A woman must meet 1 of which 6 criteria in order to be reasonably certain that she is not pregnant in order to give birth control
- < 7 days after start of normal menses
- No sex since LMP
- Has been correctly and consistently using reliable method of contraception
- Is < 7d after spontaneous/induced abortion
- W/in 4 weeks postpartum
- Breastfeeding, is amenorrheic and <6months postpartum
If reasonable certainty that patient is not pregnant is unmet, what 2 things should you consider doing
- Emergency contraception then start on chronic contraception
- Consider urine preg test/qualitative HCG
If reasonable certainty that patient is not pregnant is unmet, can you still start contraception? When should you follow up
- Benefits exceed risk even with uncertainty (EXCEPT FOR IUD)–> Start contraception
- F/U for preg test in 2-4 weeks
What are the 3 MOAs of contraception?
- Inhibit ovulation
- Prevent sperm from reaching egg
- Inhibit implantation
What are the 3 combined hormonal contraception options
COCs
Transdermal patch
Vaginal ring
What are the 2 long acting reversible contraception options
- IUDs (copper and levonorgestreal)
- Etonogestrel implant
What are the 3 least effective contraceptive methods
Fertility-awareness based methods
spermicide
What are the 4 MOST effective contraception options
Implants (i.e. Nexplanon)
Vasectomy
Female sterilization
IUDs (copper/levonorgestrel)
Standard days Method is for women with menstrual cycles from ____ - ____ days long
26-32
When should a woman abstain from sexual intercourse on the Standard Days method
Days 8-19
How long must you monitor cycles for the Calendar method?
- For women that dont have regular menses:
- Monitor cycles x6 months
- Avoid sex during fertile period
When should a patient avoid sex if using the Cervical Mucus/Two Day Method?
What is the “Peak Day”?
- “Peak” day= last day of “stretchy”, clear mucus
- Abstinence from time of any cervical secretion until 4d after peak day
- If no secretions x2 days- ok to have sex
When should you abstain from sex if using the Basal Body Temperature method?
from end of menstrual period until 3d after temp increase (0.5-1.0degF= ovulation)
Which 2 fertility awareness methods/natural family planning have the LOWEST typical use failure rate?
- Standard Days (12%)
- Two Day Method (13.7%)
(Calendar, Symptothermal and post-ovulation all have a typical use failure rate of 25%)
Which type of male condom is 2.5-5x more likely to slip or break than latex?
Polyurethane
What type of lubricants should be avoided with male condoms
oil/petroleum based lubricants
How long must female barrier methods (cervical caps, diaphragm, female condoms, sponge, spermicides) stay in place for after sex?
>6hrs but no longer than 24
Which contraceptive method increases risk for HIV transmission and is therefore contraindicated for those that are HIV+ or at high risk for HIV?
Spermicide
Which contraception method increases risk of UTI?
Diaphragm
Which patient population shoud the transdermal patch not be used in
women > 198lbs
What is the MOA of combined hormonal contraception? (4)
- Prevent ovulation (90-95% of MOA)
- Thickening of cervical mucus
- Thin, atrophic endometrium
- Tubal motility slowed
Combined hormonal contraception: No back up needed if start in first __days of bleed
5
Combined hormonal contraception: Monitoring
What is the only test needed prior to starting
Blood pressure
No routine f/u needed
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Vulvar19
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OB 1 Kenobi43
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OB 247
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Cervix 140
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Cervix 245
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Vaginal Disorders41
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OB 337
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OB 438
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OB 538
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OB 632
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Infertility51
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Menstrual disorders43
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Breast75
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Contraception 142
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Contraception 232
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Menopause18
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Pelvic Organ Prolapse22
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Uterine Disorders COPY COPY36
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Reproductive physiology review10
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Vulvar disorders66
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uterine disorders66
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ovarian disorders66
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menopause COPY44
