1 / 25

CONTRACEPTION

CONTRACEPTION. Objectives. Know the options for effective birth control Be comfortable with counseling adolescents on contraception. Background. About 1/3 of teens at time of 1 st intercourse do not use contraception

jaimie
Télécharger la présentation

CONTRACEPTION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CONTRACEPTION

  2. Objectives • Know the options for effective birth control • Be comfortable with counseling adolescents on contraception

  3. Background • About 1/3 of teens at time of 1st intercourse do not use contraception • 20% of adolescent pregnancies occur in 1st month of sexual activity, and 50% within the 1st 6 months • 85% of women become pregnant in the 1st year of not using contraception

  4. Birth Control Options • Abstinence • Timing schemes • Barrier methods • Hormonal preparations

  5. Contraceptive Efficacy

  6. Option 1: Abstinence & Timing • Abstinence • if compliant, its 100% effective • No risk of sexually transmitted infections • Timing = “the rhythm method” • Temperature, cervical mucus and record keeping are needed to do it right • About 25% get pregnant in 1st year • Withdrawal • About 20% get pregnant in 1st year

  7. Option 2: Barrier • 2nd most popular • STD protection • Inexpensive • Failure rate: 3-18%

  8. Male Condom • Latex is most effective but polyurethane condom can be used by latex allergic • Some have reactions to nonoxynol-9 and are available without • Only water based lubricants should be used with latex, both water and oil may be used with polyurethane

  9. Female Condom • Male and female condoms should NOT be used simultaneously • Male condoms have better efficacy in preventing pregnancy AND STIs • Other female barriers to be aware of (higher failure rates): • Diaphragm • Cervical Cap

  10. Intrauterine Device • IUDs release hormones, ions, or enzymes that prevent sperm from fertilizing the ova or implantation • No protection from STIs

  11. Option 3: Hormonal • Alternate delivery systems (non-oral) • Combination OCPs: • Failure rate 0.1% (2-6%) • Monophasic • Biphasic • Triphasic • Progestin only • Failure rate 0.5% (3-10%)

  12. Injectable: Depo-Provera • Depo medroxyprogesterone acetate (DMPA) • 150 mg intramuscular injection • new lower 104 mg subcutaneous injection available • Shot every 3 months/12 weeks • Prevents egg release • Failure rate: 0.3% • Adverse effects to discuss: • Acne, weight gain, initial menstrual irregularities, headaches, bloating, delayed return to fertility (9-18 mos), reduction in bone mineral density

  13. Dermal: Patch • Ortho Evra • Combination preparation • 20% bleeding in first cycle • Change patch once per week • 3 weeks on, 1 week off • May not be as effective if >90kg

  14. Vaginal Ring • NuvaRing • Combination preparation • Worn for 3 weeks at a time • Low breakthrough bleeding rate

  15. Vaginal Ring • Low failure rate • Can wear during menses • Can wear during intercourse • Can remove for intercourse • Does not have to be fitted • Vaginal position does not matter • No increased risk of infection

  16. Basic Principals: OCPs • Many combinations, may need to try a few to find right match • The lower the estrogen, the less likely you are to have hormonal side effects (HA, nausea, bloating) • Period Eliminating/Limiting • Lybrel  eliminates menstrual period but more unpredictable breakthrough bleeding • Seasonale  extends time between periods

  17. Choosing an OCP What myths have you heard? What side effects have you heard about?

  18. True or False • Causes cancer • Causes heart disease • Leads to infertility • Body needs break from OCPs ALL FALSE • 2/3 women believe OCPs unsafe!

  19. Advantages • Less dysmenorrhea • Shorter, lighter menses • Less Mittelschmerz • Acne & hirsutism improved • Prevents ovarian & endometrial cancer • Reduction in PID

  20. Nausea/vomiting Edema/leg cramps Bloating Vascular headaches Clear vaginal d/c Cystic breast changes Chloasma Androgenic Oily skin Hirsutism Acne Increased appetite Mastalgia Increased breast size Bloating Depression Possible side effects ESTROGEN PROGESTERONE

  21. You have had a blood clot You have had cancer You have liver disease You have high blood pressure You are on seizure medicine You have bad migraines Do not use if:

  22. Missed Pills • 2 per day until caught up • Condoms if miss >2 pills per month

  23. Drug Interactions • Seizure medicine • St. John’s Wort • Rifampin • Griseofulvin • Vitamin C • Irregular bleeding

More Related