Contraception

: What are the main categories of contraception?

: Hormonal methods, Barrier methods, IUDs, Natural family planning, Sterilization.

: How do hormonal contraceptives work?

: Prevent ovulation, thicken cervical mucus, thin endometrium; NO STI protection.

: Contraindications for estrogen-containing contraceptives

: HTN, DVT/PE, migraines with aura, cardiac disease, breast cancer, early breastfeeding (<4 wks).

: Common estrogen side effects

: Nausea, bloating, breast tenderness, breakthrough bleeding, headaches.

: Contraindications for progesterone-only methods

: Severe HTN, breast cancer, clotting disorders, undiagnosed abnormal uterine bleeding.

: Common progesterone side effects

: Irregular bleeding, mood changes, worsened depression.

: Benefits of combined oral contraceptives

: Regulate/shorten periods, reduce dysmenorrhea, reduce ovarian cysts, ↓ ovarian & uterine cancer risk, ↓ acne.

: Key teaching for pill-taking

: Take same time daily; if pill missed, take ASAP; if late, use condoms x 1 week.

: Progesterone-only “mini-pill”

: Must take at exact same time daily; more breakthrough bleeding; good for breastfeeding women.

: Plan B vs. Ella timing

: Plan B within 72 hours; Ella within 5 days.

: How emergency contraception works

: Delays or prevents ovulation.

: Plan B limitations

: Less effective in women >175 lbs.

: How the contraceptive patch works

: Delivers estrogen & progesterone transdermally.

: Patch effectiveness concerns

: Less effective in women >198 lbs.

: Patch teaching

: Apply weekly x3 weeks, then remove x1 week; if off <1 day reapply; if >1 day start new cycle + condoms x1 week.

: Nuvaring instructions

: Insert for 3 weeks, remove for 1 week; start new ring on time.

: If Nuvaring falls out <3 hours

: Rinse and reinsert, no backup needed.

: If Nuvaring falls out >3 hours (week 1–2)

: Reinsert + use condoms x1 week.

: Nuvaring side effects

: Increased vaginal discharge or irritation.

: Depo-Provera main side effects

: Weight gain, irregular bleeding → amenorrhea, bone density loss, delayed return to fertility.

: Depo injection schedule

: Every 12 weeks; 150 mg IM.

: Nexplanon (implant) duration and hormone

: Effective 3 years; progesterone-only.

: Nexplanon major side effect

: Irregular bleeding that often does not improve.

: How IUDs prevent pregnancy

: Thicken cervical mucus, toxic uterine environment to sperm; copper kills sperm; NOT abortifacient.

: IUD effectiveness

: >99%, lasts 5–10 years, rapidly reversible.

: IUD contraindications

: Severe uterine distortion, current PID/STI, pregnancy.

: IUD risks

: Insertion infection risk, perforation, expulsion.

: Paragard (copper) effects

: Heavier menses, increased dysmenorrhea; lasts 10 years.

: Mirena (progesterone) effects

: Irregular bleeding x 4 months, then light or no periods; may cure dysmenorrhea; lasts 5 years.

: Post-insertion instructions for IUD

: Check strings monthly; report fever, pain, heavy bleeding, foul discharge.

: Male condom benefits

: STI protection, OTC, few side effects.

: Condom teaching

: Use every time.

: Female condoms

: Polyurethane; inner ring over cervix; similar efficacy to male condoms.

: Diaphragm teaching

: Must use with spermicide; must stay in >6 hours; refit postpartum or after 10 lb weight change.

: Cervical cap

: Smaller than diaphragm; forms suction; insert before intercourse & leave >6 hours.

: Contraceptive sponge

: Contains spermicide; lower efficacy in multiparas; no extra spermicide needed.

: Spermicides

: 70% effective alone; best used with condoms; OTC.

: Fertility awareness methods

: Calendar method, cervical mucus (Billings), basal body temperature, symptothermal.

: BBT change during ovulation

: Slight rise after ovulation.

: NFP disadvantages

: Lower efficacy, less reliable postpartum, requires partner cooperation.

: Lactational Amenorrhea Method (LAM)

: 80–90% effective for first 3 months with exclusive on-demand breastfeeding.

: Tubal ligation

: Permanent; 99.7% effective; requires 30-day consent; can be done postpartum.

: Essure procedure

: Coils placed via cervix; scar tissue blocks tubes; requires 3 months + confirmation test.

: Essure risks

: Pain, perforation, expulsion, bleeding changes.

: Vasectomy

: Cuts vas deferens; 99.8% effective; requires ~20 ejaculations before sperm cleared.

: Why avoid estrogen postpartum?

: Increased risk of VTE; decreases milk supply.

: When to start estrogen postpartum?

: After 4 weeks and when breastfeeding is established.

: Breastfeeding & contraception best option

: Progesterone-only methods (mini-pill, implant, IUD, Depo).

: When to refit diaphragm postpartum?

: 6–8 weeks.

: When can an IUD be placed postpartum?

: Within 20 minutes of birth OR at 6–8 w