Entertainment

Topic Information

Outdoor

• The only birth control method that reduces the risk of both pregnancy and sexually transmitted infections (including HIV); Latex condoms are m/c types
• Typical use failure rate: 13%

Indoor

• keeps sperm from getting into the vagina; it can be inserted up to 8 hours before sexual intercourse; It may prevent STIs
• Typical use failure rate: 21%

Diaphragm and Cervical cap

• Place inside vagina to cover the cervix to block sperm before sexual intercourse
• Need a proper fitting at physician’s office b/c diaphragms and cervical caps come in different sizes
• Typical use failure rate: 17%

Sponge

• The sponge contains spermicide and is placed over the cervix
• The sponge works for up to 24 h and must be left in the vagina for at least 6 hours after the intercourse
• Typical use failure rate: 14% Nulliparous and 27% Multiparous women

Spermicides

• Placed in the vagina <1 hour before intercourse and leave them in place >6-8 hours after intercourse
• Spermicide can be used in addition to a male condom, diaphragm or cervical cap
• Typical use failure rate: 21%

Fertility Awareness Based Method and Withdrawal Method

• Fertility awareness based methods identify the fertile days of the menstrual cycle by observing cervical secretions, basal body temperature, or by monitoring cycle days; Avoid having sex on the fertile days or use a barrier method on those days
• Typical failure rate 2-23%

• Withdrawal (coitus interruptus) is a traditional family planning method
• Typical failure rate 27%

Contraceptive Effectiveness and Safety

• MEC 1 → No restriction
• MEC 2 → B > R
• MEC 3 → R > B
• MEC 4 → CI

Most effective form of birth control → Nexplanon

Vasectomy
• Comparing female sterilization; Vasectomy is safer, more effective, and less expensive
• Vasectomy is not immediately effective; An alternative form of contraception should be used to avoid pregnancy until a semen analysis confirms azoospermia
• Although the majority of males are azoospermic at 3 months, the vast majority of males are azoospermic at 6 months after vasectomy
• Vasectomy that achieves azoospermia in the 60 and 90 day periods would be the most effective in 5 years
• The most effective type of sterilization over a 5 year period → PP partial salpingectomy
• Vasectomy → occurs by ligating Ductus Deferens

Surgical sterilization and LARC methods have similar failure rates

• Postpartum tubal ligation via partial salpingectomy has a 5yr cumulative failure rate of 6.3 per 1,000 procedures, while LNG IUD has a failure rate of 5-11 per 1,000 procedures

Combined Estrogen-Progestin Hormonal Contraceptives

• 13% of US women aged 15-44yo are using OCPs
• MOA = suppression of ovulation by inhibition of GnRH, LH, FSH and the midcycle LH surge; The most important mechanism is estrogen suppression of FSH which in turn prevents folliculogenesis
• OCP decrease new cyst formation by decreasing the amount of circulating estrogens and progesterones and inhibiting ovulation, thereby inhibiting corpus luteum formation; OCPs will not help resolve current cyst but will prevent more from forming in the future
• Obese women can be offered all hormonal contraceptives with similar efficacy
• Record BP and BMI before prescribing contraception
• Breast or pelvic exam, Pap smear or STI screen are not required; lab screening for thrombophilia is not routinely recommended
• Increasing the supply of OCs (ie 7 to 13 packs) at time of initiation can improve continuation rates, especially among teenagers

Risk of VTE

• 13% of US women aged 15-44yo are using OCPs
• The estrogen of combined hormonal contraception increases hepatic production of coagulation factors
• The risk of VTE induced by CHC is low (half the risk of pregnancy)

Absolute and Relative CI to CHC

• Breast cancer (current or h/o)
• Breastfeeding
- < 21 days postpartum
- 21 to < 30 days postpartum with or without RF for VTE
- 30-42 days postpartum with other RF for VTE
• Postpartum (Non-breastfeeding)
- < 21 days
- 21 days to 42 days with other RF for VTE (AMA, Obesity, previous VTE, thrombophilia, immobility, PPH or transfusion, Cardiomyopathy, post C/S, PEC, smoking)
• Peripartum CM
• Cirrhosis → Severe (decompensated)
• DVT/PE
- H/o DVT/PE NOT receiving anticoagulant
- Risk of recurrent DVT/PE either High or Low risk
• The risk of VTE induced by CHC is low (half the risk of pregnancy)