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    Contraception: David Blair Toub, M.D. Dept. of Obstetrics and Gynecology Pennsylvania Hospital

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    drng48
    This document discusses various contraception methods including oral contraceptive pills, Depo-Provera, Norplant, intrauterine devices, condoms, diaphragms, and emergency contraception. It provides details on the efficacy, mechanisms of action, benefits, side effects, risks, and use considerations for each method. Hormonal methods like combination oral contraceptive pills and Depo-Provera are generally more effective than barrier methods but can have side effects. The intrauterine device has a very low failure rate and its risks have been overblown, though it requires monogamy.

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    Contraception: David Blair Toub, M.D. Dept. of Obstetrics and Gynecology Pennsylvania Hospital

    Uploaded by

    drng48
    20 views20 pages
    This document discusses various contraception methods including oral contraceptive pills, Depo-Provera, Norplant, intrauterine devices, condoms, diaphragms, and emergency contraception. It provides details on the efficacy, mechanisms of action, benefits, side effects, risks, and use considerations for each method. Hormonal methods like combination oral contraceptive pills and Depo-Provera are generally more effective than barrier methods but can have side effects. The intrauterine device has a very low failure rate and its risks have been overblown, though it requires monogamy.

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    This document discusses various contraception methods including oral contraceptive pills, Depo-Provera, Norplant, intrauterine devices, condoms, diaphragms, and emergency contraception. It provides details on the efficacy, mechanisms of action, benefits, side effects, risks, and use considerations for each method. Hormonal methods like combination oral contraceptive pills and Depo-Provera are generally more effective than barrier methods but can have side effects. The intrauterine device has a very low failure rate and its risks have been overblown, though it requires monogamy.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    20 views20 pages

    Contraception: David Blair Toub, M.D. Dept. of Obstetrics and Gynecology Pennsylvania Hospital

    Uploaded by

    drng48
    This document discusses various contraception methods including oral contraceptive pills, Depo-Provera, Norplant, intrauterine devices, condoms, diaphragms, and emergency contraception. It provides details on the efficacy, mechanisms of action, benefits, side effects, risks, and use considerations for each method. Hormonal methods like combination oral contraceptive pills and Depo-Provera are generally more effective than barrier methods but can have side effects. The intrauterine device has a very low failure rate and its risks have been overblown, though it requires monogamy.

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    Contraception

    David Blair Toub, M.D.


    Dept. of Obstetrics and Gynecology
    Pennsylvania Hospital
    Methods
    Oral Contraceptive Pills (OCPs)
    Depo-Provera, Norplant
    Intrauterine Device (IUD)
    Male / Female Condom
    Diaphragm
    Emergency Contraception (EC)
    Efficacy (modified from trussell, et. al 1990)
    Failure Rate (Percent) During First Year of Use
    6
    6

    4
    3
    3
    2
    2
    0.8
    1 0.5
    0.3 0.2
    0.1 0.04
    0
    Spermicides Comb. Prog. OCP's Diaphragm Condom Depo- Cu-T380A Norplant TL
    OCP's Provera
    Hormonal Contraception:
    Combination OCPs
    Contain Synthetic Estrogen/Progestin
    Modern E2 Dosage 50 Mcg
    Despite Diversity, Side Effects and
    Efficacies Similar
    Requires Patient Compliance
    May Be Monophasic or Triphasic
    Combination OCPs:
    Mechanism of Action
    Suppresses LH / FSH Release
    (E2 FSH, P LH)
    Progestin Thickens Cervical Mucus and
    Alters Endometrium
    Major Effect Is Anovulation and
    Impairment of Sperm Transport and
    Ocyte Implantation
    Combination OCPs:
    Additional Benefits
    Menstrual Regulation
    Decreased Risk of Anemia
    Ovarian, Endometrial CA: Risk
    Lower PID Risk
    Prevention of Benign Breast Disease
    Combination OCPs:
    Side Effects
    Breakthrough Bleeding ( 25%)
    Amenorrhea
    Breast Tenderness, Nausea
    H/A (+/)
    ?HTN
    ?Weight Gain
    Combination OCPs:
    Risks
    Thromboembolism ( 35 yo, Smoker)
    MI (Smokers Only):
    < 15 cig/day: 3X Risk
    > 15 cig/day : 21X Risk
    Liver Adenomas (Very Rare)
    Depo-Provera:
    Inhibits Ovulation
    150 mg q3months (14 day grace period)
    Delayed Ovulation After Discontinuation
    Main Side-Effects:
    Amenorrhea
    AUB
    Weight Gain
    Hair Loss
    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
    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
    IUD: Overview
    ParaGard (CuT380A), Progestasert
    Very Effective (~ TL), Reversable
    Risks OVERBLOWN
    Monogamy Essential, However
    Does Not Protect Against STDs
    Can Remain for 10 Years
    IUD:
    Mechanisms of Action
    NOT ABORTIFACIENT!!!!!!!!
    Prevents Conception:

    Sperm Transport Inhibited


    Sperm Survival / Capacitation
    Diminished
    Prevents Implantation: hCG Levels = 0
    IUD:
    Work-up
    History: STDs, Sexual History, Ectopic
    PEx: Size / Configuration of Uterus
    Cervical Cultures, Pap
    Counseling
    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)
    IUD:
    Complications
    PID: Usually 20 Insertional Contamination
    Unproven Role for Prophylactic ABx
    Hypermenorrhea
    Expulsion
    Perforation (< 0.1%)
    Failure: IUD Should be Removed
    ??Ectopic
    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
    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


    Summary
    A Limited, but Diverse Range of
    Contraceptive Options Exist in the USA
    Barrier Methods Tend to Have Higher
    Failure Rates than Hormonal Methods
    and the IUD
    The IUD is Underutilized
    All Methods have Risks and May Not be
    Appropriate for all Patients

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