Info
🌱 來自: Huppert’s Notes
Contraception🚧 施工中
Contraception
• Approach to contraception counseling: Recommend discussion of contraception with all patients of reproductive age. Counsel patients on the continued use of condoms for protection from STIs, screen for contraindications to certain forms of contraception (e.g., cannot use OCPs if history of DVT/PE), and educate patients about possible side effects. Consider using conversations about the initiation/continuation of contraception as an opportunity to also offer STI screening and assess for intimate partner violence.
• Treatment:
- Hormonal birth control
• Examples:
- Combination oral contraceptive pills (OCPs): Progesterone (suppresses LH, thus preventing ovulation) + estrogen (regularizes cycle, prevents breakthrough bleeding), requires daily pill compliance
- Progestin only (“mini-pill”): Preferred in women who are breast feeding, **>**40 yr, and those with a history of migraines with aura. Must be very consistent with pill compliance.
- Transdermal patch: Estrogen + progestin patch. Apply for 3 weeks, remove for 1 week.
- Vaginal ring: Estrogen + progestin vaginal ring. Patient inserts it and leaves it in place for 3 weeks, then removes it for 1 week.
- Depot medroxyprogesterone acetate (DMPA): Injectable progesterone that is administered in clinic every 3 months. Safe to use while breast feeding. Long-term risk of osteopenia.
- Subdermal implant (Implanon): Implanted by a clinician under the skin, effective for up to 3 yr, may cause irregular bleeding
• Contraindications: Cigarette smoking, history of embolism, heart failure, cerebral vascular disease, migraines with aura, known pregnancy at time of initiation, caution age **>**35 yr
• Side effects: VTE, stroke/cardiac event, elevated triglycerides. Decreased risk of ovarian/endometrial cancer and benign breast disease.
- Barrier methods
• Examples:
- Condom: Provides protection from STIs, estimated 5–8% failure rate
- Diaphragm: Inserted by patient; placed 6 hours before intercourse and should be left in place for 6 hours afterward; may increase risk of UTI
- Other: Cervical cap, sponge, spermicide
- Intrauterine device (IUD)
• Mechanism: Inserted by a clinician, prevents fertilization
• Examples:
- Mirena (levonorgestrel): Inserted every 5 yr, high rates of amenorrhea
- Paraguard (copper): Inserted every 10 yr, non-hormonal, preferred if history of breast cancer, may cause heavier menses
• Side effects: Risk for ectopic pregnancy if patient becomes pregnant with IUD in place
• Contraindications: Anatomic abnormalities that prevent placement
- Emergency contraception
• Example:
- Plan B (levonorgestrel): Effective for up to 120 hours after intercourse to reduce the risk of pregnancy
• Side effects: Nausea, vomiting
• Contraindications: Pregnancy, undiagnosed abnormal vaginal bleeding
- Sterilization
• Examples:
- Men: Vasectomy (takes 8–10 weeks to be effective, may be reversible)
- Women: Tubal ligation (effective immediately, non-reversible)