Reproductive problems, infertility, contraception, abortion

Compare and contrast existing contraceptive methods, including the mechanism of action, advantages and disadvantages, effectiveness, safety issues, and nursing education/implications. (CO 1-4) Explain the etiology, pathophysiology, clinical manifestations, screenings, and management of problems related to common reproductive health issues across the lifespan including infertility, abortion, disorders related to the menstrual cycle, sexually transmitted infections, common breast conditions, etc. (CO 1-4)

surgical sterilization

MOA: permanent contraception

!! tubal → immediate vasectomy → takes 3 months

hormonal IUD

!! contains progesterone → less bleeding

MOA: inhibits ovulation, thickens cervical mucus, creates a thin/unfavorable uterine lining

copper IUD

!! no hormones → heavier, more painful periods

MOA: dec sperm motility, produces inflammation within the uterus that makes implantation difficult

nexplanon (implant)

!! progesterone

MOA: prevents the LH surge → prevents ovulation

3 years

can migrate

depo-provera (shot)

injectable progesterone

MOA: prevents LH surge → no ovulation

every 12 weeks

!! bone demineralization after 2 years of consecutive use

progesterone-only pill

no estrogen

low dose progesterone

irregular bleeding

no placebo

VERY unforgiving

combined pill

estrogen + progesterone

better period control

ESTROGEN INC CLOTTING RISK

can dry up milk supply

xulane (patch)

estrogen + progesterone

1 patch/week x 3 weeks → no patch week 4

HIGHEST estrogen content of the combined methods → clotting risk!

no more than 198lbs

nuvaring/annovera

estrogen + progesterone

insert x 3 weeks → remove x 1 week → new ring

diaphragm

barrier + spermicide

requires fitting

leave in place 6 hrs after intervourse

male condom

NO oil based lubricant

STI protection

female condom

nitrile version can be inserted up to 8 hrs before intercourse

DO NOT use w male condom

sponge

spermicide + barrier

OTC

not very effective if the pt has previously given birth

must be placed 15 mins before sex

N-9 can disrupt tissue integrity and inc the risk of HIV

spermicides/phexxi

nonoxynol-9 : kills sperm directly

phexxi makes vaginal pH very acidic → sperm cant move effectively

intercourse must occur within 1 hr

withdrawal

!! pre-ejaculatory fluid can contain sperm

fertility awareness

track the menstrual cycle to determine when ovulation is likely and avoid intercourse during the fertile period

female infertility assessment

• anatomy eval

• detection of ovulation

• hormone analysis

• ultrasound

• endometrial biopsy

• hysterosalpingography

• laparoscopy

male infertility assessment

• semen analysis

• hormone analysis

• scrotal ultrasound

abortion

purposeful interruption of pregnancy before 20 weeks

elective → chooses without a medical indication

therapeutic → performed for a medical reason

surgical (aspiration) abortion

• aspiration

• may also involve d&c

  • dilation and curettage

• 1st tri

medical abortion

methotrexate + misoprostol (less likely combo)

mifepristone + misoprostol (opens cervix and induce contraction)

1st tri

2nd tri abortions

• dilation and evacuation of the cervix (D&E)

• cervical preparation with prostaglandins (to dilate)

• emotional considerations

• SEPSIS RISK

primary amenorrhea

absense of menarche with secondary sex characteristics present after age 13 OR no menarche by age 15

secondary amenorrhea

periods started and then stop

most common cause: pregnancy

hypogonadotropic amenorrhea

problem involving the hypothalamic-pituitary axis → hypothalamic suppression

management: excersize and weight loss, Ca, vit D, K

primary dysmenorrhea

pain during or shortly before menstruation

patho: inc prostaglandins → inc uterine activity → pain

management: heat, meds, alternative modalities

secondary dysmenorrhea

acquired menstrual pain caused by pelvic patho

PMS

occurs during luteal phase

treatment: diet, exercise, herbal therapies, yoga, massages

PMDD

PMS but much more severe mood symptoms

occurs during the last 7-10 days of the menstrual cycle

treatment: counseling, meds, hypnosis, acupuncture

endometriosis

patho: endometiral tissue grows outside the uterus

CM: dysmenorrhea, deep pelvic dyspareunia + painful intercourse

TM: drugs, surgery

fibrocystic changes

• multiple lumps

• nodular

• palpable

• movable

• round, smooth

• firm or soft

• ternderness influenced by emnstrual cycle

• bilateral

• may or may not have nipple discharge (changes occur w/ changes in menstrual cycle)