Week 2 - Birth Control and Contraception

What are the 5 P's when taking an STI history?

1) Practices

2) Partners

3)Protection from STI

4) Past History of STIs

5) Pregnancy intention

What are important questions to ask patients about their partners?

- Are you currently having sex of any kind - oral, vaginal or anal - with anyone?

- If no, have you ever had sex of any kind with another person

- In recent months, how many sex partners have you had?

- What is/are the gender(s) of your sex partner(s)?

What are LARCs?

long acting reversible contraception

What are examples of LARCs?

- Levonorgestrel IUD's (hormonal) - Mirena, Liletta, Kyleena, Skyla

- Copper IUD (non-hormonal) - Paragard

- Subdermal Etonogestrel Implant - Nexplanon

- Progestin Injection/SQ - Deposit-Provera

What is the duration of LARCs?

13 weeks - 12 years

What is the birth control duration of non-hormonal IUD's (e.g. Paragard)

10 years

What is the birth control duration for the hormonal IUDs (Mirena, Skyla, Liletta, Kyleena)?

- Mirena - 7 years

- Liletta - 6 years

- Kyleena - 5 years

- Skyla - 3 years

What is the mechanism of contraception of copper IUDs?

Acts on sperm to disrupt motility preventing migration to the tube

What is the mechanism of contraception of progestin IUD?

Thickens cervical mucous which prevents sperm from entering the uterine cavity

What are reasons to choose copper IUDs?

- Avoidance of exogenous hormones

- Continuation of pre-IUD bleeding pattern

- Desire for longer term contraception

- Need for emergency contraception

What are reasons to choose LNG IUDs?

- Reduction of menstrual bleeding and anemia

- Possible amenorrhea

- Reduction in dysmenorrhea

- Treatment of endometriosis-related pelvic pain

What are absolute contraindications for IUDs?

- Pregnancy

- Distorted Uterine Anatomy

- Unexplained vaginal bleeding

- Ongoing pelvic infection

How is Nexplanon administered?

Subdermal placement in upper arm

Contraception for up to 3 years

What is the mechanism of action of the Nexplanon?

- Thickens mucus in the cervix to stop sperm from reaching or fertilizing an egg.

- Thins the lining of the endometrium and partially suppresses ovulation

What are the cons of subdermal implants (e.g. Nexplanon)?

- Requires an in-office procedure

- Pain w/ insertion

- Removal may be difficult

- Irregular bleeding

- Implant is palpable

What is the birth control duration of Depo-Provera?

13 weeks

How does Depo-Provera work MOA?

- thickens cervical mucous

- Thins uterine lining to suppress ovulation

What are the side effects of Depo-Provera?

- Irregular menstrual bleeding

- Depression

- Weight gain

- Hair loss

- Headache

- Reduced Libido

What are the benefits of Depo-Provera?

- Decrease cancer risk

- Efficacy

What is female sterilization?

- tubal ligation - prevents pregnancy by occluding or removing the fallopian tube

What is the only indication for female sterilization?

Patient's desire and request

What is the failure rate of permanent sterilization?

0.5%-0.15%

What are the different types of oral contraceptive pills?

- Combined estrogen-progesterone

- Progesterone

- Estrogen (ethinyl estradiol)

What is MOA of combined-oral contraceptives?

- Prevent ovulation

- Also have the progesterone effects

What are monophasic (fixed-dose) pills?

Contains a fixed dose of estrogen and fixed dose f progestin in each tablet

What are triphasic pills?

3 different doses of progestin and estrogen that change approximately every 7 days

What is the 91 day oral contraceptive pill?

Provides a constant dose of estrogen and progestin for 84 days.

What is the "Sunday Start" Approach for OCPs?

- Woman starts the pill on the first Sunday after her period begins

What is the Quick Start Method for OCPs?

- Woman starts taking OCPs on the day that she is given the prescription

What are the side effects of OCPs?

- Nausea

- Breast Tenderness

- Headaches

- Increase blood pressure and lipids

- Increase risk of gallstones

- VTE

- Ischemic Stroke

What are non-contraceptive benefits of OCPs?

- Reduced risk of PID, ovarian/endometrial cancer, ectopic pregnancy, functional ovarian cysts, colorectal cancer

- Can help treat Iron-deficiency anemia, Dysmenorrhea, Acne, Hirsutism, Metorrhagia, Premenstrual syndrome

What are the absolute contraindications of OCPs?

- Smoker over 35

- Benign or malignant liver tumor

- Known or suspected pregnancy

- CAD

- CV Disease

- Breast Cancer

What are the side effects of the Nuvaring or Annorvera?

- Vaginal irritation or discharge

- Headache

- Mood changes

- Ring slipping out

- Weight gain

- Breast pain

- Nausea and Vomiting

What are the side affects of "The Patch"?

- Lack of privacy

- Skin irritation

- Estrogen side effects

When are Progesterone Only Pills (POP) indicated?

When women cannot or should not take estrogen

Side effects of POP?

- irregular bleeding

- breast tenderness

- Increased formation of follicular cysts and acne

What is the pro of progestin-only mini pills?

- Safe in lactation

- No estrogenic side effects (headaches, nausea, HTN)

- Decrease risk of ovarian and endometrial cancer

What are barrier methods of contraception?

Condoms and diaphragms

What are options or emergency contraception?

- Levonorgestrel (plan B)

- Copper IUD

- Ullipristal (Ella)

What are the side effects of Ella?

- Headache

- Dizziness

- Fatigue

- Nausea

- Abdominal pain

- Menstrual pain

What is the criteria for Ella?

Less effective over 195 lbs

What are first trimester abortion options?

- Surgical abortion

- uterine aspiration

- D&C - dilation and curettage

- D&E - dilation and evacuation

- Medical abortion

What lab tests are required prior to abortion?

- Pregnancy test

- CBC

- STI screening

What factors go into choosing an abortive procedure?

- Gestational age

- Patient preference

- Clinician experience

- Availability of equipment

- Medical conditions

What medication has been approved for abortion?

Mifepristone

When can you use and not use Mifepristone for abortion?

- <10 weeks gestation - can use

- >12 weeks gestation - cannot use