contraception

traditional/natural methods

-abstinence

-coitus interruptus

-fertility awareness: temperature awareness, calendar, cervical mucus method

coitus interruptus

-withdrawal method or pulling out

-free

-not effective is pre-ejaculation contains sperm

fertility awareness

-avoiding intercourse during days of peak fertility

-temperature method: using rise in body temp to predict fertile window

-cervical mucus method: most mucous production is right before ovulation

-calendar method: take period for 6 cycles if 31, 28 fertility window is day 10-20

barrier methods

-condoms

-diaphragm

-cervical cap

-spermicidal contraceptive sponge

-vaginal spermicide

-caginal pH regulator gel

diaphragm

-must use spermicide

-place less than 1 hour prior to intercourse

-remove 6 hours after last episode prior to intercourse

-requires prescription

-reusable for 2 years

cervical cap

-silicone cap that holds spermicide against the cervix

-place 6 hours prior to intercourse

-reusable

spermicide contraceptive sponge

-foam disc with spermacide that becomes activated when moistened

-moisten vag with water

-discard after every use

vaginal spermicide

-nonoxynol-9 destroys sperm bodt and flagella

-inserted up to 1 hour before intercourse

vaginal pH modulator gel

-combination of acids which will maintain a lower pH even in presence of sperm

-must be applied within 1 hour of intercourse

-applied via tube applicator

-prescription

hormonal contraception

-combined oral contraceptive pill

-transdermal patch

-vaginal ring

-progesterone only pill

-medroxyprogesterone injection

-etonogestrel arm implant

-intrauterine device

indication for hormonal contraception

-pregnancy prevention

-menstrual abnormalities

-PCOS

-ovarian cyst prevention

-PMS/PMDD

-menstrual migraines

-perimenopause

-acne

combined oral contraceptive pill

MOA: suppression of ovulation by inhibiting GnRH secretion from the hypothalamus further inhibiting release of LH and FSH

-take everyday at the same time

-return to fertility: 90 days after discontinuation

-contraindications: age >35, >15 cigarettes a day, mirgraine w aura, hypertension, stroke, cirrhosis, hep C, venous thromboembolism

transdermal patch

MOA: suppression of ovulation by inhibiting GnRH secretion from the hypothalamus further inhibiting release of LH and FSH

-weekly x3, 1 week free for menses

-place lower abdomen, back, shoulder

-return to fertility: 3 days of removal

-contraindications: BMI >30kg

vaginal ring

MOA: suppression of ovulation by inhibiting GnRH secretion from the hypothalamus further from hypothalamus inhibiting release of LH and FSH

-insert ring x3 week and remove 1 week for menses

-return to fertility: 1 mon after removal

progestin only pills

MOA: cervical mucus thickening to inhibit sperm migration slowing of fallopian tube motility, endometrial thinning

-daily

-SE: unscheduled bleeding

medroxyprogesterone acetate

MOA: inhibition of gonadotropic secretion, thereby inhibiting follicular maturation and ovulation

-IM or sub Q

-11-13 weeks

-SE: unscheduled bleeding

-return to fertility: 10-18 months

-can decrease bone density with prolonged use

arm implant etonogestrel

MOA: ovulation suppression, cervical mucus thickening, endometrial lining

-plastic rod inserted beneath skin to upper arm, barium sulfate

-3 years

-SE: redness, bruising, swelling, AUB, headache, acne

-return to fertility: 1 week

levonorgestrel IUD

MOA: cervical mucus thickening to inhibit sperm migration, slowing of fallopian tube motility, endometrial thinning

-3 years, 5 years, 8 years

-SE: amenorrhea, AUB, ovarian cysts

-return to fertility: rapid, immediate but average 3-4 mon

-if pregnancy occurs = ectopic

-Mirena is only FDA approved

-can be used as emergency contraception if placed within 5 days of sex

copper IUD

MOA: copper wire produces an inflammatory reaction which creates a toxic enviroment for sperm

-10 years

-SE: heavier, longer and more painful flow

-return to fertility: immediately

-can be used as emergency contraception if placed within 5 days of sex

vasectomy

-practitioner cuts and cauterizes or sutures each vas deferens so it cannot carry seminal fluid to urethra to expelled from penis during ejaculation

-2-3 day recovery

-intercourse after 1 week

-confirmatory semun analysis for sperm count 3 months after

tube ligation

-cauterize. clamp, completely remove fallopian tubes

-1 week recovery

-permanent

emergency contraception

-does not cause abortion

-prevent pregnancy

-oral: ulipristal acetate, oral levonorgestrel

-intrauterine device: levonorgestrel IUD, copper IUD

-menses should occur within 1 week after EC use

-many women experience bleeding 1 month following EC use

ulipristal acetate

-most effective oral option

MOA: selective progestin receptor modulator, binding to bodys progestin receptor. blocks progesterone production and prevents ovulation

-take within 5 days of intercourse

-prescription

-do not use any birth control with taking or within 5 days

oral levonorgestrel (plan B)

MOA: delays follicular development when administered before the level of luteinizing hormone increases which delay or inhibit ovulation

-take within 3 days of intercourse

-OTC

breast exam

-every 1-3 years for women aged 25-29 and annually for women aged 40 years or older

-may be offered for asymptomatic average risk

cervical cancer screening

-pap smear starting at 21

-every 3 years alone

-every 4 years after age 30

breast cancer screening

-mammography starting at age 40

-discontinue at age 75

colon cancer screening

-colonoscopy at age 45

STD screening

-gonorrhea/chlamydia in women <25

-hep C after 18

-HIV at least once after 15

bone mineral density

-recommended for postmenopausal women >65 for osteoporosis

-every 2 years unless more frequently warranted

-post menopausal women <65 with risk factors