Contracep*on. Potpourri

Transcription

1 Contracep*on Potpourri

2 Hormonal Contracep*on How It Works, Various Forms

3 Hormonal Contracep*ves: Mechanism of Ac*on Synthe*c estrogen and/or synthe*c progesterone Combina*on hormone contracep*ves halt ovula*on No egg = no pregnancy HybridMedical video: Ovula*on (YouTube)

4 Hormone- Based Contracep*on Estrogen Usually ethinyl estradiol Proges*n Many types Types vary in terms of side effects Blood lipids Break- through bleeding Weight gain/metabolism Acne Source: Dawn Stacey, About.com

5 Estrogen Estrogen suppresses development of follicle within ovary Estrogen changes the endometrial lining, making the uterine environment less accommoda*ng to a fer*lized ovum

6 Estrogen Estrogen makes proges*n ac*vity stronger Proges*n manipulates one of the hormones responsible for ovula*on So, even if estrogen does not completely prevent follicle development, it works with proges*n to prevent ovula*on

7 Proges*n Proges*n thickens cervical mucus Thicker mucus hampers sperm movement Proges*n also changes the endometrial lining Reduces likelihood for egg implanta*on Proges*n- only methods may not inhibit ovula*on Varies from one cycle to another Method dependent (Depo- Provera inhibits ovula*on, minipills may not) Effec*veness due to cervical mucus, endometrial changes

8 Hormonal Contracep*on: Women with history of venous clots, coronary artery disease, stroke, diabetes with blood vessel damage, high blood pressure, breast cancer, abnormal bleeding, liver problems Smoking Obesity? (pills = most controversy; IUD, implant recommended, per Edelman et. Al., uptodate.com) Contraindica*ons

9 Ortho Evra The patch Beige plas*c patch applied to the skin Once a week for three weeks Stomach, upper arm, upper torso First day of menses or first Sunday ayer period starts Releases estrogen and proges*n

10 Ortho Evra Cost: Included with insurance; average wholesale price is ~ $0-80/month (Planned Parenthood) Patch should be applied on same week day Effec*veness: 99%

11 Ortho Evra: Side Effects Breast tenderness (~20%) Headache Sensi*vity to adhesive Nausea Menstrual cramping Increase in HDL, LDL, triglycerides Upper respiratory infec*ons Increased blood clot risk vs contracep*ve pills Source: OrthoEvra.com

12 Inser*on of ring into vagina Remains in place for three weeks Combina*on method: estrogen and proges*n released Cost: $0-80/month (Planned Parenthood) Inser*on (YouTube, 0:45-1:20) NuvaRing

13 NuvaRing: Side Effects Vaginal irrita*on Nausea Weight gain Irregular bleeding/spoeng Rash Serious, rare: blood clots, gallbladder disease, cancer, liver growths, pancrea*c inflamma*on (triglycerides), cardiovascular incidents

14 Nexplanon/Implanon Implanon approved by FDA in 2006 An implant One rod (Norplant- six) Inserted under skin, inner arm Can feel implant Low- dose proges*n release Good for three years

15 Nexplanon/Implanon 1.5 inches in length Effec*veness: 99% Cost: Included with insurance; $0-800 (Source: Planned Parenthood) Upon removal, fer*lity returns to normal within several weeks Sensi*ve inser*on video (YouTube, 2:08)

16 Nexplanon/Implanon: Side Effects Irregular bleeding Headache Depression Breast tenderness Acne Weight gain

17 Approved by the FDA in 1992 Proges*n- only contracep*ve for females Hormone is injected every three months Arm Bukocks Depo- Provera works by preven*ng ovula*on, thickening cervical mucus, altering endometrium Depo- Provera

18 Depo- Provera Effec*veness Protec*on immediate if first shot occurs during first five days of period; otherwise, use other contracep*ve method for two weeks Greater than 99% effec*veness (MayoClinic.com=97%) Cost: quarterly doctor visit + $0-100 quarterly injec*on (Planned Parenthood)

19 Depo- Provera: Side Effects Headaches Dizziness Nausea Breast tenderness Fa*gue Weight gain 5 pounds or more ayer one year Appe*te change

20 Depo- Provera: Side Effects Abdominal pain Acne Mood changes Bloa*ng Menstrual irregulari*es (lighter, heavier, cessa*on) Bone density loss Unclear whether condi*on will improve when injec*ons stop Calcium supplements Weight bearing exercise advocated FDA s black box warning in 2004 Avoid long- term use (> 2 years) Associa*on of Reproduc*ve Health Professionals report concern might be less than originally thought

21 Depo- Provera Side Effects Reduced sexual appe*te Hot flashes Hair loss May reduce risk for ovarian, endometrial cancers Other, rare side effects: chest pain, pulmonary embolus, tachycardia, fever, breast lumps, anemia, fain*ng, vaginal cysts, asthma (rxlist.com)

22 Depo- Provera: Side Effects Side effects may con*nue un*l Depo- Provera is out of system, up to six months Some women experience no reversibility problems; others take 6-18 months to return to normal

23 Depo- subq Provera 104 Subcutaneous, rather than deep muscle, injec*on Thigh or abdomen 31% lower dose of proges*n (Dawn Stacey, about.com) Similar side effects Since newer product, less informa*on known

24 Contracep*ve Pills Combina*on = estrogen & proges*n Minipill = proges*n only Beyaz, Femcon Fe

25 Contracep*ve Pills Seasonique & Natazia

26 Steriliza*on

27 Steriliza*on: Vasectomy Vasectomy blocks sperm from traveling through the vas deferens, preven*ng sperm from mixing into semen No glands or organs are removed Effec*veness: 99%+ Considered irreversible

28 Steriliza*on: Vasectomy Vas deferens must be isolated Similar to tubal liga*on, the vas deferens can be cut and *ed, clamped, cauterized, no scalpel technique Another form of contracep*on must be used for a few months

29 Steriliza*on: Vasectomy Cost: $ (plannedparenthood.org) Side effects Bruising Sensi*vity/pain for up to a few weeks past the procedure Sperm leaking from tubes may lead to small lump (usually clears up on its own) An*bodies to sperm may develop, reducing chances of fer*lity in a reversal

30 Vasectomy Complica*ons Rare Usually associated with infec*on (fever, pus/ blood from incision site, swelling, pain) Ends of tubes may grow back together (very rare) Decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

31 Steriliza*on: Vasectomy Anima*on (BUPA Health via YouTube, 2:36) Open- ended (no scalpel) vasectomy (medicalvideos.us) Video (vasectomymedical.com)

32 Steriliza*on: Tubal Liga*on Surgical technique Close fallopian tubes, preven*ng egg from traveling to uterus, preven*ng sperm from reaching egg Neither organs nor glands are removed Effec*veness: 99%+ Considered irreversible

33 Steriliza*on: Tubal Liga*on Tubal steriliza*on: Tubes can be *ed and cut (Pomeroy technique) Tubes can be cauterized Tubes can be clipped, clamped These incision methods oyen performed ayer childbirth/abor*on Anima*on (SMART imagebase)

34 Steriliza*on: Tubal Liga*on Cost: $ Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions Complica*ons: infec*on, internal bleeding, ectopic pregnancy Before/aYer photos (private Flickr account)

35 Steriliza*on: Implants Non- incision method No general anesthesia Under an hour Coils inserted into fallopian tubes In following months, coils and *ssue grow together, forming barrier to prevent sperm from reaching egg

36 Steriliza*on: Implants Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomi*ng Demo (Essure) Late November: reports of problems coming to a head: headaches, pelvic pain, chronic fa*gue, coils moving to other parts of body and hur*ng *ssue, others Pre- market approval = exempt from lawsuits

37 Long- Term Contracep*on & Steriliza*on: Project Preven*on Societal aid or eugenics? FOX News program (1:30 minutes) ABC News program (2:19 minutes)

38 Fer*lity Awareness Methods

39 Temperature Method Females track temperature every morning Look for slight drop in temperature occurring immediately before ovula*on At ovula*on, temperature increases Temperature changes are small Look for trends, expect daily fluctua*ons Image source: Public domain, Wikimedia Commons

40 Temperature Method Use basal thermometer Smaller scale (1/10 degree) Chart temperature for at least three months before relying on method Safe sex *me begins 72 hours ayer temperature has risen, remains un*l temperature begins to drop Source: Dr. Sacha Elliok, ND

41 Temperature Method Day 10: 98.5 Day 17: 98.8 Day 11: 98.4 Day 18: 99.0 Day 12: 98.4 Day 19: 98.7 Day 13: 98.1 Day 20: 98.7 Day 14: 97.9 Day 21: 98.8 Day 15: 98.0 Day 22: 98.6 Day 16: 97.5 Day 23: 98.5

42 Cervical Mucus Method Tracking the varia*on in mucus consistency throughout cycle Cervical mucus begins a few days ayer menstrua*on As mucus produc*on increases, it s yellow or white in color & cloudy, s*cky Will become wet, clear Clear, slippery mucus = most fer*le Mucus produc*on decreases, cloudy & s*cky

43 Cervical Mucus Method Tracking Your Cervical Mucus, Babycenter.com Safe days = begin ayer slippery mucus decreases, con*nue into cloudy & tacky, and especially dry days Short cycles = mucus may be hidden in menstrual flow

44 Calendar Method Predic*ng safe and unsafe days based on length of monthly cycles Can use tradi*onal calendar, soyware, phone app, web tools

45 Calendar Method Count length of menstrual cycle Day #1 = first day of menses Last day = day before menses returns Eight cycles are recommended before relying on this method (Planned Parenthood) First fer*le day = shortest cycle minus 18 Last fer*le day = longest cycle minus 11

46 Calendar Method Cycle 1: 24 Cycle 2: 27 Cycle 3: 25 Cycle 4: 28 Cycle 5: 25 Cycle 6: 27 Cycle 7: 29 Cycle 8: 25 Shortest day: 24 Longest day: 29 Unsafe days: #6-18

47 Calendar Method Online calendar method tool - virtualmedicalcentre.com Irregular period cycles = reduced effec*veness Calendar method = requires another method for most to experience adequate effec*veness

48 Contracep*on in the Future: Estrogen and proges*n Gel Spray Acrux Announcement, February 2009 Figure 2: Estrogen content in Nestorone, OrthoEvra, NuvaRing, combina*on pills 2012: Combina*on of nestorone and testosterone reduced sperm count in UCLA study Nestorone

49 Contracep*on: The Future Male hormonal contracep*ve: monthly testosterone injec*on 5/ 2009: China clinical trials 1 in 100 fathered a child Reversible six months ayer stopping injec*ons 1/3 of 1000 par*cipants did not complete; no reason provided Few side effects reported (acne, weight gain), but more research needed Contracep*ve methods may work beker in Asian men vs European men Photo from BBC

50 Contracep*on: The Future RISUG Reversible Inhibi*on of Sperm Under Guidance Contracep*ve method for men Clinical trials in India Injec*on into vas deferens of male (video, wired.com, :34) RISUG disrupts membranes of sperm so they cannot fer*lize One injec*on to last 10 years Reversibility not well tested, though reports on primates appear posi*ve (requires another injec*on) Marke*ng challenges

51 Contracep*on: The Future Male contracep*ve pill research at UW (KOMO report, 2009, 2:10, YouTube) Non- hormonal manipula*on of sperm produc*on has been successful in mice (2012) Vitamin A blocking can reduce fer*lity (but Vitamin A needed for other bodily func*ons)

52 Contracep*on: The Past Male Contracep*ve: Heat Prolonged heat exposure can impair sperm produc*on in testes Ancient method Effec*veness? 116 degree bath 45 minutes Every day Three weeks

53 Contracep*on: Impact of Heat on Sperm

54 Contracep*on: Impact of Heat on Sperm Dada, R, Gupta, NP, & K. Kucheria. Deteriora*on of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 ( )

55 Contracep*on: Impact of Heat on Upper ley: coiled tail Upper right: bent tail Lower ley: double head Lower right: triple head Sperm Dada, R, Gupta, NP, & K. Kucheria. Deteriora*on of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 ( )

56 Intrauterine Contracep*ves (IUC s) IUC s are made of flexible plas*c, available only through prescrip*on Three types ParaGard (copper) Mirena (hormone) Skyla (hormone)

57 IUC s: ParaGard ParaGard contains copper Copper prevents sperm from fer*lizing an ovum Copper also makes implanta*on of fer*lized ovum difficult Amount of copper released is less than needed in daily diet Copper intolerance or insensi*vity would preclude use of ParaGard

58 IUC s: Paragard Requires inser*on into uterus by healthcare provider Takes only a few minutes Inser*on may cause cramping, dizziness Once inserted, may remain in place for ten years Pa*ent should not feel IUD Since no hormones present, monthly cycle should remain unchanged Effec*veness: 99%+ against pregnancy Requires monthly checking for IUD slippage

59 IUC s: ParaGard Side effects: heavier and longer periods, cramping, spoeng in between periods May lessen ayer a few months on ParaGard Complica*on risks: pelvic inflammatory disease shortly ayer inser*on, perfora*on of uterus, expulsion Copper may provide protec*ve benefit against endometrial cancer Cost: $ (Planned Parenthood)

60 Proges*n- only intrauterine contracep*ve Lasts for five years Mirena: Prevents sperm from fer*lizing ovum Prevents release of egg Changes uterine lining IUC s: Mirena

61 IUC s: Mirena Inser*on: Similar to ParaGard Effec*veness: 99%+ against pregnancy Cost: $0-400 (Consumer Reports) Side effects: Abdominal cramping (10% of users during first few months), acne, breast tenderness, headache, mood changes, back pain May lessen ayer a few months As use con*nues, less menstrual bleeding Complica*on effects: ovarian cysts, pelvic inflammatory disease shortly ayer inser*on, perfora*on of uterus, expulsion

62 IUC: Skyla FDA approved in 2013 Hormone Smaller than Mirena Lasts three years instead of five Marketed to women who have not had kids Mirena marketed to women with child (research done only on this group) IUC s appropriate for all women

63 IUC s Internal Birth Control- IUD s (via Youtube) Paragard inser*on (via YouTube, 0-0:53) Mirena inser*on (via YouTube, for healthcare providers) Inser*on of IUC (Medialvideos.us)