Women's Health: Fertility Control PDF

Women’s Health Chapter 145 Fertility Control Definition  Birth control is the act of preventing pregnancy  Medications, Procedures, devices and behaviors are methods to prevent pregnancy  In 2015-2017, 64.9% of women aged 15-49 used a form of birth control.  A pat...

Women’s Health Chapter 145 Fertility Control Definition  Birth control is the act of preventing pregnancy  Medications, Procedures, devices and behaviors are methods to prevent pregnancy  In 2015-2017, 64.9% of women aged 15-49 used a form of birth control.  A patient’s choice of contraceptive method involves factors such as efficacy, safety, non-contraceptive benefits, cost and personal considerations.  Following information based on CDC recommendations and WHO.  No lab testing necessary before contraception is initiated.  No physical exam other than BP check is needed before initiating combined hormonal contraception  Cervical cancer screening is not needed before IUD placement  IUD removal is not necessary if a woman develops PID; antibiotic treatment is sufficient if clinical improvement is demonstrated.  Combined Hormonal Contraception  Prevention of ovulation is considered the dominant mechanism of action with the combination of mechanism of action of 2 steroids creating a synergistic effect that greatly increases their anti-gonadotropic and ovulation-inhibitory effects  These contraceptives alter the consistency of cervical mucus, affect the endometrial lining and alter tubal transport.  Combined oral contraceptive pills are taken daily at the same time each day to attain efficacy.  Oral contraceptive pills do not protect against STDs, therefore condoms are recommended.  See contraindications for use on slide 6.  Hormonal Contraception  Oral contraceptives  The birth control pill is the most common prescribed form of contraception in the US. Approximately 25% women 15-44 years used this method. Prevents ovulation. Used as treatment for menstrual irregularity, prevention of ovulation, can reduce mittelschmerz. Women with anemia secondary to menorrhagia increase their iron stores.  Vaginal ring  NuvaRing is a nonbiodegradable, flexible, colorless ring. These devices deliver progesterone or progesterone-estrogen combinations. Combination contraceptive vaginal rings are a new form approved. Worn 3 weeks, removed for 1 week to produce menses.  Combination Contraceptive Patch  Applied and worn for 7 days for 3 conceptive weeks, the removed on day 22 for 7 days when the period is expected. After week 4 ends, a new 28 day cycle is started with a new patch applied. Not effective for females with a BMI 30 kg or greater.  Progestin-Only Products- known as the “mini pill”  Mechanisms of action include suppression of ovulation; a variable dampening the effect on the midcycle peaks of LH and FSH; an increase in cervical mucus viscosity; a reduction in the number and size of endometrial glands; and a reduction in cilia motility in the fallopian tube.  Injectable Contraception  Monthly injection of combined estrogen and progestin to prevent pregnancy. Three types are Depo-Provera, Sayana Press, or Noristert. Depo- provera needs to be administered every 3 months. Works for 5 years. Birth control methods Combined Hormonal Contraception continued.  Contraceptive Implants  The mechanism of action is a combination of suppression of the lutenizing hormone (LH) surge, suppression of ovulation, development of viscous and scant cervical mucus to deter sperm penetration, and development.  A small rod inserted under the skin of the woman’s upper arm to provide birth control. Prevents pregnancy up to 4 years. Releases progestogen into the body.  Postcoital contraception  Postcoital oral emergency contraception used for the prevention of pregnancy after intercourse. Commonly called “the morning after pill”. Common methods of this type are Plan b or the Copper T IUD.  Intrauterine Devices  Copper T380: T-shaped, polyethylene IUD with fine copper wire wrapped around the vertical stem  Liletta, Mirena: T- shaped polyethylene IUD with a reservoir that contains 52 mg of levonorgestrel, a progesterone  Kyleena: T-shaped, polyethylene IUD with a reservoir that contains 19.5 mg levonorgestrel Use of CHC: Metabolic effects and safety Low Risks for:  Venous thrombosis  Hypertension  Athrogenesis and Stroke  Hepatocelluar adenoma  Cancer  Contraindications  Cerebrovascular disease or coronary artery disease  History of DVT, PE, CHF  Untreated diabetes with vascular complications, HTN  Estrogen-dependent neoplasm  Breast cancer  Undiagnosed vaginal bleeding  Active liver disease  Age older than 35 years  Cigarette smoking Warning signs to teach CHC users with acronym ACHES  Abdominal pain (severe) which may indicate liver disease  Chest pain (severe), cough, SOB, (which may indicate angina or PE)  Headaches (severe) , dizziness, weakness or numbness (which may indicate stroke or hypertensive emergency)  Eye problems (vision loss or blurring) or speech problems (which may indicate a stroke)  Severe leg pain (calf or thigh) which may indicate a deep vein thrombosis  Women who experience any of these signs or symptoms or who develop depression, jaundice, or breast lump should discontinue the pill and consult the provider.  Women who smoke, should be encouraged to quit, if not possible then should discontinue CHCs after the age of 35 years. Barriers Methods  Condoms  Male condoms- most popular mechanical barriers among all. Provides the most effective protection of the Genital tract from STDs.98% effective.  Female- prevents pregnancy by acting as a barrier to the passage of semen into the vagina. 95% effective.  Diaphragms – Prevents pregnancy by acting as a barrier to the passage of semen into the cervix. This device is difficult to place in vagina. The inner ring may cause discomfort. It is a shallow silicone cup that covers the cervix. A pelvic exam and measurement is done to determine correct size. Inserted 6 hours before intercourse with spermicidal cream or jelly.86% effective.  Cervical caps- Acts as a mechanical barrier to sperm migration into the cervical canal. The cap must be filled one third full with spermicide. 86% effective.  Spermicides-Prevents sperm from entering the cervical os by attaching the sperm’s flagella and body, reducing their mobility. 82% effective.  Cervical Sponge- small piece of white plastic foam inserted into the vagina up to 24 hours before sex. 76-88% effective. Emergency postcoital contraception  Emergency contraceptive pills (ECP)-  Most common OTC- Plan B  Plan B, One Step OTC, an enteric coated levonorgestrel EPC that dissolves and is absorbed in the intestine, ovulation inhibition effective until the LH surge  Copper T380 IUD foreign body effect creates toxic milieu preventing implantation, not effective for emergency contraception after implantation has occurred. Permanent contraception  Surgical Sterilization  Female permanent contraception prevents fertilization by interrupting the fallopian tubes. Fallopian tube sterilization in the post partum period with small transverse incision performed with Falope rings, clips, bands or segmental destruction with electrocoagulation or suture ligation.  Male  Vasectomy involves incision of the scrotal sac. Transection of the vas deferens, and occlusion of both severed ends by suture ligation or fulguration. Remnant sperm remain in the ejaculatory ducts, the man is not sterile until sperm- free for15-20 ejaculations. Failure rate 0.1%  Hysteroscopic Sterilizations  Essure system does not require surgical incisions and perform under local anesthesia. A Hysteroscope is inserted into the fallopian tubes. Removed from US market 2018 due to problem Other methods of planning  Natural Family Planning  One of the most widely used methods of fertility regulation especially those due to religious or cultural beliefs, no using or permitted devices or drugs for contraception. This method involves periodic abstinence during a woman’s fertile period, which is around ovulation. Calendar, cervical mucus or the sympotothermal methods are used. Used with regular and predictable cycles. Requires discipline. Failure relatively high. Does not protect against STDs.  Periodic Abstinence  Coitus interruptus  Involves withdrawal of the entire penis from the vagina before ejaculation. Fertilization is prevented by lack of contact between spermatozoa and the ovum. This method of contraception remains a significant means of fertility control in the developing world. Failure rate 22%. Probability of pregnancy is high with incorrect or inconsistent use.  Lactational amenorrhea  Elevated prolactin levels and reduction of gonadotropin-releasing hormone from the hypothalamus during lactation suppress ovulation. This leads to a reduction in Luteinizing hormone (LH)release and inhibition of follicular maturation. The duration of this suppression varies and is influenced by the frequency and duration of breastfeeding and the length of time since birth. This method requires breastfeeding every 4 hours during the day and every 6 hours at night;no supplementation of formula or other foods; no return to menses and baby must be younger than 6 months for perfect use. Buttaro, 6th edition emedicine.Medscape.com 10/6/2020