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OB Tutoring
Family Planning
| Term | Definition |
|---|---|
| Long Acting Reversible Contraception | Highly effective because they are a forgettable method of contraception. ● Includes: ○ Intrauterine Devices (IUDs) ○ Intrauterine Contraceptives (IUCs) |
| Long Acting Reversible Contraceptive: Hormonal IUDs | Release progestin. They cause inhospitable changes to cervical mucus, endometrial atrophy, and have variable effects on ovulation. They are effective for 3-8 years depending on the type. |
| Long Acting Reversible Contraceptive: Hormonal IUDs Types | ■ Skyla (Up to 3 years) ■ Kyleena (Up to 5 years) ■ Liletta (Up to 8 years) ■ Mirena (Up to 8 years ) It's important to note that these are the maximum durations of effectiveness. |
| Long Acting Reversible Contraceptive: Hormonal IUDs Types | Some IUDs may need to be replaced sooner if they become dislodged or if the user experiences side effects. |
| Long Acting Reversible Contraceptive: Copper IUDs | a non-hormonal option and can be used for up to 10 years. Can also be used as emergency contraception within 5-7 days of unprotected intercourse. ○ Inhibits sperm motility, capacitation, survival, and phagocytosis. |
| Long Acting Reversible Contraceptive: Implant (IUC) | Subdermal time-release method that delivers synthetic progestin. They work by inhibiting ovulation and thickening cervical mucus. Once in place, they deliver 3 years of continuous contraception. ○ Types: Nexplanon (Up to 3 years) |
| Short Acting Contraceptive: Combined Oral Contraceptives (COCs) | Contain both estrogen and progestin. ○ They work by increasing the viscosity of cervical mucus, suppressing ovulation, and thinning the uterine lining. |
| Short Acting Contraceptive: Combined Oral Contraceptives (COCs) | ○ Healthy nonsmokers may take the pill until the age of probable menopause (which may help control the discomforts of perimenopause). ○ COCs generally contain 21 hormone-containing pills followed by 7 placebo pills. |
| Short Acting Contraceptive: Combined Oral Contraceptives (COCs) | ○ An alternative method is known as extended cycling. (An example of an alternative method of packaging is 84 hormone pills followed by 7 placebo pills.) ○ When taken correctly, the failure rate is 0.1%. With typical use, COCs are 92% effective. |
| Short Acting Contraceptive: Combined Oral Contraceptives (COCs) | ○ Contraindications for birth control containing estrogen include migraine with aura, a history of blood clots, and hypertension. |
| Short Acting Contraceptive: Progestin-Only Pills (POPs) | Contain only progestin. ○ They are usually prescribed when estrogen is contraindicated (i.e. migraine with aura or HTN) and are safe for breastfeeding mothers ○ All 28 pills in a pack contain progestin (no placebo pills) |
| Short Acting Contraceptive: Progestin-Only Pills (POPs) | ○ Must be taken within a 3-hour window every day to be effective ■ Not a good option for someone has medication adherence issues. |
| Short Acting Contraceptive: Progestin-Only Pills (POPs) | ○ A primary side effect is a less regular period and more breakthrough bleeding. ○ If pregnancy does occur, more likely to be ectopic due to the slowing of motility of cilia in the fallopian tube in response to progestin |
| Short Acting Contraceptive: Hormonal Patches | They contain estrogen and progestin ○ Applied weekly for 3 weeks, followed by a patch-free week. ○ The “patch-free week” causes a withdrawal bleed (mimicking a period) ○ Rotate the site weekly to avoid irritation |
| Short Acting Contraceptive: Hormonal Patches | ○ Should never be applied to the breast ■ Acceptable Application Locations: upper back, upper arm, upper buttock, lower abdomen |
| Short Acting Contraceptive: Hormonal Patches | ○ Venous Thrombosis and embolism is increased with the patch, however, it is still lower than the risk of venous thromboembolism during pregnancy ■ This is d/t estrogen in the patch! |
| Short Acting Contraceptive: Hormonal Vaginal Rings | Flexible silicone rings that release estrogen and progestin. ○ They are placed inside the vagina for 3 weeks and removed for one week ○ The “ring-free week” causes a withdrawal bleed (mimicking a period) |
| Short Acting Contraceptive: Hormonal Vaginal Rings | ○ The new ring can be used for up to a year (13 menstrual cycles) left in for 21 days, removed for 7, and then repeated. ○ The ring can be removed for intercourse and left out for up to 2 hours per day. |
| Short Acting Contraceptive: Hormonal Vaginal Rings | ○ The location of the ring in the vagina is not important as long as it touches the vaginal mucosa. ○ The ring can be dislodged during a bowel movement. The nurse should teach the patient to check the placement of the ring after a bowel movement. |
| Short Acting Contraceptive: Contraceptive Injections | Progestin-only injection administered every 3 months ○ DMPA works by suppressing follicle-stimulating hormone and luteinizing hormone, therefore inhibiting follicle maturation and ovulation. ○ Concerns with DMPA include weight gain. |
| Short Acting Contraceptive: Contraceptive Injections | ○ Not recommended for use greater than 2 years ○ Patients often do not menstruate ○ Name: Depot medroxyprogesterone acetate (DMPA) (Brand Name: Depo Provera) |
| Barrier Methods: Male Condoms | Less effective as contraceptives but the best protection against STIs (other than abstinence) ○ A new condom should be used with each episode of oral, rectal, or vaginal sex with a partner whose STI status is unknown. |
| Barrier Methods: Male Condoms | ○ The condom should be applied before genital contact. ○ Condoms should be removed and discarded immediately after ejaculation. |
| Barrier Methods: Male Condoms | ○ If the condom is placed upside down (evident when the condom cannot be unrolled), a new condom should be used to minimize the risk of STI exposure. |
| Barrier Methods: Female Condoms | More cumbersome and expensive than male condoms. ○ The female condom contains two semi-rigid rings attached to the opening of a nitrile tube. |
| Barrier Methods: Female Condoms | ○ A new female condom should be used with each episode of rectal or vaginal sex. ○ The placement of the female condom is similar to the placement of a tampon. |
| Barrier Methods: Diaphragms | Flexible saucers placed in the vagina to cover the cervix. ○ They do not protect against STIs. ○ Used in conjunction with spermicide |
| Barrier Methods: Diaphragms | ○ Must be fitted; diaphragms should be refit after birth, having an abortion/miscarriage, loses/gains 10lbs, or had pelvic surgery ○ Should be replaced every 2 years |
| Barrier Methods: Contraceptive Sponges | Foam disks infused with spermicide that fits over the cervix. ○ Can be placed up to 24 hours before sex but should not be in place for more than 30 hours |
| Barrier Methods: Cervical Caps | Similar to the diaphragm but smaller and holds spermicide against the cervix to prevent passage of sperm ○ More effective in patients who have not given birth |
| Barrier Methods: Cervical Caps | ○ May be inserted up to 6 hours before intercourse and should be removed 6-48 hours after intercourse. |
| Barrier Methods: Contraceptive Gel | ○ Prescription-only ○ Does not kill sperm but alters the pH of the vagina to decrease sperm motility ○ About 14% failure rate |
| Barrier Methods: Spermicides | ○ OTC jelly, cream, or suppository that kills sperm ○ Should be inserted 10 minutes before intercourse ○ 20% failure rate if used alone ○ Most effective when used with a barrier method |
| Barrier Methods: Spermicides | ○ This may make patients more prone to UTIs, vaginal irritation, and inflammation (d/t vaginal pH) ■ Inflammation makes females more vulnerable to STIs |
| Behavioral Contraceptive: Abstinence | Abstaining from sexual intercourse |
| Behavioral Contraceptive: Fertility Awareness | ○ Cervical mucus ovulation method ○ Basal body temperature ○ Symptothermal method ○ Standard days method |
| Behavioral Contraceptive: Withdrawal (coitus interruptus) | ○ Removal of the penis from the vagina before ejaculation ○ Failure can occur if pre-ejaculate contains sperm or withdrawal is poorly timed |
| Behavioral Contraceptive: Lactational Amenorrhea Method | breastfeeding as a form of birth control |
| Natural Family Planning (NFP): Fertility Awareness | relies on the predictability of the menstrual cycle to avoid conception |
| Natural Family Planning (NFP): The Standard Days Method | Avoid intercourse on days 8-19 of the menstrual cycle if you have a 26-32 day long cycle as those days are calculated to be the most fertile days. |
| Natural Family Planning (NFP): Basal Body Temperature (BBT) Method | Measuring your body’s temperature when you are fully at rest. Temperature increases slightly, in most women, during ovulation (0.5-1°F) until the end of the menstrual cycle. The most fertile days are 2-3 days before this increase in temperature. |
| Natural Family Planning (NFP): The Cervical Mucus Method | recognizing changes in cervical mucus throughout a menstrual cycle. ○ Dry, thick, sticky, creamy → NOT fertile ○ Cloudy/Stretchy → Semi-fertile ○ Watery/Stretchy/Clear → MOST fertile |
| Natural Family Planning (NFP): The Symptothermal Method | a combination of methods. The two most common methods are BBT and cervical mucus method. |
| Emergency Contraceptive: Levonorgestrel (Plan B) | Available OTC and is most effective when taken within 72 hours (3 days) of unprotected intercourse. It works by preventing ovulation. Most effective in patients under 165 lbs. |
| Emergency Contraceptive: Ulipristal (Ella) | Available by rx only, it may be used within 120 hours (5 days) of unprotected intercourse. It works as a progestin blocker and may affect an existing pregnancy. More effective in patients above 165 lbs. |
| Emergency Contraceptive: Copper IUD | Can be inserted within 5 to 7 days of unprotected intercourse |
| Emergency Contraceptive | Emergency contraception should not be used as a primary method of “birth control” |
| Sterilization Option: Tubal Ligation | Fallopian tubes are cut, banded, cauterized, clipped or tied, & sealed. ○ Can be done immediately after a c-section, 24-48 hours after vaginal birth |
| Sterilization Option: Vasectomy | Removal of a portion of the vas deferens ○ Efficacy is assessed after 3 months ○ Generally, a safe and effective procedure |
| When selecting a method of contraception, several factors should be considered | ○ Current and future reproductive needs. ○ Rule out pregnancy before starting a new method. ○ Reliability of the method. ○ Cost, convenience, and other considerations. ○ Safety, side effects, and contraindications. |
| When selecting a method of contraception, several factors should be considered | ○ Method continuation by the client. ○ STI prevention, particularly for individuals with multiple partners. ○ Client's adherence to the method. ○ Patient's tolerance of side effects. ○ Whether the patient wants hormonal or non-hormonal methods. |
| When selecting a method of contraception, several factors should be considered | ○ Desire for pregnancy in the future. ■ Some methods are permanent or have a longer return to fertility. |
| Assessment for Use (Specific Considerations) | ● COCs: Contraindicated in patients with migraine with aura, history of blood clots, hypertension, or smoking ● Diaphragms: Should be refitted after childbirth, miscarriage, abortion, weight gain or loss of 10 lbs, or pelvic surgery. |
| Assessment for Use (Specific Considerations) | ● POPs: Must be taken within a 3-hour window daily to be effective. Contraindicated in patients with a current diagnosis of breast cancer or viral hepatitis. ● Cervical Cap: More effective for users who have not given birth. |
| Assessment for Use (Specific Considerations) | ● DMPA: Not an optimal method for patients planning on pregnancy in the next year due to delay in the return of fertility. May also worsen headaches or depression. |
| Assessment for Use (Specific Considerations) | ● DMPA: Associated with decreased bone mineral density (supplement with vitamin D/Calcium), increased weight gain, and not recommended for use greater than 2 years. |
| Assessment for Use (Specific Considerations) | ● IUCs/IUDs: Patients need to be screened for gonorrhea and chlamydia to prevent the risk of ascending infection and pelvic inflammatory disease (PID). A pregnancy test is required before the insertion of a copper IUD. |
| Assessment for Use (Specific Considerations) | ● Contraceptive Ring: Can alter vaginal pH, leading to yeast infections. Consider another method if the patient is diabetic or prone to yeast infections. |
| Assessment for Use (Specific Considerations) | ● Contraceptive Patch: Place on the upper back, arm, buttock, or lower abdomen, but not on the breast. Rotate sites to prevent irritation. |
| Risk Factors | ● Hormonal Methods (COCs, Patch, Ring): ○ Increased risk of blood clots. |
| Risk Factors | ● POPs: ○ Less regular periods, but more breakthrough bleeding. ○ If pregnancy occurs, more likely to be ectopic due to decreased motility of cilia in the fallopian tubes. ○ Must be taken within a 3-hour window daily to be effective. |
| Risk Factors | ● Contraceptive Injections (DMPA): ○ Weight gain. ○ May worsen headaches or depression. ○ Associated with decreased bone mineral density. ○ Delay in return to fertility. |
| Risk Factors | ● IUCs/IUDs: ○ IUD (Incl. Copper IUD): Perforation of the uterus. ○ IUD (Incl. Copper IUD): Spontaneous expulsion. ○ Copper IUD: May cause longer, heavier periods and cramping). ○ Hormonal IUD: May cause spotting, unscheduled bleeding, and amenorrhea. |
| Risk Factors | ○ IUD (Incl. Copper IUD): Risk of ascending infection and PID if not screened for STIs. ■ Not to be confused with: PID Incidence Reduction noted with DMPA |
| Risk Factors | ● Barrier Methods: ○ Some methods may be less effective as contraceptives compared to hormonal or long-acting methods. ● Spermicides: 20% failure rate if used alone. |
| Risk Factors | ● Spermicide: This may increase the risk of UTIs, vaginal irritation, or inflammation. This inflammation makes female patients more vulnerable to STIs. ● Sterilization: ○ Tubal ligation is a surgical procedure with risks of complications |
| Risk Factors | ● Emergency Contraception: ○ Levonorgestrel (Plan B): May not be as effective in patients who weigh over 165 pounds ○ Ulipristal (Ella): may affect an existing pregnancy. |
| Discontinuation | ● Patient becomes pregnant ● Changes in reproductive goals ○ If a patient desires pregnancy. ● Adverse side effects or safety concerns. ● Development of contraindications ○ onset of migraines with aura, hypertension, or history of blood clots. |
| Discontinuation | ● Method failure or patient dissatisfaction. ● For IUDs, report new acute cramping, which may indicate the IUD has perforated the cervix/uterus ● For DMPA, not recommended for use longer than 2 years due to bone mineral density concerns |
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