Contraception

Question 1

Shared decision making

Answer 1

• Decide jointly on a contraceptive method
• Consider barriers and benefits
• Individualized
• Patient should be active participant
• Consider when she wants to conceive, what is important to her, what concerns her

Question 2

Considerations impacting choice of contraception

Answer 2

• HER PREFERENCES
• Motivation
• Cost
• Cultural/religious considerations
• Convenience
• Effectiveness (most important)
• Side effects
• Safety
• STI protection

Question 3

Address prior knowledge

Answer 3

• Past contraceptive use

- Myths and misconceptions

Question 4

Triangle for helping patients decide

Answer 4

• Begin with what is most important to her
• Explain contraindications
• Support her choice
• Offer other choices if necessary

Question 5

Nurse’s role with contraceptives

Answer 5

• Make sure patients know about available methods
• Educate them about use
• Ensure they have follow-up care

Question 6

Effectiveness of methods

Answer 6

• Most effective = implant, vasectomy, female sterilization, IUD
• Middle = injectable, pills, patch, ring, diaphragm
• Least = male condoms, female condoms, sponge, withdrawal, spermicides, fertility awareness

Question 7

Failure rate

Answer 7

• Number out of every 100 women who experienced an unintended pregnancy within the first year of typical use

Question 8

Two types of BC

Answer 8

Hormonal and non-hormonal

Question 9

Hormonal BC

Answer 9

• Pills
• Injection
• Patch
• Ring
• IUD: mirena, skyla
• Implant

Question 10

Non-Hormonal BC

Answer 10

• Paragard IUD
• Condoms
• Diaphragm/sponge
• Natural family planning
• Withdrawal

Question 11

Birth control pills

Answer 11

• Long lasting but not permanent
• Alter hormones: estrogen and progestin or progestin only used to inhibit ovulation
• Also alter cervical mucus to inhibit sperm penetration
• No STI protection
• 9% failure with typical use and 0.3% with perfect use
• Antibiotics can render ineffective

Question 12

Contraindications for combined BC pills

Answer 12

• Over 35 and smoker
• HTN
• DVT
• Migraines with aura
• Breast cancer
• Complicated diabetes
• Certain anticonvulsants
• Lupus
• Cardiac risk factors

Question 13

Progestin only pills

Answer 13

Use for:

• Breastfeeding moms
• Women over 35 who smoke

Question 14

Depo-Provera Injection

Answer 14

• Progesterone-only contraceptive
• Q12 weeks
• Potential for bone loss
• May give in mother baby
• Can cause problems with breastfeeding
• 6% failure with typical use and 0.3% failure wtih perfect use
• MOA: suppress ovulation and production of hormones, thickens cervical mucus, causes endometrial atrophy

Question 15

Ring

Answer 15

• Flexible, soft ring inserted into vagina for 3 weeks then take out for one week (period)
• Insert as far back as possible
• Estrogen and progestin
• Reduced side effects because absorbed directly into blood stream
• 9% failure with typical use and 0.3% failure with perfect
• MOA: Inhibit ovulation, change cervical mucus and endometrium

Question 16

Patch

Answer 16

• Matchbox size placed anywhere but breasts
• 3 weeks on then patch-free week (period)
• Side effects reduced because absorbed directly into bloodstream
• Risk of DVT and PE
• Hormones: estrogen and progestin
• 9% failure with typical and 0.3% failure with perfect
• MOA: prevent ovulation, also change cervical mucus

Question 17

Implant

Answer 17

• Steady dose of progestin: prevents ovulation and thickens mucus
• 3 years of protection
• Rod: Minor surgery to insert and remove
• Side effects: irregular bleeding, headache, weight gain, breast tenderness, depression
• 0.05% failure with typical use

Question 18

Contraindications for nexplanon implant

Answer 18

• Pregnancy
• Active DVT
• Severe hepatic disease
• Personal hx of breast cancer
• Undiagnosed vag bleeding
• Inability to tolerate irregular period

Question 19

Long acting reversible contraceptives

Answer 19

IUD: mirena, skyla, paragard
Impants: nexplanon

Question 20

ParaGard

Answer 20

• Copper IUD
• Use up to 10 years or as emergency contraception
• No hormones
• MOA: impairs viability of sperm and interferes with sperm movement

Question 21

Skyla

Answer 21

• Hormonal IUD
• Smaller than Mierna
• Approved for up to 3 years
• Good for nulliparas

Question 22

Mirena

Answer 22

• Hormonal IUD
• Approved for up to 5 years
• Amenorrhea in 20% of users by 1 year

Question 23

MOA of hormonal IUD

Answer 23

• Progestin only
• Creates inflammatory response = fatal to sperm
• Thicken cervical mucus
• Ovulation NOT INHIBITED
• Thin endometrial lining

Question 24

IUD contraindications

Answer 24

• Pregnancy
• Cervical malignancy
• Breast/endometrial cancer
• Distorted uterine cavity
• Current PID
• Current purulent discharge
• Wilson’s disease (just for copper IUD)

Question 25

Barrier method

Answer 25

- Physically prevent sperm from reaching ovum - Many contain latex - Diaphragm, cervical cap, condom, sponge

Question 26

Diaphragm

Answer 26

- Soft latex dome surrounded by metal ring - Use with spermacide jelly - Insert up to 4 hours before sex and leave in 6 hours after - Rx and professionally fitted - 12% failure with typical and 6% with perfect

Question 27

Spermacide

Answer 27

- Substance that is toxic to sperm - Frequent use can breakdown vag tissue and increase HIV susceptibility - Most effective when used with barrier method - 28% failure with typical and 18% perfect

Question 28

Sterilization

Answer 28

- Popular in developed nations - More women than men have it (18% women and 7% men) - Permanent but reversal is possible

Question 29

Tubal ligation

Answer 29

- Can happen during c/s, PP, after abortion or procedure unrelated to pregnancy - Laparoscope near umbilicus - Seal, cut, tie fallopian tubes - 0.5% failure with typical and 0.1% perfect

Question 30

Essure

Answer 30

- Transcervical sterilization - Visualize fallopian tubes through cervix so don't need anesthesia or surgery - Introduce coil into tube which blocks tube within 3 months

Question 31

Vasectomy

Answer 31

- Outpatient w local anethesia - Cut vas deferens - Still have semen but no sperm (have semen specimen) - 0.15% failure with typical and 0.1% with perfect

Question 32

Fertility awareness methods

Answer 32

- Cervical mucus ovulation method: clear, slippery, smooth, stretchy = fertile - Basal body temp: temp rises postovulation and stay until menses - Symptothermal method: identify s/s and monitor temp - Standard days and 2 days: avoid intercourse on days 8-19 of cycle - 24% failure with typical

Question 33

Important tips with fertility awareness

Answer 33

- Women must know their bodies and be comfortable touching themselves - Less convenient and spontaneous - Must communicate openly with partner

Question 34

Lactational amenorrhea method

Answer 34

- Continuous breastfeeding can postpone ovulation because stimulated prolactin and inhibits gonadotropin (needed for ovulation) - Good for 6 months PP but only with no period, BF 6x/day, on demand, no supplements, nighttime feeds Q6 hours - 1-2% failure

Question 35

Withdrawal

Answer 35

- Pull and pray - Least effective - Pre-ejaculate may contain sperm, requires lots of control and trust - 22% failure with typical and 4% with perfect

Question 36

Emergency Contraception

Answer 36

- Use within 72 hours unprotected sex - The sooner the better - Reduces pregnancy risk by 80% - Plan B, copper IUD - Side effects: N/V - Do not use as regular contraception - MOA: delays ovulation, thickens mucus