5 days before ovulation

5-45% chance of pregnancy during 6 day window

Calendar Method

Basal Body Temperature

Cervical Mucous Method

Symptothermal Method

More useful when PLANNING a pregnancy

- Male/Female condoms

- Sponge

- Spermicide

- Diaphragm

- Cervical Cap

- Polyurethane, not latex (Men could do either)

- 21% failure rate

- Can be inserted 8 hours prior

- Only use one condom or the other

- Barrier

- Spermicide

- Absorbs semen

- 16-32% failure rate

- Toxic shock if left in

- Can be inserted up to 24 hours before and left in 6 hours after

- Foams, gels, suppositories (more gritty?)

- Failure rate 29%, more of a backup method

- Active ingredients are NOM NOM NOM.  Nonoxynol-9, Octoxynol-9, Menfegol

- Use higher concentrations with diaphragms and cervical caps

- Diaphragms have failure rate of 16%, latex filled with spermicide, professional fit

- Cerival cap has 16-32% failure, thimble shaped latex

- Cap can be left in longer than diaphragm, and don't need to reapply spermicide

- Only male/female condoms provide STD protection

- Hormonal contraceptives more efficacious

- F, O, L

- Folicular (1-12 days), Ovulation (48 hours), Luteal (16-28 days)

Estrogen:  Inhibits FSH and LH through neg. feedback.  Inhibits ovulation.  Accelerates ovum transport.  Inhibits ovum implant.  Potentiates Progestin

Progesterone:  Thickens mucous.  Inhibits LH, preventing ovulation.  Alters endometrium to stop implantation

- Monophasic is the same dose all the time.  biphasic, or triphasic refer to either taking 1 or 2 different types of estrogen or progesterone doses, mimicing a natural cycle.  

- Excess of estrogen and progesterone cause n/v, bloating, tenderness or weight gain and acne, respectively

- Deficiency in each hormone leads to spotting and amenorrhea

- ACHES stand for what you should counsel on.  Abdominal pain, Chest pain, Headache, Eye problems, Severe leg pain.

Advantages

- 8% efficacy

- Helps with acne

- reduce risk of endometrial and ovarian CA

- Helps dysmenorrhea

Disadvantages

- Increase BP

- Increase risk of stroke, MI, or TE disease

- Hormone side effects

- TE disease

- CVD

- Impaired liver function

- Estrogen dependent cancer

- Pregnancy

- Smokers greater than 35 years

- Abnormal genital bleeding

- Migraines

- HTN

- Galbladder disease

- History of gestational diabetes

- Smoking

- Epilepsy

- Jaundice with pregnancy

- Sickle cell anemia

- Lactation

- Hyperlipidemia

Inducers: Rifampin, Phenytoin, Sulfonamides, Tetracyclines

Inhibitors:  Ketoconazole, Fluconazole

Use backup method for whichever is longer, Abx + 2 weeks, or the remainder of the cycle.

- Combo

- Quarterly menstruation

- 91 days on, 7 days off

- Could prevent anemia and endometriosis

- Disadvantages:  Prolonged exp. to hormones so more likely for DVT, could have 20 days of bleeding at start.

- Same as Seasonale except........

- 84 days on combo, 7 days of low dose estrogen

Seasonique is UNIQUE in that regard

- Useful in pt's with certain CI's

- Avoid estrogen ADR's

- Includes Micronor, Nor QD, Ovrette

- Less effective than combos, 40% may still ovulate

- May cause spotting or ectopic pregnancy

- Not for fatties > 90kg (198 lbs)

- Combo

- Use q week with one week off

- Apply pretty much any hairless area

- 2x risk of DVT

- Combo

- Remains in for 3 weeks, out  for 1

- Can be taken out for up to 3 hours

- Risks same as OC

- T shaped IUD

- Progestin only

- in place for 5 years

- 0.1% failure

- counsel on PAINS

- PID/Pregnancy, abdominal pain, infection, not feeling well string (change in length means it moved)

- Progestin-only  injection

- Need compliance (Preg. test before each injection)

- Decreases in bone density

- Delay of fertility of 10 months

- 3% failure.

- Really not to use in patients under 20 y/o or for longer than 2 years (bones)

- Implanted in arm

- Effective for 3 years

- 0.3% failure

- Progestin only

- Inhibits ovulation, alters endometrium

- 68 mg of etonogestrol, active metab. of desogestrol

- 24 day and continuous dosing to reduce menstrual sx

- Includes Yaz and Lybrel. 

- Lybrel is first continuous dosing OC

- These are combos

- Within 72 hours after unprotected sex, decreases chance of pregnancy 75-89%

- Can be used up to 120 hours after sex

- Plan B one step (w/o a script if >17), Copper IUD, and Yuzpe (5 pills of one OC, then another 5 pills 12 hours later) method available