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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

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CONTRACEPTION

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  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

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