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Contraception - Coggle Diagram
Contraception
Intrauterine Contraception
Characteristics
Long Acting Reversible Contraception
Copper IUD
Charactersitics
Different makes, and sized, different lengths of use
Mechanism of Action
Prevent foertilization via sterile foreign body reaction
Endometrial cahnges that adversely affect sperm transport
Copper has direct effect on sperm motility and reduces sperm penetration
Inhibition of implantation
Indications
Emergency contraception (up to 7 days)
LNG-IUS
Characteristics
Contains levonorgestrel progestin
Effective for 5 years
Mechanism of Action
Prevention of fertilization
Endometrial changes
Cervical mucus thiceknign to create barrier
Suppresses endometrail estrogen/progestin receptors
Inhibits ovulation in some women
Indications
Treatment of heavy menstrual bleeding
Indications
Considered for women seeking reliable, reversible, coitally indepent mehtod of contraception
Suied for women who cannot use estrogen
Contrandications
Known or suspected pregnnacy, infection, Cancer, unexvaluated abnormal uterine bleeding, Distorted uterine cavity, Pelvic tuberculosis
Side effects/Risk
Unsceduled bleeding/spotting
Pain or dysmenorrhea
Uterine perforation, Infection, Explusion,Failure
Hormonal Contraceptive
Combined Oral Contraceptive Pills
Characteristics
Effective + Reversible
Estradiol + Progestin
" Low dose pill" = Pill that contains <35 mcg
Mechanism of action
Inhibits ovulation, effect on endometrium, Increase mucus plug, Tubal perstalsis
Contraindications
<4 weeks postpartum if breastfeeding, <21 days postpartum if not breastfeeding, Hypertension, VTE, Vascular disease, SLE, Smoker >35 yo, Migraine headache, Current breast cancer, Active liver disease
Benefits
Short term
Cycle regulation, decreased menstrual flow
decreasesd dysmenorrhea, PMS, Acne, Hirsutism
Long Term
Decreased risk of endometrial/ovarina cancer, fewer benign breast disease cases, Decreased colorectal Cancer
Other
Decreased incidence of PID, Ectopic pregnancy, fewer ovarian cysts, ptoential benefits on endometriosis, Improved BMD
Adverse Effects
Nausea, breast tenderness headache (resolves within a few months)
Less common: Decreased libido, unscheduled bleeding, mood changes
Rare: VTE, MI, Stroke
Cancer Risk
Reduction in uterine, ovarian cancer, Increase in Breast/Cervical cancer
Proper Use
Start
First sunday after start of menses
Day 1 Start
Quick Start: Start immediately
Continuous/Extended Use
21/7 regimen
24/4 regiment
84/7 regimen
No More than 7 days without hormones
Advantages
decreased pill free interval symptoms, conveience
Disadvantages
Unscheudled bleeding
Patch
Usage
Application to lower abdomen, upper outer arm, buttoc, torso
Effectivenes
Similar to COC
Contraindications
Same as COC, Caution for those over 198 lbs
Side effects
Similar to COC, Local skin irritatiion
Non-Contraceptive
Assumed same benefits as OC
Pharmacokinetics
Everytime patch is applied, estradiol concentration increases
Vaginal Contraceptive Ring
Usage
1 ring use per cycle
3 Weeks of ring-use, 1 ring-free week
Effectiveness
Simialr to COC
Contraindications
Same as COC
Side Effects
Similar to OC, Vaginal symptoms
No-COntraceptive benefits
Same as OC
Hormone Free interval
Want to avoid prolonged HFI, and keep FSH low to ensure ovulation does not occur
Guidelines for Missed Hormonal Contraception
1 Active pill delayed less than 24 hours
Take 1 active pill asap and continue to take daily
1 Active pil Missed
During Week 1
More than 1 pill missed
Take 1 asap, continue taking until end of pack, use backup contraception for 7 days
During Week 2 or 3
<3 pills missed
Take 1 active pill ASAP, continue taking until end of pack, discard plaebo, start new COC without hormone free interval
3 Pills Missed
take 1 active pill ASAP and continue taking until end of pack, discard placebo, Start new cycle, consider emergency contracetion if repeated
Progestin Only
Pill
Characteristics
Often used by breast feeding women/women who can't/don't want to take estrogen
Mechanism of Action
Change in mucus
Usage
3 Hr Window to take it, backup for 48 hrs if late
Take one pill each day
Side effect
Irregular bleeding due to light lining, lack of/light periods
Injectable
Mechanism of Action
Inhibits ovulation, thickens cervical mucous, atrophy of endometrium
Absolute contraindications
Known/Suspected pregnancy, unexplained vaginal bleeding, current diagnosis of braest cancer
Side Effects
Menstrual cycle distrubance, weight gain, decreased bone density, delay fertility
Non-Contraceptive Benefits
Other Medical Conditions
Menorrhagia, Dysmenorrhea, Endometriosis, Chronic Pelvic Pain
Mensutral Supresion
Advantageous for women who prefer to not have menses related symptoms, anemia or hygenic concenrs
Other Benefits
Decreased risk of ovarian and endometrial cancer, decreased seizure incidence
Nusisane Bleeding
Breakthrough Bleeding
Exclude Genital tract pathology, provide estrogen supplementation, NSAIDS, Decrease injection interval
Late for injection
If <14 weeks, give injection
If >14 weeks, given injection and backup contraception
Etibigestrel Implant
Characteristics
Subdermal single rod implaint
Progestin-only implant preloaded in sterile disposable applicator
Etonogestrel
Effective for up to 3 years
Radioopaque
Mechanism
Inhibition of ovluation, and changes in cervical mucus
concentrations are reached in 1 day
Post Implant
levels drop immediately, and ovulation resumes within 2-4 weeks for most women
Emergency Contraception
Indications
Unplanned intercourse, Failure of contraceptive, Sexual Assault
Methods
Yuzpe Method: High doses of estrogen and lenogesterole
Plan B (Progestin Only)
Approved for use within 782 hours of unprotected intercourse, Start birth control the next day
More effective the sooner it is taken
Backup contraception for 7 days
UPA-EC
Within 5 days of unportected intercourse
Do not start hormonal contraception until 5 days after UPA-EC
Copper IUD
Mechanism of Action
Inhibit ovulation, endometrial changes, effect on luteal phase
Special considerations
Follow-Up
If missed menses
LNG-EC: Available off shelf in pharmacy
Prior to Prescribing
Do a pregnancy test, a pelvic exam
Contraindications
HSR or Pregnancy
Natural Family Planning
Fertility Awareness
6-day interval ending on day of ovulation
Billings Method
Cervical Mucous (increase elasticity at ovulation)
Basal Body temperature tracking
Increase of 0.5 degree
Contraindications
Non-Compliance, Medical condition that is CI to pregnacy, Irregular cycles, STI Risk/Behaviours
Effectiveness
Efficacy: How many are prevented with correct/consistent use
Effectiveness: "Typical use" depending on efficacy and adherence
Dual Protection is Importnat in order to protect against all forms of pregnancy
Permanent Sterilization
Male Vasectomy
Must use contraception for 3 months afterward, until 2 consecutive azoospermia
Female
Laparoscopic
Cautery, rings, clips, excision
Salpinectomy - Most effective, Hulka Clips/Spring Clips - Least effective
Risks
Bleeding, infection, anesthetic reaction, organ damage
Laparotomy
Usually conduted at time of C-Section
Contraindications
Pregnancy, PID/STIs, Gynecologic malignnacy, uncertainty
Risk of Regret is prevalent
Newer Medication
Nextellis (estetrol/Drospirenone)
Estetrol Native estrogen with selectiev tissue actio (NEST) Action
Esterol: Act as agonist on vaginal, uterine, endometrial bone, brain tissue (act as antagonist in breast tissue
Slynd
POP (Micronor)
Helpful for those who want to avoid estrogen
Progestin is the formulation in Yas -> Antiandrogenic but without the added risks of estrogen