Term | Definition |
Family Planning | Choosing if and when to have children including contraceptives to avoid pregnancy and methods to achieve pregnancy. |
Role of the Nurse | Counselor
Educator |
Contraceptive Methods (Definition) | Methods to prevent pregnancy. |
Contraceptive Methods: Hormonal (Temporary) | Combination Pill
Morning-after pill
Progestin Only |
Female Hormones | Estrogen
Proestrogen |
Estrogen | Required for development and maintenance of female reproductive system.
Develop female secondary sex characteristics. |
Proestrogen | Diminishes endometrial tissue proliferation.
Increases basal body temperature.
Thickens vaginal mucosa.
Relaxes uterine smooth muscle.
Stimulates mammary alveolar tissue growth.
Alterations in menstrual blood flow. |
Combination Pill | Contains both estrogen and proestrogen.
Taken on 5th-25th day of each cycle.
Prevents ovulation, causes changes in endometrium and alterations in cervical and tubual transtport.
99% effective IF used correctly. |
Combination Pill: Side Effects | Weight gain, N/V, spotting & breakthrough bleeding, Amenorrhea, Breast Tenderness, Headache, Chloasma, Irritability, Nervousness, Depressed, Decreased Libido |
Combination Pill: Complications | Benign Liver Tumors
Gallstones
MI
Thromboembolism
Stroke |
Combination Pill: Contraindications | Hx of cardiovascular liver disease
HTN
Breast or Pelvic Cancer
Caution with DM
Caution with sickle cell anemia |
Combination Pill: Pt Teaching | Correct use of pill.
Same time of day.
If day missed, take 2 following day.
Review S/E & contraindications
Report signs of: Cramps in legs or edema. Chest pain.
Periodic check ups.
Danger signs.
Avoid phenytoin, phenobarbital, ABx
Discourage smoki |
Contraceptive Methods: Categories | Hormonal
Barrier
Behavioral
Surgical |
Combination Pill: Action | Lower level of estrogen in pill prevent pituitary gland from releasing LH. With no LH present, egg does not mature and ovulation does not occur. |
Morning After Pill | Norgestrek (500mg) and ethinyl estradiol (50mcg)(Ovral).
98.4% Effective
Creates hostile uterine lining and alters tubal transport. |
Morning After Pill: S/E & Complications | Nausea for 1-2 days
Doesn’t prevent ectopic pregnancies
At risk for hormonal complications of:
abdominal pain
chest pain
cough
shortness of breath
headache
dizziness
weakness
leg pain |
Morning After Pill: Pt Teaching | Take 2 pills within 72 hours of coitus
Repeat if vomiting occurs
Take 2nd dose 12 hours later
Menses should return within 2-3 weeks
Start ongoing method of contraception immediately after menses |
Progestin Only Pills | Taken daily with no pill-free days
Preferred for breast feeding women
Inhibits ovulation
Thickens cervical mucus
Alters uterine lining
Lower cardiovascular risk then combination pills |
Progestin Only Pills: S/E & Complications | Menstrual changes
Breakthrough bleeding
Prolonged cycles or amenorrhea
Increase in functional cysts of the ovary
Increase in ectopic pregnancy |
Progestin Only Pills: Pt Teaching | Use alternate contraception when starting or if pill is missed
Take pill at same time every day
Keep record of menses and get pregnancy test if 2 weeks late |
Medroxyprogesterone (Depo-Provera) | Progestin only drug given by injection every 3 months.
Private, convenient and highly effective method
Efficacy similar to that of surgical sterilization |
Medroxyprogesterone (Depo-Provera): S/E & Complications | Amenorrhea
Headaches
Bloating
Weight Gain
Return of fertility may take several months |
Medroxyprogesterone (Depo-Provera): Pt Teaching | Return every 3 months for injections
Discontinue method for several months before planning to conceive. |
Levonorgestrel (Norplant) | Progestin only subdermal implant
Six capsules provide protection for 5 years
Continuous, long term contraception
Failure rate extremely low |
Levonorgestrel (Norplant): S/E & Complications | Menstrual irregularities
Amenorrhea
ABD Pain
Headaches
Weight Gain
Surgical removal after 5 years |
Levonorgestrel (Norplant): Pt Teaching | Effective after 24 hours
Keep arm dry for 48 hours
Report arm pain
Implants are soft ad flexible
Expect irregular bleeding
Report any other changes
Continue to protect against (STI)
Have implants removed after 5 years |
Barrier Methods | Diaphragms
Cervical Cap
Condoms |
Diaphragms | Dome-shaped latex cap with metal ring that covers the cervix
Inner surface coated w/ spermacide before insertion
Provides mechanical barrier to sperm
Prescription & fitting needed.
87% effective when used correctly. |
Diaphragms: Complications | Allergy to latex or spermacide |
Diaphragms: Pt Teaching | Demonstrate how to hold, insert and remove on model and allow practice sessions
Insertion may be just prior to coitus, but removal should be 6-8 hours after
Empty bowel and bladder before insertion |
Cervical Caps | Rubber thimble shaped shield covering cervix and held in place by suction.
Spermicide placed in inner surface.
Fitted by professional.
Effectiveness similar to diaphragm. |
Cervical Cap: Complications | Allergy to rubber or spermicide.
Possible irritation or erosion of the cervix. |
Cervical Cap: Pt Teaching | Provide sufficient time for practice with insertion and removal
Instruct on cleaning, storing and inspecting for damage |
Male Condom | Thin rubber sheath fitting over an erect penis providing mechanical barrier to sperm.
85% effective if no failure from tearing or slipping.
Provides some protection against STIs and HIV |
Male Condom: S/E & Complications | Allergy to rubber
Decrease in sensation
Interfere with foreplay |
Female Condom: | Double-ring system fitted into vagina up to 8 hours before intercourse
Provides protection against HIV, cytomegalovirus and Hep-B
No significant side effects and generally acceptable to couple |
Female Condom: Pt Teaching | Discuss insertion, lubrication and method of removal
More expensive than male condoms |
Other Methods | Intrauterine Device (IUD)
Rhythm Method |
Intrauterine Device (IUD) | Inserted into the uterus and are made of flexible plastic or copper wire.
Can be medicated or unmedicated
Contraception provided by inflammatory response in endometrium
97-99% effective |
Intrauterine Device (IUD): S/E & Complications | Increased menstrual flow
Intramenstrual bleeding and cramping
Ectopic pregnancy
Pelvic infection
Perforation of uterus
Infertility
Undetected expulsion leading to pregnancy |
Intrauterine Device (IUD): Pt Teaching | Discuss Procedure
Check for string to vagina after every period
Annual pelvic exams |
Rhythm Method | Complies with all religious doctrines
Abstinence during fertile portion of menstrual cycle
Requires strong motivation and self control
60-65% effective
Failure results from difficulty calculating day of ovulation and irregularity of menses |
Rhythm Method: Complications | Inaccurate or incomplete knowledge of menstrual cycle |
Rhythm Method: Patient Teaching | Discuss methods to establish baseline menstrual patterns and identify ovulation.
Instruct on calendar or basal body temperature method to determine ovulation and fertile period. |
Surgical (Permanent) Methods | Tubal sterilization
Hysterectomy
Vasectomy |
Tubal Sterilization | Permanently prevents sperm and ovum from meeting.
Achieved through crushing, ligating, clipping or plugging of fallopian tubes.
Nearly 100% effective.
Failure due to recanalazation of Fallopian tubes |
Tubal Sterilization: Complications | Bowel injury
Hemorrhage
Infection |
Tubal Sterilization: Patient Education | Ensure understanding of procedure
Ensure consent form is signed
Procedure may require short term hospitalization depending on procedure |
Hysterectomy | Removal of uterus
100% effective
ONLY performed for other diseased processes.
Sterility secondary benefit when desired. |
Vasectomy | Bilateral surgical ligation and resection of ductus deferens |
Vasectomy: S/E | Hematoma
Edema
Psychological Adjustment |
Vasectomy: Pt Teaching | Outpatient procedure taking 15-30 minutes
Alternatives form of contraception is needed until no sperm are seen on examination
Explain procedure does not affect masculinity. |