NURS 3444. Exam 5 (Ch 29)

Outline of Contraceptive Counseling Process

1. Establish rapport
2. Identify those appropriate to receive contraceptive counseling
3. Assess medical history and contraindications to methods
4. Initiate contraceptive counseling points
5. Elicit informed preferences for method characteristics
6. Facilitate preference-concordant decision making
7. Counsel about method initiation and use

PATH Pregnancy Questions

- Pregnancy Attitudes

- Timing

- How important is prevention

Combined Oral Contraceptives

contain estrogen and progestin

How do COCs work?

- increase viscosity of cervical mucus
- suppressing ovulation
- thinning uterine lining

COCs and Menopause

Healthy non-smokers may take the pill until menopause

- helps reduce hormonal changes (mood swings anger, etc)

- cannot take birth control if a smoker

Extended cyclin with COCs

84 hormone pills followed by 7 placebo pills

What else can COCs be taken for besides contraception?

- Acne

- Debilitating cramps

Contraindications for estrogen-containing birth control

- Migraine with aura
- History of blood clots
- Hypertension

Risks of COCs

- VTE
- CV risk
- Drug interactions

Progestin-only pills (POPs)

Safe for Breastfeeding mothers

- 28 pills no placebos

- must be taken within 3 hour window every day

Why would POPs be prescribed?

estrogen contraindicated

Side effects of POPs

- less regular period
- more breakthrough bleeding
- ectopic pregnancy if occurs

Most effective methods of birth control

- Abstinence
- Bilateral tube ligation
- Vasectomy
- LARC

Contraceptive ring

estrogen and progesterone

- ring in the vagina for 3 weeks and remove for 1 week (to create withdrawal bleed)

- can be removed for intercourse

- can become dislodged during bowel movement

Contraceptive patch

estrogen and progestin

- applied for 3 weeks followed by patch-free week (would create withdrawal bleed)

- rotate sites weekly to avoid skin irritation

Where should contraceptive patch be placed?

Upper back, upper arm, upper buttock, lower abdomen

Where should contraceptive patches not be placed?

breast

Types of emergency contraception (EC)

- medication
- Copper IUC

Levonorgestrel (Plan B)

available OTC or prescription

- most effective if taken within 72 hours

- prevents ovulation

- does not affect an established pregnancy

Ulipristal (Ella)

available by prescription only

- may be used within 120 hours of unprotected intercourse

- works as progestin blocker and may affect an existing pregnancy

What are EC drugs more effective with

normal BMI

Contraceptive Injection

DMPA (depo provera)

- progestin-only injection

- suppresses FSH and LH inhibiting follicle maturation and ovulation

How often is DMPA given?

13 weeks

Benefits of DMPA

- can be used with breastfeeding
- less frequent or scant menses

DMPA side effects

- weight gain

- breakthrough bleeding

Contraceptive Implant

progestin-only

- approved for 3 years

- creates changes t cervical mucus

Common side effects of contraceptive implant?

Unscheduled bleeding

- BMI above 30 may make less effective

Copper IUC

- inhibiting sperm motility

- capacitation

- survival

- phagocytosis

can be used as EC

Progestin IUC

- inhospitable changes to the cervical mucus
- endometrial atrophy
- varibale effects on ovulation

Copper IUC side effect

heavier bleeding

Progestin IUC side effect

decrease menstrual bleeding and spotting

New acute cramping with IUC

can suggest IUC has slipped into the cervix

Diaphragm

Flexible saucer that is placed into the vagina to cover cervix

- does not protect against STIs

How often is the diaphragm replaced?

every 2 years

Contraceptive sponge

2 inch round, spermicide-infused, foam disk that fits over the cervix
- wet sponge prior to insertion
- must be placed up to 24 hours before intercours

Standard Days method

avoid intercourse on days 8 through 19 of the menstrual cycle

Infertility

defined as lack of pregnancy after 12 months of well-timed intercourse (6 months if the woman is over 35 years old).

What to assess for infertility

- Semen analysis
- Testicular biopsy
- Menstrual cycle
- Hysterosalpingogram

Hysterosalpingogram (HSG)

test for fallopian tube patency

- X-ray test with contrast to assess if tubes are blocked

Clomiphene citrate (Clomid)

Selective estrogen receptor modulator and common first-line medication to induce ovulation

Progestin-only methods

- POP
- Implant
- DMPA
- IUC

Estrogen-progestin Methods

- COC
- Patch
- Ring

Contraindications with estrogen

- migraine w/ aura
- hypertension
- smoking after age 34

Contraindications with progestin

- current breast cancer
- acute viral hepatitis

Cervical secretion method

avoid cervical intercourse on days when the cervical mucus is consistency that indicates fertility

Symptothermal method

elevate cervical secretions and temperature

- Temperature will slightly dip day of ovulation and rise sharply after ovulation

Spinnbarkeit cervical mucus

looks like egg white

- no sex with that consistency

Intrauterine insemination

Ejaculated sperm is washed to remove prostaglandins and semen proteins and the concentrated in culture media → Sperm then introduced into upper uterine cavity by way of cervix

Invitro fert

- Ovaries are stimulated to maximize oocyte recruitment

- Ovulation triggered with beta hcG

- Oocytes are retrieved by follicle aspiration guided by ultrasound

- Oocytes mixed with cleaned spermatozoa

- Embryo implanted at top of uterine cavity through the cervix (number depends on age, number of oocytes received)

- More embryos transferred → higher likelihood of conceiving

- Embryos may also be frozen