Considerations in choosing contraceptives ppt

Questions and Answers

What is the significance of the Pearl Index in contraceptive methods?

It assesses the non-contraceptive benefits of contraceptive options.

It indicates the user motivation required for different contraceptive methods.

It measures the cost-effectiveness of various contraceptive methods.

It quantifies the pregnancy rate for a specific contraceptive over a year. (correct)

Which of the following characteristics is NOT considered when prescribing contraception?

Efficacy

Cost

Patient's previous sexual partners (correct)

Accessibility

Which tier of contraceptive efficacy includes methods with a Pearl Index of 6-12?

Effective methods (correct)

Least effective methods

Most effective methods

Barrier methods

What is a major health risk associated with pregnancy that outweighs the risks of any contraceptive method?

Higher mortality risk in childbirth Signup and view all the answers

What is the main challenge in using barrier methods effectively?

They depend heavily on user motivation. Signup and view all the answers

Which of the following methods is classified as a Long-Acting Reversible Contraceptive (LARC)?

Nexplanon Signup and view all the answers

What is a common side effect associated with the use of barrier methods?

Local irritation from spermicide use Signup and view all the answers

Which group of contraceptives is generally considered least effective?

Barrier methods Signup and view all the answers

What happens immediately after ejaculation when using a penile condom?

Hold the rim of the condom and withdraw while still erect. Signup and view all the answers

Which of the following statements about oral contraceptives is true?

They typically mimic typical cyclical hormone levels. Signup and view all the answers

Which contraception method has a failure rate of 12%?

Diaphragm Signup and view all the answers

What is the maximum amount of time a diaphragm can be used before needing replacement?

2 years Signup and view all the answers

What is a notable risk for women over age 35 who smoke regarding hormonal contraception?

They should avoid combination oral contraceptives. Signup and view all the answers

Which method can be inserted prior to erection and left after ejaculation?

Vaginal condom Signup and view all the answers

Which of these is a benefit of estrogen-progestin contraceptives?

Improvement of PMS symptoms Signup and view all the answers

What should be used alongside a cervical cap for effectiveness?

Spermicide Signup and view all the answers

What is the primary mode of action of Nexplanon?

Thickens cervical mucus and decreases tubal motility Signup and view all the answers

What is the recommended follow-up for a woman who has had a baby concerning the diaphragm's size?

Consult a doctor for a new fitting. Signup and view all the answers

Which factor is most crucial to consider when assessing the suitability of a contraceptive method for a patient?

Patient's medical status Signup and view all the answers

What is a significant reason for the higher rate of unintended pregnancy among women below the poverty level?

Economic disparities that limit access to effective contraception Signup and view all the answers

What is the primary characteristic of methods classified under the most effective tier of contraceptive efficacy?

Pearl Index of 1 or less Signup and view all the answers

What is a common misconception about barrier methods of contraception?

They are designed to be used without spermicide Signup and view all the answers

The Pearl Index indicates that a lower index signifies what in terms of contraceptive methods?

More effective contraception Signup and view all the answers

Which of the following options is a key aspect of the basic rules of contraceptive choice?

Assess the patient's life quality and reproductive desires Signup and view all the answers

Which statement about the failure rates of barrier methods is accurate?

They typically fail at a rate of 12-18% with typical use Signup and view all the answers

What is an important non-contraceptive benefit of using condoms?

Guaranteed prevention of STIs Signup and view all the answers

What is a crucial step when using a penile condom correctly?

Start at the tip and leave space at the tip for semen Signup and view all the answers

What is a limitation of using a vaginal condom like FC2?

There is limited data on its efficacy. Signup and view all the answers

What is one requirement for using a diaphragm?

Requires a prescription from a provider. Signup and view all the answers

What role does spermicide play in the use of a cervical cap?

It enhances the cap's contraceptive efficacy. Signup and view all the answers

Which hormonal contraceptive method mimics typical cyclical hormone levels?

Combined oral contraceptives Signup and view all the answers

What is an adverse effect associated with lowering estrogen levels in oral contraceptives?

Greater risk of unscheduled bleeding Signup and view all the answers

What is the primary action of the Nexplanon contraceptive implant?

Thins the endometrium Signup and view all the answers

What is a common reason women discontinue the use of oral contraceptives?

Irregular bleeding patterns Signup and view all the answers

What can result from using a diaphragm incorrectly?

Increased pregnancy risk Signup and view all the answers

What is a significant benefit of estrogen-progestin contraceptives aside from pregnancy prevention?

Improvement of PMS symptoms Signup and view all the answers

What is a significant risk associated with surgical management of elective operative termination in the first trimester?

Uterine perforation Signup and view all the answers

What is the mechanism of action for mifepristone in medical termination of pregnancy?

Blocks progesterone Signup and view all the answers

Which of the following is a common side effect experienced by women after taking misoprostol?

Dizziness and nausea Signup and view all the answers

What is a disadvantage of surgical management concerning the procedure's scheduling?

Needs to be scheduled, potentially delaying access Signup and view all the answers

After a medical termination with mifepristone and misoprostol, what is essential for the patient to do?

Follow up within two weeks Signup and view all the answers

Study Notes

Economic Disparities

Unintended pregnancy rate is five times higher in women below the poverty level.
Long-Acting Reversible Contraceptives (LARCs) tend to have high initial costs.

Considerations for Contraceptive Prescription

Evaluate efficacy, convenience, cost, accessibility, non-contraceptive benefits, side effects, medical contraindications, and reversibility.

Basic Rules of Contraceptive Choice

Understand patient's medical status and reproductive desires.
Acknowledge factors contributing to a high quality of life.
Pregnancy poses greater health risks than any contraceptive method.

Pearl Index

Measures contraceptive efficacy as a percentage.
Represents the pregnancy rate among 100 women using a contraceptive method over one year; lower Pearl Index indicates higher effectiveness.
Focuses on "typical use" statistics.

Successful Contraceptives

Effectiveness shows similar rates for both perfect and typical usage.
Efficacy increases as reliance on human action decreases.

Three Tiers of Contraceptive Efficacy

Most Effective (Pearl Index 1 or less): Includes progesterone-delivery IUDs (Mirena, Kyleena, Liletta, Skyla), ParaGard, Nexplanon, and sterilization.
Effective (Pearl Index 6-12): Includes Depo-Provera and hormonal contraceptive methods.
Least Effective (Pearl Index 18 or more): Includes diaphragm, cervical cap, condoms, spermicide, withdrawal, and periodic abstinence.

Barrier Contraception

Considered the least effective methods.
Includes diaphragm, cervical cap, female condom, male condom, and contraceptive sponge.
Designed for use with spermicide for enhanced effectiveness.

Penile Condom

Constitutes 97% of the U.S. condom market, predominantly latex.
Provides pregnancy and STI protection; non-latex options have higher failure rates.
Incompatible with oil-based lubricants and unsuitable for latex-allergic individuals.

Proper Use of Penile Condom

Must be placed on an erect penis before any genital contact.
Leave space at the tip for semen; ensure to unroll to the base.
Withdraw while holding the condom rim to prevent spillage, and use a new condom for each intercourse.

Vaginal Condom

FC2 is the most widely available product, with non-latex options.
Efficacy data is limited but assumed to be similar to male condoms.
Can be inserted prior to erection and left post-ejaculation.

Diaphragm

Requires fitting by a healthcare provider and a prescription.
Covers the cervix and must be used with spermicide.
Stays effective for 12% pregnancy rate over usage and lasts up to two years before replacement.

Cervical Cap

Functions like a mini diaphragm, requires RX and fitting.
Comes in three sizes based on parity and is used with spermicide.
Can remain inserted for up to 48 hours, with cost around 60−60-60−75.

Non-Implanted Hormonal Contraception

Encompasses oral contraceptive pills (OCPs), contraceptive rings, and patches.
Most are combined estrogen-progestin formulations, allowing for cyclical use with withdrawal bleeds.

Non-Contraceptive Benefits of Estrogen-Progestin Contraceptives

Reduces menstrual bleeding and dysmenorrhea.
Alleviates PMS symptoms and improves acne.
Lowers the incidence of ovarian cysts and benign breast disease; suppresses endometriosis.

Cycle Management

Preference for cycle length must consider individual symptoms and treatment needs.
Fewer cycles may result in fewer menstrual-related symptoms but can increase breakthrough bleeding.

Age Considerations with OCs

Women over 35 who smoke should avoid combination OCs.
Non-hypertensive women who do not smoke can use combination OCs safely until menopause.

LARCs and Sterilization

Represent the highest tier of effectiveness in contraceptive methods.
Nexplanon (progestin-only) acts by thickening cervical mucus, reducing tubal motility, and inhibiting ovulation along with endometrial thinning.

Economic Disparities

Unintended pregnancy rate is five times higher in women below the poverty level.
Long-Acting Reversible Contraceptives (LARCs) tend to have high initial costs.

Considerations for Contraceptive Prescription

Evaluate efficacy, convenience, cost, accessibility, non-contraceptive benefits, side effects, medical contraindications, and reversibility.

Basic Rules of Contraceptive Choice

Understand patient's medical status and reproductive desires.
Acknowledge factors contributing to a high quality of life.
Pregnancy poses greater health risks than any contraceptive method.

Pearl Index

Measures contraceptive efficacy as a percentage.
Represents the pregnancy rate among 100 women using a contraceptive method over one year; lower Pearl Index indicates higher effectiveness.
Focuses on "typical use" statistics.

Successful Contraceptives

Effectiveness shows similar rates for both perfect and typical usage.
Efficacy increases as reliance on human action decreases.

Three Tiers of Contraceptive Efficacy

Most Effective (Pearl Index 1 or less): Includes progesterone-delivery IUDs (Mirena, Kyleena, Liletta, Skyla), ParaGard, Nexplanon, and sterilization.
Effective (Pearl Index 6-12): Includes Depo-Provera and hormonal contraceptive methods.
Least Effective (Pearl Index 18 or more): Includes diaphragm, cervical cap, condoms, spermicide, withdrawal, and periodic abstinence.

Barrier Contraception

Considered the least effective methods.
Includes diaphragm, cervical cap, female condom, male condom, and contraceptive sponge.
Designed for use with spermicide for enhanced effectiveness.

Penile Condom

Constitutes 97% of the U.S. condom market, predominantly latex.
Provides pregnancy and STI protection; non-latex options have higher failure rates.
Incompatible with oil-based lubricants and unsuitable for latex-allergic individuals.

Proper Use of Penile Condom

Must be placed on an erect penis before any genital contact.
Leave space at the tip for semen; ensure to unroll to the base.
Withdraw while holding the condom rim to prevent spillage, and use a new condom for each intercourse.

Vaginal Condom

FC2 is the most widely available product, with non-latex options.
Efficacy data is limited but assumed to be similar to male condoms.
Can be inserted prior to erection and left post-ejaculation.

Diaphragm

Requires fitting by a healthcare provider and a prescription.
Covers the cervix and must be used with spermicide.
Stays effective for 12% pregnancy rate over usage and lasts up to two years before replacement.

Cervical Cap

Functions like a mini diaphragm, requires RX and fitting.
Comes in three sizes based on parity and is used with spermicide.
Can remain inserted for up to 48 hours, with cost around 60−60-60−75.

Non-Implanted Hormonal Contraception

Encompasses oral contraceptive pills (OCPs), contraceptive rings, and patches.
Most are combined estrogen-progestin formulations, allowing for cyclical use with withdrawal bleeds.

Non-Contraceptive Benefits of Estrogen-Progestin Contraceptives

Reduces menstrual bleeding and dysmenorrhea.
Alleviates PMS symptoms and improves acne.
Lowers the incidence of ovarian cysts and benign breast disease; suppresses endometriosis.

Cycle Management

Preference for cycle length must consider individual symptoms and treatment needs.
Fewer cycles may result in fewer menstrual-related symptoms but can increase breakthrough bleeding.

Age Considerations with OCs

Women over 35 who smoke should avoid combination OCs.
Non-hypertensive women who do not smoke can use combination OCs safely until menopause.

LARCs and Sterilization

Represent the highest tier of effectiveness in contraceptive methods.
Nexplanon (progestin-only) acts by thickening cervical mucus, reducing tubal motility, and inhibiting ovulation along with endometrial thinning.

Elective Operative Termination in the First Trimester

Most common method is cervical dilation and suction curettage.
Dilation and manual curettage is an alternative option.

Advantages of Surgical Management

Ensures complete evacuation of products of conception (POC).
Allows for pathology evaluation if necessary.
Minimal anesthesia required compared to other procedures.
Short and specific procedure timeline.
Can often be performed in an office setting, depending on practitioner and state regulations.
Women generally report high satisfaction with this method.

Disadvantages of Surgical Management

Requires anesthesia administration.
Necessitates the use of an operating or procedure room.
Scheduling may be required, which could be delayed.
Generally costs more compared to medical management methods.
Potential risks include uterine perforation, cervical damage, and infection.
Typically a personal preference issue for patients.

Medical Management of Termination: Mifepristone

Mifepristone can be used alone or in combination with misoprostol to terminate early pregnancies.
Effective up to 70 days post the first day of the last menstrual period.
It works by blocking progesterone, preventing the maintenance of the uterine lining.
Leads to the breakdown of the endometrial lining, ultimately terminating the pregnancy.
Has a 97% effectiveness rate for abortion.
Misoprostol is administered up to 2 days later to promote cervical softening and uterine contractions.
Most women experience abortion within 4 to 5 hours after taking misoprostol.
Common side effects include cramps, heavy bleeding, dizziness, nausea/vomiting, diarrhea, and abdominal pain.
Patients can take NSAIDs or acetaminophen for pain relief.
A follow-up appointment is necessary within two weeks to confirm the completion of the abortion due to the risk of incomplete abortion.

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Description

This quiz covers key considerations in choosing contraceptives, focusing on the impact of economic disparities. It explores factors such as efficacy, convenience, cost, and accessibility, particularly in relation to women below the poverty level. By examining these considerations, participants will gain a better understanding of the complexities in contraceptive decision-making.