s

Question 64

Intrauterine Devices

Answer 64

Intrauterine Devices

Question 65

Mirena what is it whats it MOA?

Answer 65

T-shaped polyethelene vertical stem containing 52 mg of levonorgestrel with a loop at the end of the stem attached to 2 monofilament threads to assist with removal. 1. Method of Action – Has not been conclusively determined. Believed that primary method is prevention of fertilization. Releases 10 mcg of levonorgestrel daily; thickens cervical mucous; inhibits implantation

Question 66

what is Mirenas failure rate?

Answer 66

LOW!! Perfect Use: 0.1%; Typical Use – 0.1%

Question 67

What are the pros of mirena what are the cons?

Answer 67

. Pros – Good for 5 years; Decreases menstrual flow; can be used by those who can’t take estrogen; decreases risk of endometrial cancer Cons – 5% chance of IUD expulsion; uterine perforation; inability to detect IUD threads; If pregnancy occurs is more likely to be ectopic; can cause cramping and irregular bleeding; transient increased risk of PID

Question 68

Skyla

Answer 68

T shaped poyethylene frame compounded barium sulfate to make it radioopaque. A steroid reservoir containing 13.5 mg levonorgestrel is around the vertical stem. A pure silver ring located at the top makes it seen on ultrasound. The size is 28 mm in width and 30 mm in length. The average in vivo release rate is approximately 6 mcg/day over the 3 years. (14 mcg after 24 days, 10 mcg after 60 days down to 5 mcg at 3 years. )

Question 69

Paragard what is it MOA

Answer 69

T-shaped polyethylene IUD with 68.7 mg copper sleeve on each end of its transverse arms and 176 mg of copper wire around its vertical axis. 1. Method of Action – Primary method is prevention of fertilization. Alters normal uterine contractions that may lead to decreased sperm transport; Inhibits implantation by creating an inflammatory response with production of a cytotoxic endometrial cytokine.

Question 70

what are the pros and cons of Paragaurd?

Answer 70

Pros – Efficacious for 10 years; no hormones; can be placed for emergency contraception Prolonged menses and 50% increase in the amount of menstrual blood loss; 5% incidence of spontaneous IUD expulsion; possible uterine perforation on IUD insertion; failure to detect IUD strings; Can not use if allergic to copper; cramping

Question 71

Postcoital Contraception what is it whats the MOA?

Answer 71

(AKA Emergency Contraception) – designed to prevent conception after unprotected intercourse or after failure of another method. Three options available Combined OCP’s, POP’s, or insertion of a copper containing IUD. Method of Action – OCP’s and POP’s - Block ovulation, thickens cervical mucous, and prevention of implantation; IUD – prevents implantation

Question 72

what is the failure rates of postcoital contraception?

Answer 72

Plan B: 11%; OCP’s: 25%; IUD: 1%

Question 73

what are the pros and cons of postcoital contraceptions?

Answer 73

Pros – Available for birth control failures or rape victims Cons – Related to form used: Nausea and vomiting; need to acquire from health care provider or pharmacy;

Question 74

Sterilization

Answer 74

Sterilization

Question 75

``` Male – Vasectomy what is it MOA: a: b: c: ```

Answer 75

A simple, safe office procedure with few failures for someone desiring permanent sterilization. Methods a) traditional b) No-scalpel c) surgical clips

Question 76

what is the failure rate of male vasectomy?

Answer 76

Perfect Use: 0.10%; Typical Use – 0.15%

Question 77

what are the pros and cons of male vasectomy?

Answer 77

Pros – Quick recovery period; few complications; male initiated contraception; does not interfere with libido Cons – Considered permanent (for those patients who have a change in partner options are available); side effects include bleeding or hematoma formation, incisional infections, epididymitis or orchitis; sperm granuloma; requires follow up semen analysis to demonstrate azoospermia

Question 78

Female Tubal Ligation: what is it MOA:

Answer 78

Tubal Ligation – surgical procedure to close tubes so that sperm and eggs cannot meet. Methods (5 year failure rate: 10 year failure rate) a) Bipolar Coagulation – (1.65%: 2.48%) b) Unipolar Coagulation – (0.2%: 0.75%) c) Silicone rubber band application – (1%: 1.77%) d) Spring clip application - (3.2%: 3.7%) e) Interval Partial Salpingectomy - (1.5%: 2.0%) f) Intrapartum and Postpartum Sterilization –(0.6%: 0.75%)

Question 79

Transcervical sterilization

Answer 79

Hysteroscopic procedure placing microinserts into the fallopian tube causing occlusion of the tubes over the following 3 months Methods - <1% failure rate a) Essure b) Adiana (no longer available)

Question 80

what are the pros and cons of transcervical sterilization?

Answer 80

1. Pros – Permanent protection against pregnancy; no lasting side effects; does not affect sexual pleasure or libido 2. Cons – Surgical procedure with associated risks (Bleeding, infection, scarring, death); mild to moderate pain; reaction to the anesthesia; requires time off for procedure and recovery; there are methods to reverse procedure, but the success rates are low