Contraceptives

Contraception

Prevention of pregnancy

• Educator and counselor

• Sensitive to women’s concerns, feelings, and preferences

• Check biases

• Informed consent

What is the role of the nurse on contraception?

• ACCEPTABLITY

• PREFERENCE

• Safety

• Protection from STIs

• Side effects

• Effectiveness

• Benefits

• Convenience

• Effect on spontaneity

• Availability

• Expense

• Education needed

• Religious and personal beliefs

• Culture

What are the things to consider when choosing a contraceptive?

• Behavioral

• Barrier

• Hormonal

• Permanent

What are the types of contraceptives?

• Abstinence

• Withdrawal

• Natural family planning

What are the behavioral methods of contraception?

• Condoms (male and female)

• Diaphragms

• Cervical caps

• Contraceptive sponges

What are the barrier methods of contraception?

• Oral contraceptives

• Vaginal ring

• Hormone injections

• Transdermal patch

• Hormone implants

• IUDs (except copper)

What are the hormonal methods of contraception?

• Tubal ligation

• Vasectomy

What are the permanent methods of contraception?

Abstinence

• Only sure why to prevent pregnancy

• Decreases risk of STI and HIV (spread skin to skin)

Withdrawal (coitius interruptus)

• “pull out” method

• Removal of penis from vagina before ejaculation

• Use physiologic cues to predict ovulation

• Avoid intercourse when conditions are favorable for fertilization

• Based on the knowledge that ovulation occurs ONE DAY during each cycle

• Sperm can live up to 5 days

• Avoids the use of drugs, chemicals, devices

What does natural family planning mean?

• Calendar or Rhythm method

• Cervical mucous method

• Symptothermal method

• Basal body temperature method

• Standard days method

What are the types of natural family planning?

• Based on timing of ovulation

• Ovulation occurs approximately 14 DAYS before onset of menses (if 28 days cycle)

• Keep track of menstrual period on calendar for 6 MONTHS

• Abstain or use another method during fertile days

What is the calendar or rhythm method?

14 days before onset of menses

When does ovulation occur?

SUBTRACT 18 DAYS from the SHORTEST cycle and 11 DAYS from the LONGEST cycle

How to find the fertile period?

On fertile days

When should you abstain from intercourse if using the calendar or rhythm method?

Monitors CHANGES IN CERVICAL MUCUS to detect ovulation

• 2 day method

What is the cervical mucus method?

Abundant, slippery, and smooth

What is the texture of cervical mucus before ovulation happens?

From the time mucus is first present after menses until 4 DAYS after end of slippery mucus

When should you abstain from intercourse if using the cervical mucus method?

Every other day when little or no mucus, as semen interferes with mucus assessment

When is intercourse allowed if using cervical mucus method?

2 day method

Abstain if any vaginal secretions

• BBT + Cervical Mucus + SX detect ovulation

• Temperatures LOWER in first part of cycle (preovulation) (minor changes)

• Temperatures may drop slightly before ovulation and then RISE in SECOND PART of cycle

What is the symptothermal method?

Basal body temperature (BBT)

Lowest temp upon awakening

Preovulation (first part of cycle)

When are temperatures in the female body lowest?

From onset of PERIOD UNTIL BBT temperatures have been ELEVATED for 3 DAYS to have intercourse

When should you abstain from intercourse if using the symptothermal method?

• Take the temp at SAME TIME in the SAME WAY EVERY MORNING BEFORE GETTING OUT OF BED (ELECTRONIC THERMOMETER)

• Take the temp BEFORE TALKING, EATING, DRINKING, HAVING SEX, CHECKING PHONE, ETC.

• Track on calendar to determine ovulation

• Track period and sx on calendar (weight gain, bloating, increased libido)

How do you preform the symtothermal method?

Uses cycle beads to track fertile window

• Women with cycles that last between 26-32 days should avoid unprotected intercourse on days 8-19 of their cycles

What is the standard days method?

1. Red: 1st day

2. White: fertile (can get pregnant)

3. Brown: pregnancy unlikely

What does each part of the standard day cycle bead mean?

• Can postpone ovulation

• Temporary method used by breastfeeding mothers by to 6 MONTHS after giving birth (solid foods start)

• Frequency, intensity, and duration of breastfeeding important in inhibiting ovulation

• Exclusive breastfeeding only

How is breastfeeding a natural family planning method of contraception?

Use of formula, solid foods, pumping which decreases breastfeeding frequency

What can lead to quicker ovulation in breastfeeding?

• Latex or polyurethane or natural membrane

• May be coated with spermicide (chemical barrier)

• Helps protect against some STIs

What are male condoms?

• Polyurethane or nitrile pouch

• Flexible ring inside closed end fits over the cervix

• Another ring extends outside the vagina to partially cover perineum

• Helps protect against some STIs

What are female condoms?

Diaphragm

Latex or silicone dome surrounded by a metal spring or coil

• Prescription only and requires fitting and must be placed correctly

• Used in conjunction with spermicide

Weight changes of 10 lbs or more

When does refitting happen for diaphram?

Insert up to 6 HOURS before sex, must stay in for 6 HOURS after sex

• Replaced every 2 YEARS or sooner if needed

How do you use diaphragms?

Cervical cap

Small flexible cup made of silicone that fits over cervix

• Prescription only, requires fitting by healthcare provider

• Used in conjunction with spermicide (fill)

• Can be inserted anytime between 15 MINS and 42 HOURS before sex, must stay in for 6 HOURS after sex

• Can stay in place for 48 HOURS

• Replaced every YEAR

How do you use a cervical cap?

After weight changes, pregnancy, etc.

When do cervical caps need refitting?

Contraceptive sponge

One time soft disposable piece of polyurethane foam that covers the cervix

• Non prescription and no fitting

• Non hormonal

• Already contains spermicide

• Insert up to 24 HOURS before sex, leave in for 6 HOURS after sex

• Should not be left in for MORE THAN 30 HOURS to avoid risk for TOXIC SHOCK SYNDROME (bacterial)

How to use a contraceptive sponge?

• Progestin

• Combination

What are the 2 types of oral concraceptives hormones?

THICKENING of cervical mucus, endometrial lining unfavorable for implantation

What is progestin?

Inhibit ESTROGEN and LH, inhibiting maturation of follicle and ovulation, thickens cervical mucus, endometrium unfavorable for implantation

What is combination oral contraceptives?

At the same time of day

How should you take oral contraceptives?

Advantages:

• Regulate menstrual cycles and help dysmenorrhea

• Reduce blood loss and associated anemia

• Decrease breast disease and some cancers

• Improves acne and some premenstrual sx

Disadvantages:

• N/V

• Headache

• Breast tender

• Amenorrhea

What are the advantages and disadvantages of oral contraceptives?

• No protection against STD

• Increase cervical cancer

• Increase: DVT, PE, MI, Stroke, HTN

What are the complications of oral contraceptives?

• Smoking

• Hx DVT

• Breast cancer

• HTN

What are the risk factors for COMBINATION oral contraceptives?

• Ab pain

• CP

• Headache

• Eye problems (blurry vision, flashing lights)

• Severe leg pain, swelling legs/feet

ACHES

What are the EARLY SIGNS of oral contraceptives complications?

Vaginal rings

Absorbs estrogen and progestin through the vaginal mucosa to prevent ovulation

• No fitting and placed behind pubic bone, low dose

3 weeks in/1 week out

When are vaginal rings placed?

Medroxyprogesterone (Depo-Provera) (IM or SQ)

What is the med for hormone injection?

Medroxyprogesterone (Depo-Provera)

Inhibits ovulation, thickens cervical mucus

Every 12 WEEKS (3 months)

When are hormone injections used?

• Irregular menses

• Loss of bone density

What are the adverse effects of medroxyprogesterone (Depo-Provera)?

Transdermal patches

Estrogen and progestin, suppresses ovulation, thickens cervical mucus

3 weeks on/1 week off

When are transdermal patches placed?

Oral contraceptives and transdermal patches

What two hormonal methods increases risk for DVT?

etonogestrel (Nexplanon)

• Progestin only

What is the med for hormone implants?

etonogestrel (Nexplanon)

Implanted subdermally and thickens cervical mucus

3 years

How long does etonogestrel (Nexplanon) last?

Intrauterine devices (IUDs)

T shaped object inserted in the uterus

• 2 types: HORMONAL (levonogestrel) and NON HORMONAL (COPPER)

Levonogestrel

• 3-7 YEARS

• Thicken cervical mucus, can stop ovulation

What is the hormonal IUD?

COPPER

• 10 years

• Toxic to sperm

What is the non hormonal IUD?

• Painful insertion

• Cramp, bleeding with insertion

• May increase bleed during period

What are the side effects of IUD?

IMPORTANT TO CHECK PLACEMENT (1-2 STRINGS protrude into the vagina)

What is the education for IUDs?

• P = period late, pregnancy, abnormal spotting, bleeding

• A = abdominal pain, pain with intercourse (infection)

• I = infection exposure, abnormal vaginal discharge

• N = not feeling well, fever, chills

• S = string length shorter or longer or missing

What are the warning signs of potential IUD complications?

• Levonorgestrel (Plan B)

• Copper-releasing IUD

What are the types of emergency contraception?

The earlier it is used

When is Plan B most effective?

Used within 72-120 hours (3-5 days) after unprotected intercourse

When is Plan B used?

5 days post unprotected intercourse

When is copper releasing IUD used?

Tubal ligation

Sterilization technique for women that is a permanent MINIMALLY INVASIVE (LAPAROSCOPIC) procedure that prevents pregnancy by cutting, tying, clipping, or removing the fallopian tubes; blocks eggs from traveling to ovaries and prevents sperm from reaching them

Vasectomy

Surgical sterilization technique that is done OUTPATIENT, which the vas deferens are cut or blocked so sperm cannot mix with semen

• Specimen analysis

Specimen analysis

Checks semen post vasectomy to look for prescence of sperm that might be left over

• Implant

• IUD

• Surgical sterilizaiton

Which contraceptives are most effective?