NUR 439 - Contraception

Contraception

The intentional prevention of pregnancy during sexual intercourse

Birth control

The device or practice that decreases the risk of conceiving

Family planning

The conscious decision on when to conceive throughout the reproductive years

Assisted reproductive technology

Any fertility treatment involving the handling of eggs or embryos to achieve pregnancy

Fertility awareness based methods (FABs)

Also known as natural family planning (NFP)

Only contraceptive practices acceptable to the Roman Catholic Church

Rely on avoidance of intercourse during fertile periods

Combine charting menstrual cycle with abstinence or other contraceptive methods

NFP pitfalls

The 5 Rs: Restriction on sexual spontaneity, rigorous daily monitoring, required training, risk of pregnancy during prolonged training period, risk of pregnancy high on unsafe days

Also, lower typical effectiveness, no protection from STIs, and decreased effectiveness in women with irregular menses (harder to predict ovulation)

NFP benefits

Low to no cost, awareness and understanding of personal fertility, absence of chemicals, instant availability (on safe days), increased involvement with partner, ability to follow religious traditions

Standard days method (SDM)

Women are taught to avoid unprotected intercourse on days 8 to 19

This a problem because not everyone has a 28 day cycle

Two day method

Based on the monitoring and recording of cervical secretions (but does not involve analyzing the appearance/texture of secretions)

Did I notice secretions today? Did I notice secretions yesterday? If not, woman may resume unprotected intercourse

Cervical mucus ovulation detection method

Cervical mucus changes throughout the menstrual cycle. Right before ovulation, the watery, thin, clear mucus becomes more abundant and thicker (feels like lubricant, can be stretched 5 cm+ between thumb and forefinger) which indicates period of maximal fertility

Intercourse is considered safe without restriction beginning the fourth day after the last day of wet, clear, slippery mucus, which would indicate that ovulation occurred 2 to 3 days prior.

Basal body temperature (BBT) method

Monitoring BBT upon awakening (before getting out of bed)

Fertile period is the first day of the first temperature drop (however, some women do not experience a temperature drop prior to a temperature increase), or first elevation through 3 consecutive days of elevated temperature

Abstinence begins 1st day of menses and lasts through 3 consecutive days of sustained temperature rise

Symptothermal method

Combines BBT with cervical mucus methods with awareness of related symptoms of the menstrual cycle

Ovulation predictor test kits

Urine test for ovulation that detects sudden surge of LH that occurs 12-24 hours before ovulation

How do spermicides work?

They decrease the motility of sperm. Chemicals attack the sperm flagella and body

When should spermicide be inserted?

At least 15 minutes prior to intercourse but no longer than 1 hour before

Pitfall of spermicide

Using N-9 as a lubricant during anal intercourse may increase the transmission of HIV and can cause lesions

Male condoms

Provide a barrier for several STIs and prevent pregnancy

Male condoms benefits

Safe, no side effects, readily available, premalignant changes in cervix can be prevented

Male condoms pitfalls

Must interrupt sexual activity to apply sheath, sensation may be altered, spillage of sperm can result in pregnancy, risk of tears

Can you use a male and female condom at the same time?

No. The friction from both sheaths can increase the likelihood of either or both tearing

Diaphragm

Shallow dome-shaped latex or silicone device with a flexible ring that covers the cervix

MUST be fitted by GYN provider. Need an annual appointment to assess fit and should be replaced every two years

Used with spermicide

Diaphragm pitfalls

TSS risk, some couples object to messiness of spermicide, woman must empty bladder before insertion and immediately after intercourse to prevent urethral pressure, contraindicated for women with uterine prolapse

Signs of TSS

Sunburn type rash, diarrhea, dizziness, faintness, weakness, sore throat, aching muscles and joints, sudden fever, vomiting

Cervical cap

FemCap is the only one available in the US

Used with spermicide (adds a chemical barrier)

Higher failure rate in multiparous women

How long should a cervical cap remain in place after intercourse?

At least 6 hours, no longer than 48 hours

Cervical sponge

Small round sponge that contains N-9 spermicide

One size fits all

Up to 24 hour protection

How long after intercourse should a cervical sponge be left in place for?

At least 6 hours

Main action of combined oral contraceptives (COCs)

Prevents ovulation

Benefits of COCs

Has non-contraceptive health benefits of reduction of menorrhagia and regulation of irregular cycles as well as protection against endometrial and ovarian cancers

Pitfalls of COCs

Many side effects and contraindications

Some side effects include stroke, MI, thromboembolisms, hypertension, gallbladder disease, liver tumors

Patients with hypertension or thromboembolic disorders should not use this medication (also many other contraindications in addition to these)

Can a smoker over 35 use COCs?

No. Only under 35 can use COCs

T or F: Fertility resumes quickly after COCs discontinuance

T

Warning signs to teach patients starting or taking COCs (ACHES acronym)

Abdominal pain (may indicate liver/gallbladder problem)

Chest pain or SOB may indicate clot problem within lungs or heart

Headaches may be caused by CVA or HTN

Eye problems may indicate vascular accident or HTN

Severe leg pain may indicate DVT

Oral progestins (minipill)

Must be taken within a 3 hour window

Injectable progestins

Injections every 3 months. Do not massage site after injection

Implantable progestins

Jadelle and Nexplanon

Effective up to 3 years

Implants prevent some, but not all, ovulatory cycles and will thicken cervical mucus

Which type of EC is the only type of EC available without a prescription and sold without age restriction?

Oral levonorgestrel (Plan B)

Within how many hours of unprotected intercourse should emergency contraception be taken?

120 hours (5 days). The sooner the better, though!

Obesity and EC

Obese women have an increased risk of pregnancy after using EC compared to women of normal weight

How many years is a copper IUD good for?

10 years, despite this being an emergency contraceptive

IUDs

Small T shaped device inserted into uterine cavity (with two strings hanging from the base of the stem through the cervix and protruding through the vagina). Offers constant contraception

Medicated IUDs loaded with either copper or progestational agent

IUD advantages

Long term pregnancy protection, cost effective, suitable for clients with estrogen contraindications, reduces cervical/endometrial/ovarian cancer risk, immediate return to fertility when it is removed

IUD pitfalls

No protection against STIs/HIV, increased bleeding if copper, risk of infection in first month (PID), unintentional expulsion of device, possible uterine perforation (can be caused by improper insertion)

Para-Gard Copper IUD

Serves as a spermicide and inflames the endometrium, preventing fertilization

Levonorgestrel releasing IUD

Good for 3-5 years depending on brand

Impairs sperm motility, thickens cervical mucus, decreases lining of uterus

Signs of IUD complications (PAINS acronym)

Period late, abnormal spotting or bleeding

Abdominal pain, pain with intercourse

Infection exposure, abnormal vaginal discharge

Not feeling well, fever, or chills

String missing - shorter or longer

What is sterilization

A form of permanent contraception for both males and females

Tubal occlusion

Closing of fallopian tubes with bands or clips

Theoretically reversible with tubal reconstruction

Vasectomy

Surgical interruption of a man's vas deferens, which is responsible for transporting mature sperm to the urethra

Easiest and most common method for male sterilization

Lactational amenorrhea method (LAM)

When an infant suckles on mother's breast, a surge of prolactin hormone is released which inhibits estrogen production and suppresses ovulation and the return of menses

If a woman chooses to breastfeed as a form of contraception, she must breastfeed consistently and do so exclusively for up to 6 months after birth

Methods of contraception requiring a visit to a provider and a prescription

Diaphragm, IUDs, hormonal methods, ella EC

Which methods of contraception help protect against STIs?

Barrier methods - male and female condoms

COCs contraindications

History of thromboembolic disorders, smoking over age 35, cerebro/cardiovascular disease, HTN, breast cancer, multiple sclerosis, IBS, pregnancy, malignant hepatoma, severe cirrhosis, DM over 20 years' duration or with vascular disease, nephropathy, neuropathy, retinopathy