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Flashcards in Contraception Deck (113)
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1

Why use contraception?

Prevent unwanted pregnancies
Space pregnancies
Prevent pregnancy when it's dangerous or life-threatening to mother

2

Other Names for Emergency Contraception

Postcoital contraception
"Morning after pill"

3

Examples of Emergency Contraception

Plan B: levonorgestrel
Plan B One Step: levonorgestrel
Ella: ulipristal
Copper IUD

4

Oral Hormonal Emergency Contraception (Levonorgestrel)

No pregnancy test or exam
No medical contraindication
OTC
Effective up to 120 after event

5

SE of Levonorgestrel

N/V
Irregular bleeding the month after treatment
Dizziness
Fatigue
HA
Breast tenderness

6

Emergency Contraception that Requires Precautions or Some Contraindications

Ulipristal
IUD insertion

7

Levonorgestrel MOA

Inhibiting or delaying ovulation

8

Copper IUD MOA

Interfering with fertilization or tubal transport
Prevent implantation by altering endometrial receptivity

9

Counseling for Emergency Contraception

Obtain pregnancy test if no menses 3-4 weeks after EC
Discuss risk of pregnancy & STIs with unprotected sex
Encourage patient to start a regular contraception method OR review correct use of current one
EC is back up, not a primary contraceptive method

10

Considerations for Choosing a Contraceptive Method

Efficacy (failure rate)
Safety
SE
Convenience
Cost
Personal lifestyle & pattern of sexual activity
Reversibility

11

Goals for Educating Patients

Dispel misconceptions
Review SE & risks
Compare options to maximize choice appropriate to lifestyle & ability to use correctly
Educate proper use
Distinguish between contraception & protection for STIs
Encourage patients to talke about birth control issues with partner
Patient's personal needs change over time
Discuss EC with all patients

12

Categories of Contraception

Hormonal
IUD (IUC)
Barrier
Permanent

13

Options for Contraception Failure

Inappropriate use
Failure to use
Failure of method

14

Hormonal Methods of Contraception

Oral pills
Transdermal patch
Injections
Intrauterine devices
Subdermal implants
Intravaginal

15

MOA of OCP

Suppression of GnRH
Stabilizes endometrium to minimize breakthrough bleeding
Influence of progestin

16

Types of Suppression of GnRH

Inhibits the LH surge
Prevents ovulation
Suppresses FSH secretion
Prevents ovarian folliculogenesis

17

The Influence of Progestin in OCPs

Suppress LH secretion
Suppress ovulation
Thickens cervical mucus
Creates atrophic endometrium unfavorable to implantation
Impairs normal tubal motility/peristalsis

18

Advantages of Newer Progestins

Less effect on carb & lipid metabolism
More effective at reducing acne & hirsutism
Higher HDL/lower LDL
Higher sex hormone binding globulin (SHBG)
Greater affinity to progesterone binding sites
Reduced amenorrhea

19

Other Uses for OCP

Endometriosis: reduce pain
Treatment for acne or hirsutism
Treatment for heavy, painful or irregular menstrual periods
Reduce occurrence of recurrent ovarian cysts
PCOS
PMS/PMDD
Decreased risk of ovarian CA & colon CA
Decrease menstrual migraine

20

Reasons for High Dose Estrogen

Spotting or absence of withdrawal bleeding that can't be managed at lower doses
Dysfunctional uterine bleeding
Reduce recurrent ovarian cysts

21

OCP Preparation Types

Mono phasic
Multiphasic (biphasic or triphasic)
Extended cycle (withdrawal flow every 12 weeks)
Progestin-only pill

22

Choosing a Pill Formulation

Start with monophasic
Perimenopausal women: lower estradiol pill
Consider androgenic influence of progestin
Breastfeeding women: progesterone only pill

23

Education for Patients on OCP

When to start pill
Take at same time everyday
Miss 1 pill: take ASAP
Miss 2 pills: double up for 2 days
High risk if next cycle not started on time
Nausea in first days
Notify office if: severe/frequent HA, SOB, chest pain, or edema
Menses shorter, lighter, with less cramping

24

Contraceptive Patch

Change every 7 days for 3 weeks; then 1 week off
Delivers constant medication

25

Vaginal Ring

Delivers medication for 3 weeks intravaginally
Remove 1 week, then insert new one
Falls out: rinse with water & reinsert

26

Absolute Contraindications for Estrogen Contraception

Hx of thromboembolic event, stroke, or known thrombogenic mutation
Known CVD, cardiomyopathy, BP 160/100 or greater, complicated valvular HD
SLE with positive antibodies
Women 35+ who smoke
Migraines with aura
Women 35+ with migraines
Hx of cholestatic jaundice
Hepatic CA or benign adenoma
Active liver disease or severe cirrhosis
Breast CA
First 21 days postpartum
Undiagnosed abnormal uterine bleeding

27

Careful Consideration prior to Estrogen Contraception

HTN
Anticonvulsant therapy
Migraines without aura
DM
Hx of bariatric surgery with malabsorptive procedure
Psychotic depression
Ulcerative colitis
Obese

28

Hormone Contraceptive SE

Nausea/bloating
Breast tenderness
Spotting/break through bleeding
Amenorrhea
Fatigue
Headache
Depression/moodiness
Decreased libido

29

Early SE of Hormone Contraceptives

Bloating
Nausea
Breast tenderness
Mood changes

30

Most Common SE of Hormone Contraception

Breakthrough bleeding