Transcript Slide 1

Contraceptive Methods
Volume I
Ana H. Corona, DNP, FNP-BC
July 2013
Revised
Learning Objectives
• COURSE OBJECTIVE: The
purpose of this course is to
provide an overview of the
historical, legal, social and
cultural issues surrounding the
practice of contraception/family
planning; the factors involved
in choosing and using
contraception; and the
advantages and
disadvantages of various
methods of contraception.
• •Outline the personal and public
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health benefits of
contraception/family planning.
•Identify the social and cultural
issues involved in
contraception/family planning.
•Discuss the trends and disparities
in use of contraception.
•Identify populations of women at
high risk of unintended pregnancy.
•Delineate the factors affecting
use of contraception.
•List the advantages and
disadvantages of available
contraceptive methods.
Methods of Contraception
Categories
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Fertility awareness
Situational
Spermicidal
Barrier
Long-acting reversible
Shorter-term hormonal
Permanent (sterilization)
Clinical interruption of pregnancy (medical/surgical abortion)
• These methods demonstrate differing levels of effectiveness, side
effects, cost, ease of use, and other advantages and disadvantages.
Oralcontraceptives
What are they?
• Prescription tablets taken once a day
• There are two main types:
1. Combination pill which contains two female hormones
similar to the body’s own estrogen and progesterone
2. Progestin-only pill (or mini-pill) which does not
contain estrogen (are more likely to cause breakthrough
bleeding)
• Available under a variety of brand names with various
strengths and formulations
Failure rate: 80 per 1000 women per year
COCs: Mechanisms of Action
Suppress ovulation
Reduce sperm transport
in upper genital tract
(fallopian tubes)
Change endometrium making
implantation less likely
Thicken cervical mucus
(preventing sperm
penetration)
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Oral Contraceptives
• The estrogen compound used in most oral
contraceptives is estradiol and is always
used with a progestin.
• May cause fluid retention.
• Blood Pressure should be checked
periodically
• Effects on Reproduction. When used
throughout a menstrual cycle with
progesterone:
• Estrogen changes the cellular structure of
the endometrium and prevents implantation
of a fertilized egg.
Progesterone
• A high level of progesterone is maintained which
blocks the actions of LH (stimulates corpus
luteum), and FSH and prevents ovulation.
• The result is that no new egg follicles are
developed and no ovulation occurs.
• It changes the lining of the uterus and makes it
more difficult for the fertilized egg to implant.
• Keeps the cervical mucus thick and sticky
serves as barrier against entry of sperm into the
uterus.
• Inhibiting sperm transport by reducing fallopian
tube mobility.
Combined Oral Contraceptives Types
• Monophasic: All 21 active pills contain a fix
dosage (same amount) of Estrogen &
Progestin (E/P) throughout the cycle.
• Biphasic: 21 active pills contain 2 different
E/P combinations (e.g., 10/11)
• Triphasic: 21 active pills contain 3 different
E/P combinations (e.g., 6/5/10)
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What are the advantages?
1. One of the most effective reversible birth control
methods when taken consistently and reliably
2. Simple and easy to use
3. Regulates menstrual cycle and reduces cramps
4. Does not interfere with intercourse
5. Decreases acne
6. Reduces the risks of endometrial and ovarian
cancer
7. May reduce perimenopausal symptoms
What are the Disadvantages?
1. Must be taken every day. The progestin-only pill must
be taken at the same time every day
2. May cause irregular bleeding or spotting
3. Effectiveness may be reduced by other medications
4. Should not be used by women over the age of 35 who
smoke
5. May increase the risk of thromboembolic disease In
users of these oral contraceptives, particularly in women
who have certain blood disorders or a family history of
blood clots
6. Does not protect against STIs
7. May increase the number of headaches
8. May not be suitable for breastfeeding women
Who Can Use COCs
Women:
• Of any reproductive age or parity who want
highly effective protection against pregnancy
• Who are postpartum and are not breastfeeding
(begin after third week)
• Who are postabortion (start immediately or
within 7 days).
• Women with Anemia
• Irregular menstrual cycles
• Severe menstrual cramping
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COCs: Who Should Not Use
COCs should not be used if a woman:
– Is pregnant (known or suspected)
– Is breastfeeding (can take progestin only)
– Is jaundiced (symptomatic viral hepatitis or
cirrhosis)
– Has ischemic heart disease or stroke (current
or history of)
– Has blood clotting disorders (deep vein
thrombophlebitis or pulmonary embolus)
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COCs: Who Should Not Use - continued
COCs should not be used if a woman:
– Is a smoker and age 35 years or older
– Has diabetes (> 20 years duration)
– Has headaches (migraine)
– Has high blood pressure
– Has breast cancer
– Has liver tumors
– Has to undergo major surgery with prolonged
bed rest
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COCs: Conditions Requiring Precautions
COCs are not recommended unless other methods
are not available or acceptable if a woman:
– Is < 4 weeks postpartum (even if not
breastfeeding)
– Has unexplained vaginal bleeding (only if serious
problem suspected)
– Has high blood pressure
– Has a history of breast cancer
– Has symptomatic gall bladder disease
– Is taking drugs for epilepsy (phenytoin or
barbiturates) or tuberculosis (rifampin)
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COCs: Conditions for Which There Are No
Restrictions
• Age
• Diabetes (uncomplicated or < 20 years
duration)
• Endometriosis
• Genital tract cancers (cervical, endometrial or
ovarian)
• High blood pressure - mild hypertension
• Pregnancy-related benign jaundice
(cholestasis)
• Trophoblastic disease (benign or malignant)
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COCs: When to Start
• Anytime you can be reasonably sure the
client is not pregnant
• Days 1B7 of the menstrual cycle
• Postpartum:
– after 4 weeks if not breastfeeding
• Post-abortion (immediately or within 7
days)
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COCs: Common Side Effects
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Amenorrhea
High blood pressure
Nausea/dizziness/vomiting
Bleeding/spotting
Acne
Breast fullness or tenderness (mastalgia)
Chest pain (especially if it occurs with
exercise)
• Depression (mood change or loss of libido)
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COCs: Client Instructions
• Take 1 pill each day, preferably at same time of
day.
• Take first pill on first to seventh day (first day
preferred) after beginning of your menstrual
period.
• Some pill packs have 28 pills. Others have 21 pills.
When 28-day pack is empty, immediately start
taking pills from a new pack. When 21-day pack is
empty, wait 7 days and begin taking pills from new
pack.
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COCs: Client Instructions
• If you forget to take 1 pill, take it as soon as you
remember, even if it means taking 2 pills on 1
day.
• If you forget to take 2 or more pills, you should
take 2 pills every day until you are back on
schedule. Use a backup method (e.g., condoms)
or do not have sex for 7 days.
• If you miss 2 or more menstrual periods, you
should go to the clinic to check to see if you are
pregnant.
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ACHES
• Abdominal pain (severe)
• Chest pain (severe), cough, shortness of
breath
• Headache (severe), dizziness, weakness,
or numbness
• Eye problems (vision loss or blurring),
speech problems
• Severe leg pain (calf or thigh)
Morning after pill
• Norgestrel and ethinyl estradiol are
administered as soon after unprotected
intercourse as possible and repeated 12
hrs after.
• Should be no longer than 72 hours after
unprotected sexual intercourse
Emergency Pill
• Plan B
• Levonorgestrel
Seasonale
• I tablet every day for 91 day regimen
• Women can predict having menstrual
cycle every 3 months
Injectablecontraceptive
What is it?
• It contains a hormone called progesterone; it does not
contain estrogen
• The injection is given in the upper arm or buttocks every
12 to 13 weeks (every 3 months, four times a year)
How does it work?
• Prevents the ovary from releasing an egg
• Thickens the cervical mucus making it difficult for sperm to
get to the egg
• Changes the lining of the uterus making implantation
difficult
Failure rate: 30 per 1000 women per year
What are the advantages?
1. One of the most effective reversible birth control methods available
2. Does not contain estrogen
3. No daily contraceptive routine required; 1 injection lasts for 3 months
4. Effectiveness is not reduced by other common medications
5. May be suitable for breastfeeding women or women who smoke
6. With continued use, menstrual cycles cease in over half of users after the
first year, and two-thirds of users after two years of use
7. Improves symptoms of endometriosis
8. Reduces the risk of endometrial cancer
9. Effective immediately when given during the first 5 days of a normal
menstrual period
10. it is inexpensive
What are the Disadvantages?
1. Initially, irregular bleeding is the most common side effect
2. Decrease in bone mineral density which may be reversible
when a woman stops taking the injection. Calcium
supplementation is advised.
3. May be associated with weight gain in some women
4. Takes an average of nine months after the last injection for
the ovaries to start releasing eggs again
5. Does not protect against STIs
6. The lack of a monthly period may be bothersome for some
women
Side-Effects of Hormonal Contraception
During the 1st few months on hormonal contraception:
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Irregular bleeding, spotting
Nausea
Mood swings
Bloating
Breast tenderness
Headaches