contracpetion - hormonal methods

with hormonal birth control if estrogen AND progesin are used what happens to fertility and the ovulation cycle + cervical mucus

fertility takes longer to return, disrupts ovulation and cervical mucus

what are the three types of estrogen/progestin hormonal contraceptives

combo pill, patch, vaginal ring

with hormonal birth control if ONLY progesin is used what happens to fertility and the ovulation cycle + cervical mucus

fertility returns quicker, cervical mucus thickens

what does the combo pill do

suppress ovulation and thicken cervical mucus

requires a rx, requires consistent use to be effective, must be taken in a specific order, are all patient education points for what hormonal birth control

combo pill

if one dose is missed of the combo pill what should the nurse educate the patient to do

take ASAP

if 2-3 doses of the combo pill are missed what should the nurse educate the patient to do

use alternative form of contraception

the combo pill has shown a reduced incidence of what 3 CAs

ovarian, colon, endometrial

when taking oral contraceptives what is the mnemonic that the nurse should teach the patient to report

ACHES

what does the A in ACHES stand for

abd pain

what does the C stand for in ACHES

chest pain/SOB

what does the H stand for in ACHES

HA

what does the E stand for in ACHES

eye problems

what does the S stand for in ACHES

severe leg pain

what is the advantage of the combo pill

low dose estrogen has other effects

decrease bleeding/anemia, regulate menstrual cycles, reduce dysmenorrhea, improves acne, decreases milk production are all effects of what from what contraceptive

lose dose estrogen; combo pill

what are the 5 disadvantages of the combo pill

no STI protection, increased risk of blood clots, increased risk of HTN, stroke, MI

what 3 things are contraindicated with the combo pill

smoking, hx of venous thromboembolism, >35

what is the mini pill

progestin only, thickens cervical mucus

take pill same time every day, don’t miss a pill, if D/V use backup method, backup needed for first month of use, fertility returns within 3 months are all teaching points for what hormonal birth control

mini pill

what are the two advantages to the mini pill

less AE then combo pill, safe while breastfeeding

what are the 3 disadvantages of the mini pill

less effective suppressing ovulation, no STI protection, AE

breakthough bleeding, irregular bleeding, breast tenderness, HA are all AE of the

mini pill

with the mini pill there is the risk that it is less effective when taken with what two meds

abx or anticonvulsants

what are the contradindications for the mini pill

bariatric surgery, liver tumors/cirrhosis, lupus

release continuous small amounts of estrogen and progestin to suppress ovulation and thicken cervical mucus is the MOA of the

transdermal patch

can be applied to the buttocks, abd, upper arm, upper torso is which birth control

transdermal patch

how often should the transdermal patch be replaced

once a week on the same day

the patch should be removed (and not replaced) every

4th week

no oils/lotions, don’t cut/alter shape, do not use more than one at a time are teaching points for what hormonal birth control

transdermal patch

if 2+ days late changing the transdermal patch what should the nurse educate the patient to do

use backup method for 7 days

the transdermal patch is more effective when the patient weighs

<198 lbs

if the transdermal patch fell off <24 hours then the patient can ___________ but if > 24 hours what should the nurse educate the patient to do

reapply; start new 4 week cycle

as effective as PO contraception, regulates menstrual cycles, avoids liver metabolism, safe in water, less risk of forgetting to take pill are all advantages of what hormonal contraceptive

transdermal patch

how soon after d/c the transdermal patch does fertility come back

1 month

what are the 3 disadvantages to the transdermal patch

requires rx, skin irritation, no STI protection

what is the rate of failure for the transdermal patch

9%

what are the two risks with the transdermal patch

less effective for >198 lbs, higher risk of VTE

a soft, flexible, vinyl ring releasing small amounts of estrogen and progestin continuously to prevent ovulation is called a

vaginal ring

can be stored in the fridge, no fitting required, can be inserted immediately after delivery of placenta, insert for 3 weeks, remove for one week, and breakthrough bleeding is all less common with what hormonal birth control

vaginal ring

how long after removing a vaginal ring does fertility come back

a couple weeks to 1 month

what are the three advantages to the vaginal ring

no fitting needed, not visible, less risk of forgetting a pill

what is the failure rate of the vaginal ring

9%

must remember to remove and reinsert, no STI protection, discomfort during intercourse, requires rx, same AE as PO contraception are all the disadvantages of the

vaginal ring

blood clots, HTN, stroke, MI, expulsion and vaginal prolapse are all risks with the

vaginal rings

what are 3 SE of the vaginal ring

breast tenderness, nausea, vaginitis

a chemical or hormonal active device which is inserted into the uterus, damages sperm, and prevents fertilization is the

IUD

inserted by the HCP, check strings monthly to confirm placement, sign consent form prior to insertion and the testing that will be done are all patient education points for what contraception

IUD

what 3 tests should be negative before inserting an IUD

pregnancy test, pap smear, cervical cultures

stays in place, can place anytime during cycle and immediately after a delivery, safe for breast feeding, reduced cramping/bleeding, immediate return of fertility are all advantages of the

IUD

the hormonal IUD is effective for

3-5 years

the copper IUD is effective for

10 years

no protection of STIs, increased cramping/bleeding 1st cycles are the disadvantages of the

IUD

if a person is already anemic which birth control is not usually recommended

IUD

menorrhagia, PID, ectopic pregnancy or sponatneous abortions, and perforation of uterus are all risks of the

IUD

what is contraindicated with an IUD

abnormal pap, hx of pelvic infections

what is the failure rate of the IUD

1%

what is the conctraceptive implant

progestin filled rod that is placed in the upper arm under a local anesthetic

requires minor surgical office procedure, effective within 24 hours of insertion, increased risk of ectopic pregnancy, fertility returned once removed, avoid trauma to area of insertion, can be inserted immediately after delivery are all teaching points for which contraceptive device

implant

what are the 3 advantages of the implant

continuous, long acting, reversible, safe for breastfeeding

how long is the implant good for

3 years

what is the failure rate of the implant

1%

no protection of STIs, irregular/unpredictable menstrual bleeding, scarring at insertion site, removal required are all disadvantages of the

implant

the 2 risks for the implant are

ectopic pregnancy, infection at insertion site

the implant is contraindicated with a

hx of unexplained vaginal bleeding

progestin injections can be

IM or SQ

a progestin injection is the injection of

medroxyprogesterone preventing pregnancy by thickening cervical mucus

the 1st dose is given the during the 1st five days of the menstrual cycle, keep f/u appts, increase Ca and Vit. D, fertility may take up to 6 months to return, do not massage after inj are all teaching points of

progestin inj

only given 4x/year, does not impair lactation, decrease bleeding or absence of periods, if used long term can decrease risk of uterine CA are all advantages of

progestin inj

no protection against STIs, decreased bone density, nervousness, dizziness, GI disturbances, HA, weight gain are all disadvantages of

progestin inj

what is the failure rate of the projestin inj

4%

the progestin inj is contraindicated with a hx of what 4 things

breast CA, stroke, blood clots, liver disease

if used longterm what birth control can decrease the risk of uterine CA

progestin inj

what should the patient be educated to increase to decrease the chances of osteroporosis

calcium and Vitamin D

take with 72 hours after unprotected sex, be evaluated for pregnancy if no menses after 21 days, not to be used as a regular form of birth control are all teaching points for

morning after pill

what is the advantage of the morning after pill

OTC

no protection against STIs, does not provide long term contraception, N/V, HA, fatigue, abd cramping, heavier bleeding, failure depending on time taken after sex are all disadvantages to the

morning after pill

what are contraindications for the morning after pill

pregnancy, undx vaginal bleeding