Contraception 001

8/4/2019 Contraception 001

1/15

Hormonal Contraception:Combination OCPs

Contain Synthetic Estrogen/Progestin

Modern E2Dosage 50 Mcg

Despite Diversity, Side Effects andEfficacies Similar

Requires Patient Compliance

May Be Monophasic or Triphasic


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Combination OCPs:Mechanism of Action

Suppresses LH / FSH Release

(E2 FSH, P LH)

Progestin Thickens Cervical Mucus andAlters Endometrium

Major Effect Is Anovulation and

Impairment of Sperm Transport andOcyte Implantation


3/15

Combination OCPs:Additional Benefits

Menstrual Regulation

Decreased Risk of Anemia

Ovarian, Endometrial CA: Risk Lower PID Risk

Prevention of Benign Breast Disease


4/15

Combination OCPs:Side Effects

Breakthrough Bleeding ( 25%)

Amenorrhea

Breast Tenderness, Nausea H/A (+/)

?HTN

?Weight Gain


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Combination OCPs:Risks

Thromboembolism ( 35 yo, Smoker)

MI (Smokers Only):

< 15 cig/day: 3X Risk > 15 cig/day : 21X Risk

Liver Adenomas (Very Rare)


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Depo-Provera:

Inhibits Ovulation

150 mg q3months (14 day grace period)

Delayed Ovulation After Discontinuation Main Side-Effects:

Amenorrhea

AUB

Weight Gain

Hair Loss


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Norplant:

Implantable for 5 Years

Similar Side Effects as Depo-Provera

Avg. Yearly Failure Rate: 0.8/100(Increases : > 2/100 after 5 years)

Occasionally Difficult to Remove


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Barrier Methods:

Diaphragm: High Failure Rates

Must Remain in ~6 Hrs post-coitus

Best if Combined with Spermicide UTI Potential

Condom: STD Protection, Inconsistent

Use by Men Female Condom: Cumbersome,

Learning Curve

Today Sponge: As seen on Seinfeld


9/15

IUD: Overview

ParaGard (CuT380A), Progestasert

Very Effective (~ TL), Reversable

Risks OVERBLOWN Monogamy Essential, However

Does Not Protect Against STDs

Can Remain for 10 Years


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IUD:Mechanisms of Action

NOT ABORTIFACIENT!!!!!!!!

Prevents Conception:

Sperm Transport Inhibited Sperm Survival / Capacitation

Diminished

Prevents Implantation: hCG Levels = 0


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IUD:Work-up

History: STDs, Sexual History, Ectopic

PEx: Size / Configuration of Uterus

Cervical Cultures, Pap Counseling


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IUD:Contraindications

Lack of Monogomy, High Risk for STDs

Abnormal Uterine Bleeding

Current Pelvic Infection (GC, Chl) Actinomyces on Pap

???Nulliparity

Pregnancy

Wilsons Dz, Cu Allergy (both rare)


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IUD:Complications

PID: Usually 20 InsertionalContamination

Unproven Role for Prophylactic ABx

Hypermenorrhea Expulsion

Perforation (< 0.1%)

Failure: IUD Should be Removed

??Ectopic


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Emergency Contraception

IUD, OCPs

Specific OCP Regimens Given 72

Hours After Unprotected Intercourse~ 75% Effective

Yuzpe Method: Ovral 2 tabs po now and

2 tabs 120 later May Cause Nausea

Consider Dispensing at Yearly Visit


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Special Circumstances

Postpartum/Postabortion:

IUD, Progestins, Combination OCPs*

Anticonvulsant/Antibiotic Use: TCN Probably OK

Most Anticonvulsants Impair Efficacy

of Hormonal Contraceptives

* may affect lactation before milk flow established

Contraception 001

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