- levonorgestrel (Mirena - Skyla - Liletta

(estrogen and progesterone) - for 3 wks - greater risk of thrombosis

Contraception Flashcards by Sammy Adhikari

2 general contraceptive mech’s

inhibit formation and release of egg

- mechanical, chemical, or temporal barrier b/w sperm and eggq

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Hormonal contaceptives

pills
injectable
implantable
IUD
contraceptive patches
contraceptive rings

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Injectable

-depo medroxyprogesterone acetate (DepoProvera)

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Implantable

-etonogestrel rod implant (Nexplanon)

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IUD

levonorgestrel (Mirena
Skyla
Liletta

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Contraceptive patches

-OrthoEvra

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Contraceptive rings

NuvaRing

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Oral Contraceptives- combo- moa

suppress GnRH- suppression of FSH and LH
progesterone- major player- suppress LH and ovulation, thicken cervical mucus, creates an unfavorable atrophic endometrium for implantation
estrogen- improves cycle control- stabilize endometrium, allows less breakthru bleeding

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Progesterone- consider what?

androgenic effect!!

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Progestin-only oral contraceptives (mini-pill)- moa

make cervical mucous thick and impermeable
ovulation continues in 40%
used in breastfeeding women and women how have a contraindication to estrogen!!

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Oral contraceptives- benefits

menstrual cycle regularity
improve dysmenorrhea
dec risk of iron def anemia
lower incidence of endometrial and ovarian cancers

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oral contraceptives- SE’s

breakthru bleeding- in 1st 3 months
amenorrhea
mild SEs- bloating, breast tenderness, nausea, fatigue, HA

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oral contraceptives- serous SE’s

venous thrombosis!!
PE!!
cholestasis and gallbladder dz
stroke and MI
hepatic tumors

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Transdermal patch

(estrogen and progesterone)

for 3 wks
greater risk of thrombosis

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vaginal ring

(estrogen and progesterone)

-for 3 wks

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who CANT use oral contraceptives?

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> 35 yo and smoke cigarettes
hx of thromboembolic event
CAD, cerebral vascular dz, CHF, migraine with aura, uncontrolled HTN
liver dz/tumors

Depot Medroxyprogesterone Acetate (Depo Provera)

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IM injection every 11-13 wks
maintains contraceptive level of progestin for 14 wks
thickens cervical mucus, decidualization of endometrium, blocks LH surge and ovulation

Depot Medroxyprogesterone Acetate (Depo Provera)- bone effects?

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alterations of bone metabolism (dec estrogen levels)

- reversible after discontinuation

Depot Medroxyprogesterone Acetate (Depo Provera)- SEs

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irregular bleeding!- menses can take up to a yr to regulate after discontinuation
weight gain (hungry)
exacerbation of depression!!!

Depot Medroxyprogesterone Acetate (Depo Provera)- contraindications

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pregnancy
vaginal bleeding
malignancy of breast
thromboembolic events
liver dz

LARCs

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-implants and IUDs

Implant

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etonogestrel- Nexplanon

Nexplanon

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radiopaque, implant- etonogestrel
used for 3 yrs
moa- thickens cervical mucus, inhibits ovulation

Nexplanon- SEs

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irregular vaginal bleeding
HA
weight inc
breast pain

Nexplanon- contraindications

- pregnancy - liver tumors/ active liver dz - breast cancer- only absolute contraindication!!

Nexplanon- complications with insertion

- infection - deep insertion - persistent pain or paraesthesia at insertion site

IUD- 3 available in US

- copper T (paragard) - levonorgestrel releasing- Mirena/Liletta and Skyla - expulsion rate- 1-5%

risks with IUDs

- infection within 1st 20 days - ectopic pregnancy - uterine perforation - malposition

IUDs- contraindications

- breast cancer - puerperal sepsis - septic abortion - cervical infection - wilsons dz (copper T) - uterine malformations

Levonorgestrel IUDs

- Mirena- 5 yrs - Liletta- 3 yrs - Skyla- 3 yrs

IUDs- benefits

- dec in menstrual blood loss - less dysmenorrhea - protection of endometrial lining from unopposed estrogen - convenient, long-term

Copper T (paragard)

- 10 yrs | - copper interferes with sperm transport or fertilization and prevention of implantation

barrier contraceptives

- condoms - diaphragm - cervical cap - sponge - spermicides

diaphragms

- must be used with a spermicide - must be left for 6-8 hrs after intercourse - more likely to get UTIs

fertility awareness methods

- calendar methods (cycle beads) - basal body T method (0.5 to 1 degree change at time of ovulation- avoid sex for 3 days after) - cervical mucus method - symptothermal method (cervical mucus and basal body T)

Emergency contraception

- prevent ovulation and fertilization - plan B- progestin only (levonorgestrel)- 2 pills, use within 120 hrs!!! - Ella- ulipristal acetate- up to 5 days- postpones follicular rupture/inhibit or delay ovulation

Sterilization decision- counsel pts

- permanent - address all other options- LARCs - reasons for choosing sterilization - risks/benefits - screen for regret (esp at young age) - possibility of failure and inc risk of ectopic pregnancy

male sterilization

Vasectomy | -occlusion of vas deferens

Female sterilization

-laparoscopy, mini-laparotomy, hysteroscopy

Contraception Flashcards

(39 cards)