Signs of Potential Complications, Disadvantages, and Side Effects of Contraceptives

Patch 1st yr of use is 8% - Side effects similar to OCP's - Risk of venous thrombophlebotic conditions because of total estrogen level can be higher than w/ OCPs. - Attributed to amt of estrogen, progestin, or both in doses. - With high doses of estrogen and progesterone include stroke, MI, thromboembolism, HTN, gallbladder disease, and live tumors. - With estrogen excess include nausea, breast tenderness, fluid retention and chloasma (dark patches of skin) Skin reaction at site...site rotation suggested Rx only - Application is on the same day once a week for 3 wks followed by a week w/out patch. Withdrawal bleeding occurs during the no patch week. - Over the counter meds, herbs (e.g. St Johns wort) can alter the effectiveness. - Review information w/ patient and ensure clear a understanding of dose regimen to her. Instruct about backup methods. - Signs of potential complications (p. 111) "ACHES" A - abdominal pain may indicate problem with liver or gall bladder. C - Chest pain or SOB may indicate possible clot problems w/in the lungs or heart. H - HA (sudden or persistent) may be caused by CVA or HTN. E - Eye problems may indicate a vascular accident or HTN. S - Severe leg pain may indicate a thromboembolic process.

Pills "OCP's" (oral contraceptive pills) (Combo or estrogen and progestin or Progestin only)

- History or presence of thromboembolic disorders, Cerebrovascular or CAD, valvular heart disease, breast cancer, or other estrogen dependent tumors, impaired liver function and liver tumor. Women older then 35 and smoke. - Severe HTN or have HA w/ focal neurologic symptoms should NOT use COCs. Reduce effectiveness of anticonvulsants, systemic antifungals, antituberculosis drugs, anti-HIV protease inhibitors.

Contraceptive Injections

Effectiveness compared to that of OCP's 3% in the 1st yr of use

- Delayed return of fertility after stopping. 6-12M Side effect at the end of the year include decrease bone mineral density, wt gain. lipid changes, increase risk of venous thrombosis and thromboembolism, irreg. vaginal spotting, decrease libido and breast changes

Women high risk for - Can be administered SQ or IM osteoporosis maybe not be good - Initiated during first days of s candidates cycle and administer every 12 weeks or 3 months. - Do not massage the site after injection because this action can hasten the absorption and shorten the period of effectiveness. - DMPA or Depo-Provera should not be used as a longterm birth control (> than 2 yrs)... Educate about calcium intake and exercise.

Signs of Potential Complications, Disadvantages, and Side Effects of Contraceptives

IUDs (T-shaped w/bendable arms) 0.8% w/in the 1st yr with copper IUD 0.2% w/in 1st yr with Mirena

- With ParaGard T- aka

"Copper T" 380A (copper IUD) may experience bleeding or cramps w/in 1st yr after insertion can be treated with NSAIDS for pain.

- With Mirena uterine

cramping and bleeding slight improved with this device but irregular spotting common first few months after insertion.

- Increase risk for of pelvic - Inserted by trained provider. inflammatory disease (PID) - Woman should have neg. prego shortly after placement, possible test, HX for dysphsia, cervical uterine perforation of the culture to rule out STDs and device, infection, and possible consent formed signed before uterine perforation. insertion. - Woman should report any S/S of - Nulliparity is related to an influenza-like illness, indicate increase in expulsion. septic miscarriage. - Potential complications: Ectopic Pregnancy severe abd pain, pain w/ sex, a late or missed period; abnormal spotting or bleeding, abnormal discharge, not feeling well, fever, chills, presence of device outside or inside the cervix or in vagina. Read Evidence Based Practice on p. 115 Teach patient how to check the strings of the IUD, wrap them around the cervix. Warn her that her partner may feel poking f/the strings. Similar to OCP's - Prescription only. - Wear 3 wks with ring and then 1 wk w/out or or change every 21 days. - Does not have to be fitted. - Discomfort during sex, ring should not be removed longer than 3 hrs. - Mechanism of action, efficacy are similar to COCs.

Vaginal Ring (flex. ring of ethylene vinyl acetate copolymer)

8% first yr of use

Vaginitis, leukorrhea, vaginal discomfort, w/drawl bleeding w/ no ring week. Side effect similar to OCP's

Male Condom

Typical users 15%. Correct and consistent users 2%.

None

- Interruption, sensation altered, Safe, no side effects, readily spillage of sperm result in avail., changes in cervix prego, condoms can break/tear. prevented. - Latex allergies...latex - Check expiration dates, use sensitivity water-based lubricate, oil based lubricates, oil based lube will break down latex condoms, etc.... - Condoms lubricated with N-9 not recommended for prevention of STIs and HIV. - Inquire about latex allergies. - natural skin condoms < protection against STIs and HIV Same as above. Good for partner that doesnt like or cant wear male condom. - One time use - Avail. one size fits all - Do not use male condom in addition could cause tearing. 2

Female Condom (made of polyurethane and flex. ring

21% in the first year use.

None

Signs of Potential Complications, Disadvantages, and Side Effects of Contraceptives

Spermicides (reduce sperm mobility) 29% if used alone. - Irritation of tissue with contact w/ spermicides Nonoxynol-9 (N-9) most common destroys sperm cell membrane.., can increase transmission of HIV if used more than 2x/day. - Inserted high in to vagina to make contact with cervix. - Some spermicides need to be inserted least 15 min prior but no longer than 1 hour before. - Need to be reapplied for each act of intercourse - Contraindicated for women with pelvic relaxation (uterine prolapse) or a lg cystocele - Dont use Latex dia. w/ latex allergy. - Not a good option for women w/ poor vaginal muscle, or recurrent UTIs - Requires prescription. - Annual gynecologic exam to assess fit needed. - Replace Q 2 yrs. - Refit for 20% wt fluctuation, abd. or pelvic surgery, every term pregnancy, miscarriage or abortion that occurs after 14 wks of gestation. - Reduction is TSS is prompt removal 6-8 hrs after sex, not using the diaph. during menses, and watching for signs of TSS. - Patient instructions see p.106 -Reduction is TSS is prompt removal 6-8 hrs after sex, not using the diaph. during menses, and watching for signs of TSS -Remains in place for no < 6 hours and no more than 48 hrs at a time. -Patient instructions p.106. Similar to diaph. placem. but can be inserted hours before intercourse w/out additional spermicide and none needed for repeated acts of sex. -Cap refit gyno surgery, birth, major wt loss/gain, otherwise check 1/yr.

Diaphragm (3 types: coil spring, arcing spring, & wide seal rim) p. 104-107

16% in 1st yr of - Irritation of tissue use. with contact w/ < when used spermicides w/out -Toxic Shock Syndrome spermicide (TSS): S/S are a high fever up to 105 degrees F (40.6 degrees C), sometimes a sudden fever, sore throat, headache, vomiting, diarrhea, fainting, a rash that looks like a sunburn, and muscle aches. ?

Cervical Caps (3 types made of rubber or latex free silicone, soft domes firm brims)

-Toxic Shock Syndrome - Angle of uterus, the vaginal (TSS) reported muscle tone, and the shape of the cervix may interfere with ease of fitting and use. Patient must check fit after each act of sex. See p. 108 for patient self management. - Not goo for women who exper. abnormal Pap test results, not able to fit with existing cap sz, find it difficult to insert or remove, allergic reactions to spermicide/latex, history of TSS or cervical infections.

Surgical

Same as Sterilization Less than 1% Post surgical pain and discomfort Costly and not always effective to reverse Pts fear that sterilization will affect sex life. Heal time is 3 months for both men and women Teach that sterilization wont affect sex life

Sterilization

Signs of Potential Complications, Disadvantages, and Side Effects of Contraceptives

Emergency Contraception Ineffective if woman is pregnant. 641% fail rate 27% Nausea/vomiting Pregnancy, undiagnosed abnormal vaginal bleeding or hypersensitivity to product Take over the counter antiemetic one hour before each dose

Withdrawal

Messy Sheets! (Lori H wanted me to add that) None

Men with no control (also Lori)

Withdrawal is not very effective method and it does not protect against STDS LAM works best if mom is exclusively breastfeeding, if mom has not had period or if infant is under 6 months of age. Must do frequent feeding q4 hours during day and q6 hours during night Only fool proof method Teach Menstrual Cycle: 3 phases. Infertile phase: before ovulation. Fertile phase: approx 5-7 days around the middle of cycle. Infertile phase: after ovulation

Lactational amenorrhea method

2%

Mother must be aware of diet and alcohol intake while breastfeeding

Abstinence Fertility Awareness

0% 25%

Sexual Frustration Accidental pregnancy Decrease Spontaneity of coitus

None Illness can alter womans body temp and vaginal secretions. Irregular cycles decrease effectiveness Does not protect against STDs

Combined oral contraceptive pills (COC) - suppresses the action of the hypothalamus and the anterior pituitary that inhibits production of the follicle-stimulating hormone (FSH) and LH; therefor follicles do not mature, suppressing ovulation. - COCs also affect the endometrium by but altering maturation of the endo Advantages: - Taking pills does not relate to sexual act, don't have to do anything in the heat of the moment. - Know what to expect menstrual flow is comforting to some women. - Decrease menstrual blood loss, iron-deficiency anemia, regulation of period and irregular cycles, and reduced incidence of premenstrual syndrome (PMS). - Also protect against the development of functional ovarian cysts and salpingitis and decrease the risk of ectopic pregnancy. Requires medical examination before being prescribed and then yearly thereafter. Assessment after 3 months after the beginning of COCs to detect any complications Signs of potential complications (p. 111) A - abdominal pain may indicate problem with liver or gall bladder. C - Chest pain or SOB may indicate possible clot problems w/in the lungs or heart. H - HA (sudden or persistent) may be caused by CVA or HTN. E - Eye problems may indicate a vascular accident or HTN. S - Severe leg pain may indicate a thromboembolic process.