Narrated Birth Control (61)

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Lehne

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Chapter 61: 

Chapter 61 Birth Control

Birth Control: 

Birth Control Interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)

Safety: 

Safety Difficult to assess Much of our data was gathered when birth control was used in higher doses than we use today Effectiveness versus safety

Selecting a Birth Control Method: 

Selecting a Birth Control Method Consider: Effectiveness Safety Personal preference

PowerPoint Presentation: 

Fig. 61-1. Percentage use for birth control methods, United States, 2002. Note: The segment labeled “ other methods ” refers to Norplant (no longer used), Lunelle, contraceptive patches, spermicides, cervical caps, female condoms, and other techniques.

Oral Contraceptives : 

Oral Contraceptives Mechanism – inhibits ovulation Classification (two main categories) Combination oral contraceptives (OCs) Estrogen and progestin Progestin-only OCs Three major subgroups of combination OCs Monophasic Biphasic Triphasic

Combination Oral Contraceptives – Adverse Effects: 

Combination Oral Contraceptives – Adverse Effects Thromboembolic disorders Hypertension Cancer Teratogenic effects Abnormal uterine bleeding Use in pregnancy and lactation Benign hepatic adenoma Glucose intolerance Other adverse effects

Noncontraceptive Benefits of OCs: 

Noncontraceptive Benefits of OCs Decrease the risk of ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease, iron deficiency, anemia, and acne Favorable effect on menstrual cycles Reduced cramps; lighter, shorter, and more predictable flow

Combination Oral Contraceptives – Drug Interactions: 

Combination Oral Contraceptives – Drug Interactions Drugs and herbs that reduce the effects of OCs Rifampin Ritonavir Troglitazone Antiepileptic drugs St John ’ s wort

Combination Oral Contraceptives – Drug Interactions: 

Combination Oral Contraceptives – Drug Interactions Drugs whose effects are reduced by OCs Warfarin Insulin Oral hypoglycemics Drugs whose effects are increased by OCs Theophylline Imipramine Drugs that elevate potassium should be avoided by patients on yasmin (Yaz)

Dosing Regimens: 

Dosing Regimens See Table 61-2

Combination Contraceptives with Novel Delivery Systems: 

Combination Contraceptives with Novel Delivery Systems Transdermal contraceptive patch Vaginal contraceptive ring

Long-Acting Contraceptives: 

Long-Acting Contraceptives Subdermal etonorgestrel implants Depot medroxyprogesterone acetate (MPA) Intrauterine devices Spermicides Barrier devices Condoms – male and female Diaphragm Cervical cap

Drugs for Medical Abortion: 

Drugs for Medical Abortion Mifepristone (RU 486) with misoprostol Blocks uterine progesterone receptors Adverse effects Bleeding Cramping Nausea Vomiting Diarrhea Headache

Drugs for Medical Abortion: 

Drugs for Medical Abortion Methotrexate with misoprostol Prostaglandins: misoprostol, carboprost, dinoprostone

Emergency Contraception: 

Emergency Contraception Contraception implemented after intercourse Following assault, failed contraception, or failure to use contraception Plan B 2 high-dose tablets of levonorgestrel (progestin) 1 tablet within 72 hours and another 12 hours later Alternatives to Plan B