Contraception

what are 3 reasons contraceptive are used for?

Prevent pregnancy

Space pregnancies

Avoid high risk pregnancy

A health-care provider can be reasonably certain that a woman is not pregnant if she _________ and meets _____ of the following criteria:

is ≤7 days after the start of normal menses

has not had sexual intercourse since the start of last normal menses

has been correctly and consistently using a reliable method of contraception

is ≤7 days after spontaneous or induced abortion

is within 4 weeks postpartum

is fully or nearly fully breastfeeding (exclusively breastfeeding or the vast majority [≥85%] of feeds are breastfeeds),* amenorrheic, and <6 months postpartum

has no symptoms or signs of pregnancy; one

what are 3 natural contraception methods? briefly explain each

coitus interruptus- pulling out

fertility awareness- avoiding intercourse while fertile

lactational amenorrhea-amenorrhea secondary to breastfeeding

what are the 3 categories on non-hormonal contraception methods?

barrier methods, vaginal preparations, copper IUD

what are the 2 barrier methods?

condoms and diaphragm/cervical cap

condoms

male and female Impermeable to sperm and STDs Can be used in combination with jelly or foam

what are some things to note about diaphragms/cervical caps?

Spermicide must be applied

Can be inserted up to 6 hours before sex, should stay in for 6 hours after sex but not longer than or 24 hours total

Must be fitted and prescribed by a provider (small, medium large)

Side effects include vaginal wall or cervical irritation from device or spermicide, TSS is rare but possible

diaphragm

Flexible rings with a membrane that covers the cervix

Decreased effectiveness with prolapse syndromes, retroflexed or anteflexed uterus, or shortened vagina

cervical cap

Fits with suction over the cervix

More difficult to insert and remove than the diaphragm

what are the 2 kinds of vaginal preparations? describe them

Prescription contraceptive gel (Phexxi®): Lowers vaginal pH (to 3.5-4.5), which incapacitates sperm

Spermicides: Contains nonoxynol-9, which results in sperm immobilization and death

what are some things to note about vaginal preparations?

Must be inserted shortly before intercourse, effective for up to one hour

Not considered effective in preventing STDs, some studies show that spermicides may increase STD risk

Side effects include vaginal and vulvar irritation

what are the 3 types of combination hormonal birth control methods?

pills, rings, transdermal patches

what are combination oral contraceptive pills initiated? what are the possible ratios/patterns of pills/placebo pill dosing?

Initiated on day 1 of menses, or any time if the provider is reasonably certain that there is no pregnancy

21/7, 24/4, 84/7, 365/0, continuous active pills

which progesterone only OCP is approved for mild-moderate acne and PMDD?

Drospirenone

what are the 2 brands of vaginal rings? differentiate them

Nuvaring®

transparent, ethinyl estradiol/etonogestrel continuous release, lifespan of 1 cycle, refrigeration required

Annovera®

thicker, white, softer, ethinyl estradiol/segesterone acetate continuous release, life span of 13 cycles, no refrigeration

what are the 2 brands of transdermal patches? what is the day system?

Xulane® and Twirla®

28 day system - one patch is applied weekly for three weeks and on the fourth week no patch is worn

what is the MOA for cOCPs?

Inhibition of ovulation by negative feedback on the synthesis and release of GnRH from the hypothalamus, limiting pituitary gonadotropin effect which suppress ovulation

cOCPs suppress ovulation but what other secondary mechanisms do they have to prevent pregnancy

thickening of cervical mucous, decreased ciliary action in the fallopian tubes, and thinning of the endometrium

what are contradictions based upon CDC and WHO date for cOCPs?

Known or suspected pregnancy

Age ≥35 years and smoking ≥15 cigarettes per day (vaping)

Known ischemic heart disease or two or more risk factors for IHD

Hypertension with ≥ 160, diastolic ≥ 100, and/or with vascular disease

Current venous thromboembolism, or history of not receiving anticoagulation

Thrombogenic mutations

History of stroke

Complicated valvular heart disease

Current breast cancer

Cirrhosis

Migraine with aura

Hepatocellular adenoma or malignant hepatoma

which combination hormonal method has the advantage of possibly improving sexual function?

ring

2 multiple choice options

which combination hormonal method has the risk of toxic shock syndrome?

ring

2 multiple choice options

which combination hormonal method has the risk of increased thyroxine binding globulin and cortisol binding globulin?

patch

2 multiple choice options

which combination hormonal method has the possible side effect of amenorrhea?

cOCPs

2 multiple choice options

which combination hormonal method has the possible side effect of dysmenorrhea?

patch

2 multiple choice options

which combination hormonal method has the possible side effect of vaginitis?

ring

2 multiple choice options

which combination hormonal method shows lower rates of insulin resistance?

ring

2 multiple choice options

what are 3 systemic progesterone only contraception methods?

progesterone only contraceptive pills

depo-medroxyprogesterone acetate injection

subdermal implant

what are the 3 generic progesterone only contraceptive pills (POPs)? which have 28 active pills? which has 24 active pills? which can be purchased over the counter?

Norethindrone 28)

Drospirenone (24)

Norgestrel (over the counter, 28)

what is the difference between depo (DMPA injection) and nexplanon (subdermal implant)?

depo is injected like a shot in the office every 12-14 weeks; nexplanon is inserted into the upper arm and is effective for 3 years

what is the MOA of systemic progesterone only methods?

Inhibition of ovulation by negative feedback on the synthesis and release of GnRH from the hypothalamus

Cervical mucous changes making it impermeable and hostile to sperm

Decreased ciliary action in the fallopian tubes affecting sperm and egg transport

Endometrial thinning that discourages implantation

what are the contraindications based upon CBC and WHO data for systemic progesterone only methods?

Known or suspected pregnancy

Hepatic tumor or active liver disease

Undiagnosed abnormal genital bleeding

Known or suspected breast cancer, history of breast cancer, or other progestin-sensitive cancer

Some forms of lupus

what are the contraindications for POPs?

History of bariatric surgery

Use of certain anticonvulsants

what are the contraindications for DMPA?

Pregnancy planned in the nest year

Long-term use of corticosteroid therapy with risk of non traumatic fracture

Diabetes with end organ damage

Significant HTN

History of stroke

IHD or significant vascular risk

what are the contraindications for nexplanon?

Allergy to any component of the device

which systemic progesterone only contraceptive has the advantage of regulating menstrual bleeding?

POPs

2 multiple choice options

which systemic progesterone only contraceptive is a LARC (long term reversible contraception)?

Nexplanon

2 multiple choice options

which systemic progesterone only contraceptive has the risk of decreasing bone mineral density?

DMPA

2 multiple choice options

which systemic progesterone only contraceptive has the possible side effect of nausea?

POPs

2 multiple choice options

which systemic progesterone only contraceptive has the possible side effect of extended return of infertility?

DMPA

2 multiple choice options

which POP is the only progesterone only method that offers menstrual regulation?

Slynd® (drospirenone)

what are the 2 types of intrauterine methods?

progesterone (levonorgestrel) IUD

copper IUD

compare and contrast copper and levnogestrel IUDs

copper (Paragard) is T shaped, hormonal free, effective up to 10 years

levnogestrel is T or Y shaped, contains progesterone, effective 3-8 years depending on brand

both are LARCs and are inserted/removed in outpatient settings

which levonogestrel releasing IUD is effective for up to 8 years?

Mirena

3 multiple choice options

which levonogestrel releasing IUD is effective for up to 3 years and is priced under market value?

Liletta

3 multiple choice options

which levonogestrel releasing IUD is effective for up to 5 years and FDA approved for nulliparous patients?

Kyleena

3 multiple choice options

which levonogestrel releasing IUD is effective for up to 3 years and FDA approved for nulliparous patients?

Skyla

3 multiple choice options

the exact MOA for copper IUDs are unknown but what are some theories?

Interference with egg development

Interference with fertilization of the egg

Promotion of phagocytosis of sperm in the endometrial cavity

Creating an unfavorable uterine environment for implantation

what is the MOA for a levonogestrel IUD?

Cervical mucous changes making it impermeable and hostile to sperm

Decreased ciliary action in the fallopian tubes affecting sperm and egg transport (prevents sperm from meeting egg)

Endometrial thinning that discourages implantation

what are contraindications based upon CDC and WHO data for IUDs?

Known or suspected pregnancy

Distorted uterine cavity

Current cervical cancer

Endometrial cancer

Undiagnosed abnormal genital bleeding

PID/septic abortion/postpartum sepsis

Pelvic tuberculosis

Current cervicitis due to active gonorrhea or chlamydia

Gestational trophoblastic disease with persistently elevated ß-hCG

Complicated organ transplant

Lupus with severe thrombocytopenia

what are contraindications for copper IUDs?

Wilson's disease or a copper allergy

what are contraindications for levonogestral IUDs?

Current breast cancer

Hematic tumor or active liver disease

which IUD has significantly less menstrual bleeding and a decrease in dysmenorrhea?

levonorgestrel

1 multiple choice option

which IUD has maintenance of monthly cycle?

copper

1 multiple choice option

which IUD has a possible elevated breast cancer risk?

levonorgestrel

1 multiple choice option

which IUD has a possible side effects of heavier menstrual cycles?

copper

1 multiple choice option

which IUD has possible side effects of headache, acne, and breast tenderness?

levonorgestrel

1 multiple choice option

what are 3 options for emergency contraception?

hormone formulations, paragard, selective progesterone receptor modulator

what are the 2 types of hormone formulations for emergency contraception? how are they taken/when should they be taken?

combination and progesterone only (Plan B) forumula; One tablet taken once, or two tablets taken 12 hours apart

Must be started within 72 hours of intercourse

when must paragard be inserted to work as emergency contraception?

within 7 days if intercourse

when must selective progesterone receptor modulator (Ella) be taken to work as an emergency contraception?

120 hours of unprotected intercourse

what is permanent sterilization for females and males respectively?

females: tubal sterilization via cautery, salpingectomy, or clips/bands

males: vasectomy via excision of a section of the vas deferens

what are birth control options for a postpartum patient that can be initiated immediately?

Progesterone-only methods

Barrier methods

All IUDs

Permanent sterilization

Breastfeeding

Age alone is not a contraindication for any form of contraception t/f

true

1 multiple choice option