Contraception, Infertility, Womens Health

Role of the nurse in contraception counseling

The nurse teaches contraceptive types, risks/benefits, correct use, actions for errors, emergency contraception, backup methods, partner involvement, and provides ongoing support.

Factors influencing contraceptive choice

Safety, STD protection, effectiveness, convenience, acceptability, cost, spontaneity, benefits, side effects, personal and cultural preferences.

Three categories of pregnancy-related methods

Methods to achieve pregnancy; methods for couples with infertility; methods to prevent pregnancy.

Adolescent contraception considerations

Adolescents often have misinformation, increased risk-taking, and need accurate education and counseling.

Perimenopausal contraception needs

Continued fertility, menstrual irregularity, increased cardiovascular risk, and need for contraception until 12 months without menses.

Tubal sterilization

Cutting, blocking, or removing fallopian tubes to permanently prevent pregnancy.

Vasectomy

Cutting or removing part of the vas deferens; requires semen analysis 8–16 weeks later.

Sterilization advantages

Permanent, highly effective, immediate, does not affect sexual function.

Sterilization disadvantages

Surgical, considered irreversible, no STI protection, reversal not guaranteed.

IUD mechanism

Creates a spermicidal intrauterine environment preventing fertilization.

IUD advantages

Very effective, long-lasting (3–10 years), reversible with immediate return of fertility.

IUD disadvantages

Increased risk of PID, expulsion, ectopic pregnancy; must check strings.

Nexplanon

Single-rod progestin implant that inhibits ovulation, thickens cervical mucus; effective for 3 years.

Depo-Provera

Progestin injection every 12 weeks; suppresses ovulation; decreases bone density; safe while breastfeeding.

Depo-Provera considerations

Delayed fertility return, requires calcium/Vitamin D, no estrogen.

Types of oral contraceptives

Combined estrogen + progestin pills, and progestin-only pills.

Benefits of oral contraceptives

Regulate cycles, reduce dysmenorrhea, decrease bleeding, improve acne, reduce ovarian/endometrial cancer, improve endometriosis.

Teaching for oral contraceptives

Take daily at same time; instructions for missed doses; interactions with medications; POPs must be taken at same time daily.

Side effects of combined OCs

Breakthrough bleeding, nausea, headache, breast tenderness, increased DVT/stroke risk.

Contraindications to combined OCs

Thromboembolic disorders, stroke, estrogen-dependent cancer, migraines with aura, uncontrolled HTN, liver disease, complicated diabetes.

ACHES warning signs for OCs

A: Abdominal pain; C: Chest pain/SOB; H: Headache severe; E: Eye problems; S: Severe leg pain/swelling.

Patch contraception

Weekly patch releasing estrogen/progestin; higher risk of VTE due to estrogen.

Vaginal ring

Flexible ring inserted for 3 weeks releasing hormones; same effects as OCs.

Spermicides

Chemical barrier used 15 min before sex; must reapply; effective for 1 hour.

Mechanical barrier methods

Male condom, female condom, sponge, diaphragm, cervical cap.

Calendar method

Ovulation estimated 14 days before menses; abstinence during fertile days; unreliable due to cycle variability.

Standard Days Method

Used for 26–32 day cycles; days 8–19 are fertile.

Cervical mucus method

Thin, stretchy “egg-white” mucus indicates ovulation and fertility.

Basal body temperature method

BBT rises 0.4–0.8°F after ovulation due to progesterone.

Lactational amenorrhea

Natural infertility during exclusive breastfeeding; temporary.

Coitus interruptus

Withdrawal before ejaculation; least reliable method.

Emergency contraception

Used after unprotected sex; includes Plan B, Ella, and Copper IUD.

Types of emergency contraception

Plan B (levonorgestrel), Ella (ulipristal), Copper IUD.

Copper IUD for EC

Inserted within 5 days; 99% effective; provides 10 years of contraception.

Women’s Health Initiative

Research program improving women’s health and preventing disease.

Healthy People 2030 goals

Reduce obesity, cancer deaths, PID, congenital syphilis, CHD, stroke; increase screenings.

Health history

Assessment of personal, menstrual, obstetric, sexual, family, and psychosocial factors.

Personal history

Demographics, allergies, medications, habits, diet, exercise, sleep, stress.

Menstrual history

Menarche, cycle regularity, discomfort, duration, menopause timing.

Obstetric history

Gravida, para, gestation length, labor experience, delivery method.

Sexual history

Partners, STI history, contraception use, HIV protection.

Family history

Cardiovascular issues, cancers, osteoporosis.

Psychosocial history

Language, education, employment, support, domestic violence screening.

Physical assessment

VS, height/weight, abdominal exam, osteoporosis indicators, STI testing as needed.

Vulvar self-exam

Monthly exam of vulva to identify changes.

Pelvic exam

Exam of reproductive organs including speculum and bimanual exam.

Pap test

Detects cervical cancer or abnormal cells.

Rectal exam

Detects lesions, hemorrhoids, or abnormalities.

BRCA gene testing

Identifies mutations increasing breast/ovarian cancer risk.

CA-125

Biomarker elevated in ovarian cancer.

Transvaginal ultrasound

Imaging test to assess uterus, ovaries, and pelvic structures.

Bone density test

Test for osteoporosis; recommended starting age 65.

Colonoscopy

Colon cancer screening every 10 years starting at age 45.

FGM

Nonmedical removal of genitalia causing long-term harm; human rights violation.

Cardiovascular disease in women

1 killer; atypical symptoms like fatigue, nausea, back pain.

Fibrocystic breast changes

Benign lumpiness and tenderness before menses.

Fibroadenoma

Benign, mobile, rubbery breast tumor in ages 15–25.

Breast cancer

Uncontrolled malignant growth of breast cells.

Nonmodifiable breast cancer risks

Age, genetics, family history, early menarche, late menopause.

Modifiable breast cancer risks

Obesity, smoking, alcohol, physical inactivity, high-fat diet.

Amenorrhea

Absence of menstruation; primary or secondary.

Dysmenorrhea

Painful menstruation.

Mittelschmerz

Ovulation pain on one side mid-cycle.

PMS

Cyclic symptoms in luteal phase affecting physical and emotional health.

PMS physical symptoms

Bloating, headaches, fatigue, breast tenderness, appetite changes.

PMS psychological symptoms

Depression, anxiety, irritability, mood swings.

Endometriosis

Endometrial-like tissue growing outside uterus causing pain and infertility.

Dyspareunia

Painful intercourse.

Abnormal uterine bleeding

Includes menorrhagia, metrorrhagia, and menometrorrhagia.

Menorrhagia

Heavy menstrual bleeding.

Metrorrhagia

Bleeding between periods.

Menometrorrhagia

Irregular heavy bleeding.

Menopause

Permanent cessation of menstruation for 12 months.

Perimenopause

Transition phase leading to menopause.

Hot flashes

Heat episodes caused by hormonal changes in menopause.

HRT

Hormone therapy for menopause; increases stroke/CVD risk.

Cystocele

Bladder prolapse into vagina.

Rectocele

Rectum bulges into vagina.

Uterine prolapse

Descent of uterus into the vaginal canal.

Pessary

Device supporting prolapsed pelvic organs.

Cervical polyps

Small benign growths causing abnormal bleeding.

Uterine fibroids

Estrogen-dependent benign uterine tumors.

Ovarian cysts

Fluid-filled sacs forming on ovaries.

PCOS

Hormonal disorder with high androgens, cysts, irregular cycles, infertility.

Anovulation

Absent ovulation, common in PCOS.

Gynecologic cancer signs

Nonspecific symptoms; often diagnosed late.

Cervical cancer management

LEEP or hysterectomy.

Endometrial cancer management

Hysterectomy and chemotherapy/radiation.

Ovarian cancer management

Surgery and chemo depending on stage.

Osteoporosis

Loss of bone density; called “silent thief.”

Dowager’s hump

Spinal curvature from vertebral collapse.