NCMA 217 Maternal and Child Health Nursing PDF

WEEK 3: RESPONSIBLE PARENTHOOD NCMA 217 - Maternal and Child Health Nursing (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) ➔ Health teaching is necessary because some OUTLINE couples...

WEEK 3: RESPONSIBLE PARENTHOOD NCMA 217 - Maternal and Child Health Nursing (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) ➔ Health teaching is necessary because some OUTLINE couples want counseling about how to avoid 1. The Responsible Parenthood and Reproductive conception. Others need information on Health Act of 2012 increasing fertility and their ability to conceive. 2. Family Planning Others need counseling because contraception 2.1. Function of the Health Professional in has failed. It is important for the health of children Family Planning that as many pregnancies as possible be 2.2. Family Planning Services intended, because when a pregnancy is 2.2.1. Methods of Contraception unintended or mistimed, both short-term and 2.3. Natural Family Planning and Fertility long-term consequences can result such as a Awareness woman being less likely to seek prenatal care, 3. Barrier Methods 4. Prevention of Ovulation being less likely to breastfeed, and possibly 5. Hormonal Contraception being less careful to protect her fetus from harmful substances. 1. THE RESPONSIBLE PARENTHOOD AND A disproportionate share of women who bear REPRODUCTIVE HEALTH ACT OF 2012 children whose conception was unintended known as the RH Law are unmarried; such women are less apt to is a groundbreaking law that guarantees complete high school or college and more likely universal and free access to nearly all to require public assistance and to live in poverty modern contraceptives for all citizens, including than are their peers who are not mothers. impoverished communities, at government health The child of such a pregnancy is at greater risk of centers. low birth weight, dying in the first year, being The law also mandates reproductive health abused, and not receiving sufficient resources for education in government schools and recognizes healthy development a woman’s right to post-abortion care as part of the right to reproductive healthcare. 2. FAMILY PLANNING It mandates the government to adequately address the needs of Filipinos on responsible The concept of enhancing the quality of families parenthood and reproductive health. w/c includes: The law aims to empower the Filipino ○ Regulating & spacing childbirth people, especially women and youth, through ○ Helping subfertile couples beget children informed choice and age- and developmentally- ○ Counseling parents and would-be appropriate education. parents ➔ Responsible parenthood is the will and ○ The privilege and the obligation of the ability of parent(s) to respond to the needs and (married) couple exclusively to decide aspirations of the family and children. It is the w/love when and how many children shared responsibility between parents to provided: the motive is justified and the determine and achieve the desired number and means are moral. timing of their children according to their own ○ Involves personal decisions based on aspirations. each individual’s background, ➔ (RA 10354 Section 4v) experiences and sociocultural beliefs. It ◆ These principles are based on the involves thorough planning to be certain four (4) pillars of Responsible that the method chosen is acceptable Parenthood, Respect for Life, Birth and can be used effectively. Spacing, and Informed Choice. Health services, including 2.1 Function of the Health Professional in Family Reproductive Health services, are Planning devolved by the Local Government To counsel, reassure, give information and allow Code to the local government units an individual/couple to decide his/her/their (Philippine Commission on Women, course of action according to what he/she thinks 2021). is appropriate for them and in accordance with ➔ Reproductive life planning includes all the their own personal, societal, religious beliefs & decisions an individual or couple makes values. about whether and when to have children, how many children to have, and how they are spaced.  2.2 Family Planning Services 2.3 NATURAL FAMILY PLANNING AND FERTILITY AWARENESS 1. Temporary Conception Control Methods used to prevent conception The contraceptive approach of natural family Methods used to prevent ovulation planning (also called periodic abstinence Methods used to prevent implantation methods) involves no introduction of chemical or 2. Sterilization/Permanent Conception Control foreign material into the body or sustaining from Tubal Occlusion / Bilateral Tubal sexual intercourse during a fertile period. Many Ligation people hold religious beliefs that rule out the use Vasectomy or Vas Ligation of birth control pills or devices; others simply prefer natural methods because no expense or foreign substance is involved. 2.2.1 Methods of Contraception The effectiveness of these methods varies Individuals or couples should choose a greatly from 25% to 85%, depending mainly on contraceptive method carefully, considering the the couple’s ability to refrain from having sexual advantages, disadvantages, and side effects of relations on fertile days or days on which the the various options. Important things to consider woman has the most likely chance to become when doing this are: pregnant. Fertility awareness involves detecting ○ Personal values when a woman is fertile so she can use periods ○ Ability to use a method correctly of abstinence during that time. ○ How the method will affect sexual enjoyment METHODS TO PREVENTS CONTRACEPTION ○ Financial factors ○ Status of a couple’s relationship NATURAL METHODS ○ Prior experiences a. Coitus Interruptus ○ Future plans ➔ Oldest type of birth control practiced by ○ As nurses’ roles are to educate couples man. on what methods are available and how ➔ The premature withdrawal of the penis to use methods, understanding how before ejaculation during sexual various methods of contraception work intercourse and how they compare in terms of ➔ Reliability is low because sperms are benefits and disadvantages is necessary emitted in varying quantities in the for successful counseling. normal lubricating fluid secreted ○ A major benefit of contraception that has throughout intercourse occurred is that there are both fewer ➔ Psychological disadvantage adolescent pregnancies today and fewer ➔ Not accepted by the Catholic Church elective terminations of pregnancy than formerly (CDC, 2009). IMPORTANT INFO ○ With information and the ability to discuss specific concerns, clients can be Coitus interruptus is one of the oldest known better prepared to make the decisions methods of contraception. The couple proceeds with that are right for them (Nettleman, coitus until the moment of ejaculation. Then the man Brewer, & Ayoola, 2007). withdraws and spermatozoa are emitted outside the ○ An ideal contraceptive should be: vagina. Unfortunately, ejaculation may occur before Safe withdrawal is complete and, despite the care used, One hundred percent effective some spermatozoa may be deposited in the vagina. Compatible with religious and Furthermore, because there may be a few cultural beliefs and personal spermatozoa present in preejaculation fluid, fertilization preferences of both the user may occur even if withdrawal seems controlled. For and sexual partner these reasons, coitus interruptus is only about 75% Free of side effects effective. Convenient to use and easily obtainable b. Coitus Reservatus Affordable and needing few ➔ Male does not reach orgasm and instructions for effective use therefore no ejaculation occurs Free of effects after ➔ Requires considerable control over the discontinuation and on future sexual urge pregnancies. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 2 WITHDRAWAL METHOD CALENDAR METHOD removal of penis from the vagina before The use of mathematical calculations to predict ejaculation occurs the probable time of ovulation. “Ovulation most NOT a sufficient method of birth control by itself often takes place 14 days before the onset of the Effectiveness rate is 80% (very unpredictable in next menstruation.” teens, wide variation) Ogino-knaus formula 1 of 5 women practicing withdrawal become 1. Determine the Examples: pregnant shortest and longest a. Shortest Cycle = Very difficult for a male to ‘control’ cycle 28 days b. Longest Cycle = RHYTHMIC ABSTINENCE 36 days Identification of the periods of fertility and periods of sterility in the menstrual cycle of a woman and 2. If the cycle is Examples: irregular, subtract 18 a. 28 - 10 = 10 the restriction ofsexual intercourse to the sterile from the shortest and 11 36 - 11 = 25 periods or the time when the pregnancy is b. 25 - 18 = 7 unlikely because the woman is biologically from the longest 29 - 11 = 18 prepared to conceive. Also known as “safe or infertile period”technique 3. The difference between the shortest cycle and and “natural birth control” orNFP because there 18 determines the earliest time when ovulation is nothing artificial used to prevent conception. occurs. These methods are based on the ff.principles: ○ The human ovum is susceptible to 4. The difference between the longest cycle and 11 fertilization for approx. 18-24 hours after determines the last day when ovulation can occur ovulation ○ The sperms deposited in the vagina are 5. OVULATION CAN OCCUR ANYTIME IN ordinarily capable of fertilizing the ovum BETWEEN. for no more than 72 hours ○ Present methods of determining 6. In a regular 28 day cycle, abstinence should be ovulation time are inexact and seldom observed from day 9 to day 17. (count 5days sufficiently predictive (by at least 48 before the earliest ovulation and 3days after the hours) so that inpractice, it is necessary last day) to avoidintercourse for a far longer period of time than 72 hours before ovulation and 24 hours after ovulation IMPORTANT INFO Abstinence Abstinence, or refraining from sexual relations, has a theoretical 0% failure rate and is also the most effective way to prevent STIs. However, clients, particularly adolescents, may find it difficult to adhere to abstinence, or they may completely overlook it as an option. Because it fails as an effective birth prevention measure for so many people, use of no contraceptive has a failure rate of 85%. Many sex education classes advocate abstinence as the only contraceptive measure, IMPORTANT INFO so adolescents who take these courses may know little about other options. When Calendar (Rhythm) Method discussing abstinence as a contraceptive The calendar method requires a couple to method, be sure to provide information not abstain from coitus (sexual relations) on the only on the method but suggestions of ways to days of a menstrual cycle when the woman is comply with this method. most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation). BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 3  BILLINGS OR CERVICAL MUCUS METHOD To plan for this, the woman keeps a diary of A particular type of cervical mucus felt by the six menstrual cycles. woman at the vaginal opening is a signal of To calculate “safe” days, she subtracts 18 from ovulation the shortest cycle documented. This number Research shows this type of mucus appears represents her first fertile day. She subtracts necessary for conception. Without the mucus, 11 from her longest cycle. This represents her sperm transport is impeded. last fertile day. This type of mucus is described as “clear and If she had six menstrual cycles ranging from translucent and about the consistency of raw egg 25 to 29 days, her fertile period would be from white.” the 7th day (25 minus 18) to the 18th day (29 minus 11). To avoid pregnancy, she would avoid coitus during those days BASAL BODY TEMPERATURE This relies on slight changes (0.3 to 0.6ºC) in basal body temp. that may occur just before ovulation Preovulatory temperature is low because of high estrogen levels Post-ovulatory temp. rise is due to high progesterone The temperature is taken every morning at the same time with the same thermometer just before rising and after at least 4-6hours of continuous sleep. 3 days of elevation indicate temperature change is due to ovulation Abstinence should be observed 5 days before IMPORTANT INFO and 3 days after temperature rise. Phases of Wetness/Dryness 1. Wet IMPORTANT INFO a. menstruation b. days of possible fertility Basal Body Temperature Method c. changing mucus; non-slippery at first Just before the day of ovulation, a woman’s later becoming slippery basal body temperature has ovulated. She d. peak: last day of slippery mucus refrains from having coitus for the next 3 days e. days 1-3 after the peak are part of (the life of the discharged ovum). Because fertile period sperm can survive for at least 4 days in the 2. Dry female reproductive tract, it is usually a. basic infertile pattern recommended that the couple combine this b. infertile days method with a calendar method, so that they c. day 4 after the peak till the end of the abstain for a few days before ovulation as cycle well. The calendar method has an ideal failure d. ends about 2 weeks after the peak rate of 9%, a typical rate of 25% (MacKay, i. sequence of dry days (or 2009). days of unchanging mucus) A problem with assessing BBT for fertility indicating low level of awareness is that many factors, such as estrogen and present taking an antipyretic, can affect the BBT. infertility Changes in the woman’s daily schedule, such ii. duration is invariable, could as starting an aerobic program, can also be days, weeks,months or influence the BBT. A woman who works nights zero (if cycle is short) should take her temperature after awakening from her longer sleep period, no matter what Yet another method to predict ovulation is to use the time of day. the changes in cervical mucus that occur naturally with ovulation. Before ovulation each month, the cervical mucus is thick and does not BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 4  stretch when pulled between the thumb and Helpful for inconvenient for finger. planning the couple. Just before ovulation, mucus secretion pregnancy and Not ideal to increases. With ovulation (the peak day), cervical avoiding women with mucus becomes copious, thin, watery, and pregnancy irregular cycles. transparent. It feels slippery and stretches at Promotes Not very reliable least 1 inch before the strand breaks, a property communication because of about family menstrual cycle known as spinnbarkeit. planning and variations that All the days on which cervical mucus is copious, contraception may occur and for at least 1 day afterward, are considered between couples. anytime. to be fertile days, or days on which the woman should abstain from coitus to avoid conception. A woman using this method must be IMPORTANT INFO conscientious about assessing her vaginal secretions every day, or she will miss the change Lactation Amenorrhea in cervical secretions. The feel of vaginal As long as a woman is breastfeeding an secretions after sexual relations is unreliable, infant, there is some natural suppression of because seminal fluid (the fluid containing sperm ovulation. Because women may ovulate, from the male) has a watery, postovulatory however, but not menstruate, a woman may consistency and can be confused with ovulatory still be fertile even if she has not had a period mucus. since childbirth. If the infant is receiving a supplemental feeding or not sucking well, the LACTATION AMENORRHEA METHOD use of lactation as an effective birth control LAM is based on scientific evidence that a method is questionable woman is not fertile and unlikely to become As a rule, after 3 months of breastfeeding, the pregnant during full lactation or exclusive woman should be advised to choose another breastfeeding. method of contraception (Burkman, 2007). Full lactation describes breastfeeding when no regular supplemental feeding of any type is given SYMPTOTHERMAL METHOD (not even water) and the infant is feeding both The symptothermal method of birth control day and night with little separation from the combines the cervical mucus and BBT methods. mother. The woman takes her temperature daily, LAM provides maximum protection as long as: watching for the rise in temperature that marks ○ Menstruation has not resumed and ovulation. She also analyzes her cervical mucus ○ Bottle feeds or regular food supplements every day and observes for other signs of are not introduced and ovulation such as mittelschmerz (mid cycle ○ Baby is less than 6 months of age. abdominal pain). The couple must abstain from Successful use of natural methods to prevent intercourse until 3 days after the rise in pregnancy depends upon: temperature or the fourth day after the peak of ○ The accuracy of the method in mucus change, because these are the woman’s identifying the woman's actual fertile fertile days. The symptothermal method is more days effective than either the BBT or the cervical ○ A couple's ability to correctly identify the mucus method alone (ideal failure rate, about fertile time 2%). ○ The couple's ability to follow the rules of the method they are using OVULATION DETECTION TEST KITS Test kits that measure the level of LH and predict ADVANTAGES DISADVANTAGES ovulation are now available in the USA and other countries. Safe and has no Involves long These kits detect the level of LH in the urine w/c side-effects preparation and surges 12-24 hours before ovulation. Inexpensive intensive It is 98 to 100% effective. Acceptable to recording before When a woman sees that her LH level is high, religious it can be used. she should avoid coitus. affiliations that do There is a need not accept to abstain on artificial methods certain days of contraception which may be BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 5  also change the vaginal pH to a strong acid level, IMPORTANT INFO a condition not conducive to sperm survival. Ovulation Detection. They do not protect against STIs. Still another method to predict ovulation is by In addition to the general benefits for barrier the use of an over-the-counter ovulation contraceptives, the advantages of spermicides detection kit. These kits detect the midcycle include: surge of luteinizing hormone (LH) that can be ○ They may be purchased without a detected in urine 12 to 24 hours before prescription or an appointment with a ovulation. Such kits are 98% to 100% accurate health care provider, so they allow for in predicting ovulation. Although they are fairly greater independence and lower costs. expensive, use of such a kit in place of ○ When used in conjunction with another cervical mucus testing makes this form of contraceptive, they increase the other natural family planning more attractive to method’s effectiveness. many women. Combining it with assessment ○ Various preparations are available, of cervical mucus is becoming the method of including gels, creams, sponges, films, choice for many families using natural family foams, and suppositories. planning. Another form of spermicidal protection is a film of glycerin impregnated with a spermicidal agent that is folded and inserted vaginally. On POSTCOITAL DOUCHING contact with vaginal secretions or precoital penile Douching following intercourse, no matter what emissions, the film dissolves and a carbon solution is used, is ineffective as a contraceptive dioxide foam forms to protect the cervix against measure as sperm may be present in cervical invading spermatozoa. mucus as quickly as 90 seconds after Sponges are foam-impregnated synthetic ejaculation. sponges that are moistened to activate the impregnated spermicide and then inserted EMERGENCY CONTRACEPTION vaginally to block sperm access to the cervix. Emergency contraception pills can reduce the Well liked by most users, they are easy to insert chance of a pregnancy by 75% if taken within 72 and have an efficiency rate of 80% (ideal) and a hours of unprotected sex! typical use failure rate of about 60% Must be taken within 72 hours of the act of (Cunningham et al., 2008). They should remain unprotected intercourse or failure of in place for 6 hours after intercourse to ensure contraception method sperm destruction. Must receive ECP from a physician 75 – 84% effective in reducing pregnancy Floods the ovaries with high amount of hormone and prevents ovulation Alters the environment of the uterus, making it disruptive to the egg and sperm Two sets of pills taken exactly 12 hours apart 3. BARRIER METHODS Barrier methods are forms of birth control that work by the placement of a chemical or other barrier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes and fertilize the ovum. SIDE EFFECTS AND CONTRAINDICATIONS A major advantage of barrier methods is that they lack the hormonal side effects associated Vaginally inserted spermicidal products are with COCs. However, compared with COCs, their contraindicated in women with acute cervicitis, failure rates are higher and sexual enjoyment because they might further irritate the cervix. They are may be lessened. generally inappropriate for couples who must prevent conception (perhaps because the woman is taking a CHEMICAL BARRIERS drugs that would be harmful to a fetus or the couple A spermicide is an agent that causes the death absolutely does not want the responsibility of children), of spermatozoa before they can enter the cervix. because the overall failure rate of all forms of these Such agents are not only actively spermicidal but products is about 20%. Some women find the vaginal BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 6  leakage after use of these products bothersome. displaced by bladder or bowel, may make insertion of Vaginal suppositories, because the cocoa butter or a diaphragm difficult. Users of diaphragms may glycerin base, are the most bothersome in this regard. experience a higher number of urinary tract infections (UTIs) than nonusers, probably because of pressure on the urethra. MECHANICAL BARRIERS Other contraindications include: Mechanical barriers, such as a diaphragm, work by History of toxic shock syndrome (TSS; blocking the entrance of sperm into the cervix. staphylococcal infection introduced through A diaphragm is a circular rubber disk that is the vagina) placed over the cervix before intercourse. A Allergy to rubber or spermicides Lea’s Shield, made of silicone rubber and bowl History of recurrent UTIs shaped, is a new design. Although use of a spermicide is not required for diaphragms, use of a spermicidal gel with a diaphragm combines a CONDOM barrier and a chemical method of contraception. A condom is a latex rubber or synthetic sheath With this, the failure rate of the diaphragm is as that is placed over the erect penis before coitus low as 6% (ideal) to 16% (typical use). to trap sperm. Condoms have an ideal failure A diaphragm is prescribed and fitted initially by a rate of 2% and a typical failure rate of about physician, nurse practitioner, or nurse-midwife to 15%, because breakage or spillage occurs in up ensure a correct fit. Because the shape of a to 15% of uses (Kaplan & Love-Osborne, 2007). woman’s cervix changes with pregnancy, A thin stretchable rubber sheath worn over the miscarriage, cervical surgery (dilatation and penis by the man during intercourse. curettage [D&C]), or elective termination of A major advantage of condoms is that they are pregnancy, teach women to return for a second one of the few “male responsibility” birth control fitting if any of these circumstances occur. A measures available, and no health care visit or woman should also have the fit of the diaphragm prescription is needed. Latex condoms have the checked if she gains or loses more than 15 lb, additional potential of preventing the spread of because this could also change her pelvic and STIs, and their use has become a major part of vaginal contours. the fight to prevent infection with human A diaphragm is inserted into the vagina, after first immunodeficiency virus (HIV). Recommend them coating the rim and center portion with a for any partners who do not maintain a spermicide gel, by sliding it along the posterior monogamous relationship. wall and pressing it up against the cervix so that To be effective, condoms must be applied before it is held in place by the vaginal fornices. A any penile vulvar contact, because even woman should check her diaphragm with a finger preejaculation fluid may contain some sperm. A after insertion to be certain that it is fitted well up condom should be positioned so that it is loose over the cervix; she can palpate the cervical os enough at the penis tip to collect the ejaculate through the diaphragm. without placing undue pressure on the condom. A diaphragm should remain in place for at least 6 The penis (with the condom held carefully in hours after coitus, because spermatozoa remain place) must be withdrawn before it begins to viable in the vagina for that length of time. It may become flaccid after ejaculation. If it is not be left in place for as long as 24 hours. If it is left withdrawn at this time, sperm may leak from the in the vagina longer than this, the stasis of fluid now loosely fitting sheath into the vagina. Some may cause cervical inflammation (erosion) or men find that condoms dull their enjoyment of urethral irritation. coitus; After use, a diaphragm should be washed in mild soap and water, dried gently, and stored in its protective case. With this care, a diaphragm will last for 2 to 3 years SIDE EFFECTS AND CONTRAINDICATIONS Diaphragms may not be effective if the uterus is prolapsed, retroflexed, or anteflexed to such a degree that the cervix is also displaced in relation to the Pregnancy rate is 7- 28% vagina. Intrusion on the vagina by a cystocele or Added potential of preventing STDs rectocele, in which the walls of the vagina are ○ Disadvantages of condom BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 7  Self-lubricated type breaks IMPORTANT INFO easily Penis must be withdrawn from Condoms for females are latex sheaths made of the vagina before it becomes polyurethane and prelubricated with a spermicide. The flaccid inner ring (closed end) covers the cervix, and the outer Lessen sexual enjoyment by the ring (open end) rests against the vaginal opening. The male sheath may be inserted any time before sexual activity begins and then removed after ejaculation occurs. Like male condoms, they are intended for one-time use and offer protection against both conception and STIs Male and female condoms should not be used together. The failure rate is somewhat greater than the failure rate for male condoms, 12% to 22%. Most failures occur because of incorrect or inconsistent use. VAGINAL DIAPHRAGM A shallow,dome-shaped rubber device with a flexible wire rim that covers the cervix; maybe inserted several hours before intercourse and left in place for at least 6 hours after the last MALE CONDOM intercourse Perfect effectiveness rate = 97% Initially fitted by a health professional Typical effectiveness rate = 88% Weight loss/gain of 15 lbs may require re-fitting Latex and polyurethane condoms are available Inserted before intercourse with the woman in Combining condoms with spermicides raises squatting or supine position, or with one leg effectiveness levels to 99% elevated on a chair May cause cervicitis if left in place for too long HOW TO USE THE FEMALE CONDOMS Washed with mild soap & water, lasts for 2-3 Open the Female condom package carefully; years tear at the notch on the top right of the package. 97% efficiency Do not use scissors or a knife to open. The outer ring covers the area around the CERVICAL CAP opening of the vagina. The inner ring is used for A cervical cap is yet another barrier method of insertion and to help hold the sheath in place contraception. Caps are made of soft rubber, are during intercourse shaped like a thimble with a thin rim, and fit While holding the Female condom at the closed snugly over the uterine cervix. The failure rate is end, grasp the flexible inner ring and squeeze it estimated to be as high as 26% (ideal) to 32% with the thumb and second or middle finger so it (typical use). The precautions for use are the becomes long and narrow same as for diaphragm use except they can be Choose a position that is comfortable for kept in place longer. insertion – squat, raise one leg, sit or lie down. Many women cannot use cervical caps because Gently insert the inner ring into the vagina. Feel their cervix is too short for the cap to fit properly. the inner ring go up and move into place. Also, caps tend to dislodge more readily than Place the index finger on the inside of the diaphragms during coitus. An advantage is that condom, and push the inner ring up as far as it cervical caps can remain in place longer than will go. Be sure the sheath is not twisted. The diaphragms, because they do not put pressure outer ring should remain on the outside of the on the vaginal walls or urethra; however, this vagina. time period should not exceed 48 hours, to To remove the Female condom, twist the outer prevent cervical irritation. Cervical caps, like ring and gently pull the condom out diaphragms, must be fitted individually by a Wrap the condom in the package or in tissue, health care provider. and throw it in the garbage. Do not put it into the Comes in 2 types: presized (S-ML) and custom toilet. fitted (a plastic cap fitted to conform to the individual woman’s cervix made after making a mold of cervix with non-toxic substance used to make contact lenses) BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 8  They are contraindicated in any woman who has: When used ○ An abnormally short or long cervix frequently ○ A previous abnormal Pap smear spermicides may ○ A history of TSS irritate the vagina ○ An allergy to latex or spermicide making it easier ○ A history of pelvic inflammatory disease, to catch HIV/STI cervicitis, or papillomavirus infection ○ A history of cervical cancer ○ An undiagnosed vaginal bleeding SURGICAL METHODS OF REPRODUCTIVE PLANNING Surgical methods of reproductive life planning, often called sterilization, include tubal ligation for women and vasectomy for men. Tubal ligation is chosen by about 28% of all women in the United States of childbearing age as their contraceptive of choice. Vasectomy is the contraceptive method of choice for about 11% of men, making these two procedures the most frequently used methods of contraception in the United States for couples older than 30 years of age. ADVANTAGES DISADVANTAGES Counseling should be especially intensive for Can be inserted Does not protect men and women younger than 25 years of age, many hours against because the possibility of divorce, death of a before sex play. HIV/AIDS. sexual partner, loss of a child, or remarriage Easy to carry Requires a fitting could change a person’s philosophy toward around, in a clinic. childbearing in the future. In addition, sterilization comfortable. Some women is not recommended for individuals whose Does not alter cannot be fitted. fertility is important to their self-esteem. In a the menstrual Can be difficult to cycle. insert or remove. vasectomy, a small incision or puncture wound is Does not affect Can be dislodged made on each side of the scrotum. The vas future fertility. during deferens at that point is then located, cut and May help you intercourse. tied, cauterized, or plugged, blocking the better know your Possible allergic passage of spermatozoa. Vasectomy can be body. reactions. done under local anesthesia in an ambulatory setting, such as a physician’s office or a reproductive life planning clinic. The man INTRAVAGINAL CONTRACEPTIVES (SPERMICIDES) experiences a small amount of local pain SIde effects of Spermicides afterward, which can be managed by taking a You or your partner may be allergic to materials mild analgesic and applying ice to the site. in spermicide. This can cause genital irritation, The procedure is 99.5% effective (MacKay, rash, or itchiness. If this happens and your 2009). Spermatozoa that were present in the vas spermicide has nonoxynol-9, try a spermicide deferens at the time of surgery can remain viable without this chemical. for as long as 6 months. Therefore, although the man can resume sexual intercourse within 1 ADVANTAGES DISADVANTAGES week, an additional birth control method should be used until two negative sperm reports have Available without Does not protect been obtained (proof that all sperm in the vas a prescription. against deferens have been eliminated, usually requiring Lubrication may HIV/AIDS. 10 to 20 ejaculations). increase Must be readily They can be assured that vasectomy does not pleasure. available and interfere with the production of sperm; the testes Use can be part used prior to of sex play. penetration. continue to produce sperm as always, but the Does not affect Can be messy. sperm simply do not pass beyond the severed future fertility. Can have a bad vas deferens and are absorbed at that point. The taste during oral man will still have full erection capacity. Because sex. he also continues to form seminal fluid, he will Possible genital ejaculate seminal fluid—it will just not contain irritation. sperm. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 9  A few men develop chronic pain after vasectomy 4. PREVENTION OF OVULATION (post vasectomy pain syndrome); having the procedure reversed relieves this pain. Some men Use of contraceptives: develop autoimmunity or form antibodies against ○ Pills sperm, so that even if reconstruction of the vas ○ Injectable deferens is successful, the sperm they produce ○ Implant do not have good mobility and are incapable of fertilization. Men who feel a need to have their CONTRACEPTIVE PILLS sperm available for the future can have it stored Estrogen & progesterone prevent pregnancy by in a sperm bank before vasectomy. inhibiting the hypothalamus and anterior pituitary Tubal ligation, where the fallopian tubes are so that ovulation does not occur. They also inhibit occluded by cautery, crushing, clamping, or fertility by: blocking, thereby preventing passage of both ○ Altering the motility of the fallopian tubes sperm and ova. A fimbriectomy, or removal of the 2 fimbria at the distal end of the tubes, is another ○ Inadequately developing the possible but little used technique. Tubal ligation endometrium has a 99.5% effectiveness rate (Cunningham et ○ Keeping cervical mucus unreceptive and al., 2008). Although the reason is not clear, tubal unsupportive of sperm ligation is associated with a decreased incidence of ovarian cancer. TYPES OF PILL The most common operation to achieve tubal Combination pills ligation is laparoscopy. After a menstrual flow contain both progesterone & estrogen; taken and before ovulation, an incision as small as 1 from day 5 to day 25 of the menstrual cycle cm is made just under the woman’s umbilicus Sequential with the woman under general or local 2 types of pills are taken: anesthesia. A lighted laparoscope is inserted ○ Contains estrogen alone – taken from through the incision. Carbon dioxide is then day 5-19 pumped into the incision to lift the abdominal wall ○ Contains progestin-taken from day upward and out of the line of vision. The surgeon 20-25 locates the fallopian tubes by viewing the field through a laparoscope. All-progestin (minipill) - taken everyday The procedure can also be done by culdoscopy ○ Does not necessarily inhibit ovulation; (a tube inserted through the posterior fornix of prevents implantation of the zygote the vagina) or colpotomy (incision through the vagina), but the incidence of pelvic infection is Client Instructions on taking CPs higher with these procedures and visualization is Before starting CP, the woman must undergo less. The woman is discharged from the hospital physical examination, pelvic exam and Pap a few hours after the procedure. She may notice smear to rule out contraindications. CP should be abdominal bloating for the first 24 hours, until the prescribed by a physician. carbon dioxide infused at the beginning of the Must be taken on a Sunday following menses procedure is absorbed. This can also cause and abortion or the first Sunday 2 weeks after sharp diaphragmatic or shoulder pain if some of delivery,she is to use condom on the first 7 days the carbon dioxide escapes under the diaphragm of pill taking. They should be taken at the same and presses on ascending nerves. time everyday. A woman may return to having coitus as soon as If she is taking 28 day pills, there is no rest day 2 to 3 days after the procedure. Be certain that or interval. If she is taking a 21 day pill, she ends they understand. Tubal ligation, unlike a on a Saturday and begins a new pack on the hysterectomy, does not affect the menstrual next Sunday. Bleeding will occur around 4 days cycle, so they will still have a monthly menstrual after stopping pills. If she expected bleeding did flow. Be certain that women know to have no not come, she should consult the doctor before unprotected coitus before a tubal ligation (sperm starting a new packet of pill. trapped in the tube could fertilize an ovum there Minor side effects: nausea, weight gain, and cause an ectopic pregnancy). headache, breast tenderness, breakthrough bleeding, yeast infections, mild hypertension, potential depression If a woman forgets one pill, take one now and then the next on the regular schedule of pill BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 10  taking. If two pills, take two pills now and two pills ○ Expensive tomorrow and use a backup method for the next Side-effects 7 days. If 3 pills, discard the remaining pack and ○ Extremely irregular menstrual bleeding start a new pack, use a back-up method for the and spotting for 3-6 months! next 7 days. ○ NO PERIOD after 3-6 months ○ Weight change CONTRACEPTIVE PILLS ○ Breast tenderness If accidentally taken by a child, side-effect is ○ Mood change increased blood clotting, stimulate vomiting by ○ *NOT EVERY WOMAN HAS giving child syrup of ipecac SIDE-EFFECTS Danger signs: ○ A- abdominal pain Injectable contraceptives (Depo-provera, Noristerat, etc.) ○ C-chest pain and dyspnea Synthetic progestin hormones injected into ○ H- headache muscle: administered every 3 months ○ E-eye problems ○ S- severe leg pain DEPO-PROVERA OC users should have a check-up after 4 months Birth control shot given once every three months then annual check-ups to have pelvic exam, to prevent pregnancy breast exam and Pap Smear. 99.7% effective preventing pregnancy Another contraceptive method should be used No daily pills to remember until a woman has had 2 regular menstruations or wait for three months after stopping taking OC How does the shot work? before attempting pregnancy. There is usually a The same way as the Pill! 1-2 month delay in the resumption of Stops ovulation menstruation after discontinuing OC. Stop menstrual cycles!! Folic acid deficiency is common in long term user Thickens cervical mucus so that it is advisable to take folic acid supplement Disadvantages: If used by adolescents, they should have a Fertility return is usually delayed by 6 months regular menstruation for at least two years before Higher risk for osteoporosis so advise to increase beginning OC use. calcium intake and engage in weight bearing Side-effects: exercise 1. Thrombo-embolic disorders and other vascular Impair glucose tolerance in women at risk for DM problems including CVA & MI ○ Oral pills should be discontinued for 4-8 Estrogen excess weeks before anticipated surgery Nausea & vomiting 2. Alterations in metabolism,esp. of CHOs and Dizziness B-vitamins (pyridoxine & folic acid) Edema 3. Fetal effects after discontinuing the pill evidence Leg cramps of increased of chromosomal changes Increase in breast size 4. Amenorrhea after discontinuing the pill Chloasma 5. Neoplastic disease (breast, liver hepatocellular Visual changes adenoma) Hypertension 6. Hypertension vascular headache 7. Adverse drug interactions Estrogen deficit IMPLANT (NORPLANT) Early spotting (days 1-14) 6 tiny silicone rubber capsules or 2 rods Hypomenorrhea containing progestin (levonorgestrel), surgically Nervousness implanted under the skin of the upper arm; Atrophic vaginitis leading to painful intercourse removed surgically in about 5 years or when the woman wishes to discontinue the method. Progesterone excess Disadvantages: Increased appetite ○ Weight gain Tiredness ○ Irregular menstrual cycle Depression ○ Hair loss Breast tenderness ○ Depression Vaginal yeast infection ○ Scaring at the insertion site Oily skin and scalp BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 11  Hirsutism Conception may occur; if implantation takes Post Pill amenorrhea place, it causes early abortion Usually inserted during the menstrual phase Progesterone deficiency The intrauterine device shown uses copper as Late spotting and break-through bleeding (days the active contraceptive, others use 15-21) progesterone in a plastic device. IUDs are very Heavy flow with clots effective at preventing pregnancy (less than 2% Decreased breast size chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). Safety measures in the use of pills IUDs come with increased risk of ectopic Careful screening to detect women who are at pregnancy and perforation of the uterus and do risk of developing problems not protect against sexually transmitted disease. Use of lowest possible dose for each women IUDs are prescribed and placed by health care Careful follow-up should be done every 6-12 providers. months to detect problems — complete health assessment: should include history, PE, Pap IMPORTANT INFO smear & lab studies An intrauterine device (IUD) is a small plastic object CONTRAINDICATIONS: that is inserted into the uterus through the vagina Family history (Postlethwaite et al., 2007). IUDs became popular as a Vascular accident (stroke) method of birth control in the 1980s, and although still DM a popular choice worldwide, IUDs are used by only a Breast Ca small number of U.S. women. Few manufacturers continue to provide them since several lawsuits were Medical history filed in association with the increased incidence of Hepatitis or hepatic insufficiency pelvic inflammatory disease (PID) in women using one Thrombo-embolic disease particular brand, now no longer available. Moderate/severe hypertension Today, the IUD is thought to prevent Smoking more than 15 cigarettes a day fertilization as well as creating a local sterile Psychic depression inflammatory condition that prevents Sickle-cell disease implantation. When copper is added to the device, sperm mobility appears to be affected History of conditions that can be aggravated by fluid as well. This decreases the possibility that retention sperm will successfully cross the uterine Migraine space and reach the ovum. Convulsive d/o An IUD must be fitted by a physician, nurse Asthma practitioner, or nurse-midwife, who first Cardiac & renal insufficiency performs a Pap test and pelvic examination. The device is inserted before a woman has PE findings Pregnancy & Lactation had coitus after a menstrual flow, so the health 30 years old or older care provider can be assured that the woman Presence of hormone-dependent tumors is not pregnant at the time of insertion. Breast nodules Fibrocystic disease The insertion procedure is performed in an Abnormal mammogram ambulatory setting such as a physician’s office or Varicose veins a reproductive planning clinic. The device is inserted in a collapsed position, then enlarged to PREVENTION OF IMPLANTATIONS its final shape in the uterus when the inserter is IUD (Intrauterine Device) withdrawn. The woman may feel a sharp cramp An object made of plastic or non-reactive metal as the device is passed through the internal (nickel-chromium alloy) that fits inside the uterine cervical os, but she will not feel the IUD after it is cavity in place. Properly fitted, such devices are Manufactured in several shapes (loop, coil, contained wholly within the uterus, although the spiral) attached string protrudes through the cervix into Causes a chronic inflammatory response in the the vagina. endometrium, discouraging implantation of a IUDs have several advantages over other fertilized ovum contraceptives. BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 12  ○ Only one insertion is necessary, so there accompanying valve involvement from is no continuing expense. bacterial endocarditis. ○ The device does not require daily attention or interfere with sexual enjoyment. Effect on Pregnancy ○ It is appropriate for women who are at If a woman with an IUD in place suspects that she is pregnant, she should alert her primary risk for complications associated with health care provider. Although the IUD may be COCs or who wish to avoid some of the left in place during the pregnancy, it is usually systemic hormonal side effects. removed vaginally to prevent the possibility of ○ They may create lighter or fewer infection or spontaneous miscarriage during the periods. pregnancy. The woman should receive an early Teach women to regularly check after each ultrasound to document placement of the IUD. menstrual flow, to make sure the IUD string is in This can also rule out ectopic pregnancy, which has an increased incidence among IUD users place, and to obtain a yearly pelvic examination. who become pregnant with the IUD in place. SIDE EFFECTS AND CONTRAINDICATIONS TYPES OF IUD Non-medicated A woman may notice some spotting or uterine 1. Lippes-Loop- available in 4 sizes (A-small to cramping the first 2 or 3 weeks after IUD Dlarge); has been withdrawn from the market insertion; as long as this is present, she 2. Saf-T-coil – available in 2 sizes (small & large) should use an additional form of contraception, such as vaginal foam. Medicated Occasionally, a woman continues to have 1. Copper 7 (Cu 200) – copper has direct cramping and spotting after insertion; in such spermicidal effect; has been withdrawn from the instances, she is likely to expel the device market spontaneously. Women with IUDs in place 2. Copper-T (T-Cu 200, tatum copper-bearing IUD) should take active steps to avoid toxic shock 10 years syndrome (TSS; a staphylococcal infection 99.2 % effective from the use of tampons), because infection Copper on IUD acts as spermicide, IUD might travel by the IUD string into the uterus to blocks egg from implanting cause uterine infection. Must check string before sex and after IUDs are not recommended for women with an shedding of uterine lining. increased risk of contracting STIs, such as 3. Progestasert-T those who have multiple sexual partners, 1 year because this combination could lead to pelvic 98% effective infection. T shaped plastic that releases hormones They also are not recommended for women over a one year time frame who have never been pregnant (their small Thickens mucus, blocking egg uterus could be punctured with insertion) or Check string before sex & after shedding who have a history of having had PID. If PID is of uterine lining. suspected, the device should be removed and the woman should receive antibiotic therapy to Contradictions of IUD treat the infection. Any inflammatory condition or infection of the IUDs are also contraindicated in the woman reproductive tract or PID whose uterus is distorted in shape (the device Abnormalities of the uterus might perforate an abnormally shaped uterus). Severe dysmenorrhea They are not advised for women with severe Uterine bleeding of unknown origin dysmenorrhea (painful menstruation), Suspected pregnancy menorrhagia (bleeding between menstrual periods), or a history of ectopic (tubal) Complications / Adverse reactions pregnancy, because their use may increase Syncope during insertion the symptoms or incidence of these Increased risk of PID w/c may result in conditions. Sterility or infertility Women with valvular heart disease may be Medical-surgical intervention for complications advised against the use of an IUD because such as twisted ovary, bowel obstruction, the increased risk of PID could lead to unilateral tubo-ovarian abscess Perforation of the uterus BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 13  Dysmenorrhea IMPORTANT INFO Increased blood loss (anemia) Ectopic pregnancy A major advantage of this long-term reversible Expulsion contraceptive is that compliance issues associated with COCs are eliminated. It also IUD danger signs offers an effective and reliable alternative to P – period late or skipped period the estrogen-related side effects of COCs. A – abdominal pain Sexual enjoyment is not inhibited, as may I – increased temperature (fever) happen with condoms, spermicides, N- noticeable vaginal discharge; foul smelling diaphragms, and natural family planning S – spotting, heavy periods, bleeding methods. Implants can be used during breastfeeding without an effect on milk VAGINAL RING (NUVARING) production. 95-99% Effective A new ring is inserted into the A disadvantage of the implant method is its vagina each month cost ($500 on average) and side effects such Does not require a "fitting" by a health care as: provider, does not require spermicide, can make ○ Weight gain periods more regular and less painful, no pill to ○ Irregular menstrual cycle such as take daily, ability to become pregnant returns spotting, breakthrough bleeding, quickly when use is stopped. amenorrhea, or prolonged periods NuvaRing is a flexible plastic (ethylene-vinyl ○ Depression acetate copolymer) ring that releases a low dose ○ Scarring at the insertion site of a progestin and an estrogen over 3 weeks. ○ Need for removal Injection A (NuvaRing) is a silicone ring that surrounds the cervix and continually releases a combination of A single intramuscular injection of estrogen and progesterone. medroxyprogesterone acetate (DepoProvera It is inserted vaginally by the woman and left in [DMPA]), a progesterone, given every 12 weeks place for 3 weeks, then removed for 1 week inhibits ovulation, alters the endometrium, and (Roumen, 2007). Menstrual bleeding occurs changes the cervical mucus (Box 6.8). The during the ring-free week. The hormones effectiveness rate of this method is almost 100%, released are absorbed directly by the mucous making it an increasingly popular contraceptive membrane of the vagina. method (Chrousos, 2008). Do not massage the injection site after administration as you want the Fertility returns immediately after discontinuing drug to absorb slowly from the muscle. Because using the ring. Women may need to make out a DepoProvera contains only progesterone, it can calendar that they post conspicuously to remind be used during breastfeeding. themselves to remove and replace the ring. Advantageous effects are reduction in ectopic Implantation pregnancy, endometrial cancer, endometriosis, Five subdermal implants, rods the size of pencil and, for unknown reasons, reduction in the lead are embedded just under the skin on the frequency of sickle cell crises (Burkman, 2007). Potential side effects are similar to those of inside of the upper arm. subdermal implants: irregular menstrual cycle, The rods contain etonogestrel, the metabolite of headache, weight gain, and depression. desogestrel, the same progestin that is used in Depo-Provera may impair glucose tolerance in the NuvaRing. Once embedded, the implants women at risk for diabetes. Because there also appear as irregular lines on the skin, simulating may be an increase in the risk for osteoporosis small veins. Over the next 3 to 5 years, the from loss of bone mineral density, advise women to include an adequate amount of calcium in their implants slowly release the hormone, diet (up to 1200 mg/day) and to engage in suppressing ovulation, stimulating thick cervical weight-bearing exercise daily to minimize this mucus, and changing the endometrium so that risk, rules that are good for all women. implantation is difficult. Two disadvantages are that a woman must The implants are inserted with the use of a local return to a health care provider for a new anesthetic, during the menses or no later than injection every 4 to 12 weeks for the method to day 7 of the menstrual cycle, to be certain that remain reliable, and the return to fertility is often delayed by 6 to 12 months. the woman is not pregnant at the time of insertion. They can be inserted immediately after an elective termination of pregnancy or 6 weeks after the birth of a baby. The failure rate is less than 1% (Cunningham et al., 2008). BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 14 STERILIZATION/PERMANENT CONCEPTION ○ Dysmenorrhea, because of lack of CONTROL ovulation Tubal Occlusion / Bilateral Tubal Ligation ○ Premenstrual dysphoric syndrome and Involves tying, cutting or cauterizing the fallopian acne, because of the increased tubes progesterone levels Usually done immediately after delivery (within ○ Iron deficiency anemia, because of the 24- 48 hours) when the incidence of morbidity & reduced amount of menstrual flow failure are lowest ○ Acute pelvic inflammatory disease (PID) May also be done in any phase of the menstrual and the resulting tubal scarring cycle ○ Endometrial and ovarian cancer, ovarian Methods: cysts, and ectopic pregnancies ○ Mini-laparotomy ○ Fibrocystic breast disease ○ Laparoscopy or “band-aid surgery” ○ Possibly osteoporosis, endometriosis, ○ Vaginal tubal sterilization uterine myomata (fibroid uterine tumors), and progression of rheumatoid arthritis Vasectomy/Vas ligation ○ Colon cancer Accomplished without entry into the abdominal COCs are packaged with 21 or 28 pills in a cavity; twin incisions are made in the area where convenient dispenser. It is generally the scrotum joins the body, just over the vas recommended that the first pill be taken on a deferens Sunday (the first Sunday after the beginning of a The tubes are tied and separated; portions menstrual flow), although a woman may choose maybe excised to begin on any day. Beginning pills as soon as Follow-up sperm counts may be done after. they are prescribed this way (a Quick Start system) rather than have to wait for a set day may increase compliance. 5. HORMONAL CONTRACEPTION After childbirth, a woman should start the Hormonal contraceptives are, as the name implies, contraceptive on the Sunday closest to 2 weeks hormones that cause such fluctuations in a normal after birth; after an elective termination of menstrual cycle that ovulation does not occur. Hormonal pregnancy, she should start on the first Sunday contraceptives may be administered orally, transdermally, after the procedure. Because COCs are not vaginally, by implantation, or through injection. effective for the first 7 days, advise women to use a second form of contraception during the initial 7 ORAL ROUTE days on which they take pills. Oral contraceptives, commonly known as the pill, A woman prescribed a 21-day cycle brand takes OCs (for oral contraceptive), or COCs (for a pill at the same time every day for 21 days. combination oral contraceptives), are composed Pill taking by this regimen will end on a Saturday. of varying amounts of synthetic estrogen The woman would then not take any pills for 1 combined with a small amount of synthetic week. She would restart a new month’s supply of progesterone (progestin). pills on the Sunday 1 week after she stopped. A The estrogen acts to suppress follicle stimulating menstrual flow will begin about 4 days after the hormone (FSH) and LH, thereby suppressing woman finishes a cycle of pills. ovulation. The progesterone action complements To eliminate having to count days between pill that of estrogen by causing a decrease in the cycles, most brands of OCs are packaged with permeability of cervical mucus, thereby limiting 28 pills—21 active pills and 7 placebo pills. With sperm motility and access to ova. Progesterone these brands, a woman starts a second also interferes with tubal transport and dispenser of pills the day after finishing the first endometrial proliferation to such degrees that the dispenser. There is no need to skip days possibility of implantation is significantly because of the placebo tablets. Menstrual flow decreased. will begin during the 7 days on which she is COCs must be prescribed by a physician, nurse taking the placebo tablets. practitioner, or nurse-midwife after a pelvic For ovulation suppressants to be effective, examination and a Papanicolaou (Pap) smear. women must take them consistently and When used correctly, they are 99.7% effective in conscientiously. Women who have difficulty preventing conception. Women who forget to remembering to take a contraceptive in the take them as scheduled, however, experience a morning may find it easier to take a daily pill at failure rate of 95%. bedtime or with a meal (the time of day makes no Oral contraceptives have non-contraceptive difference; it is the consistency that is important) benefits such as decreased incidences of: (Box 6.5). Also, some women find that taking pills BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 15  at bedtime rather than in the morning eliminates TRANSDERMAL ROUTE any nausea they otherwise experience. Transdermal contraception refers to patches that slowly but continuously release a combination of estrogen and progesterone. Patches are applied SIDE EFFECTS AND CONTRAINDICATIONS each week for 3 weeks. No patch is applied the Nausea fourth week. During the week on which the Weight gain woman is patch free, a menstrual flow will occur. Headache After the patch-free week, a new cycle of 3 Breast tenderness weeks on/1 week off begins again. The efficiency Breakthrough bleeding (spotting outside the of transdermal patches is equal to that of COCs, menstrual period) although they may be less effective in women Monilial vaginal infections who weigh more than 90 kg (198 lb). Mild hypertension Patches may be applied to one of the following Depression four areas: upper outer arm, upper torso (front or back, excluding the breasts), abdomen, or buttocks. They should not be placed on any area COCs are not routinely prescribed for women where makeup, lotions, or creams will be applied; with a history of thromboembolic disease or a at the waist where bending might loosen the family history of cerebral or cardiovascular patch; or anywhere the skin is red or irritated or accident, who are over 40 years of age, or who has