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 John’s 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.

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

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- 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 Injection’s

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.

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. and Side Effects of Contraceptives IUD’s (T-shaped w/bendable arms) 0. leukorrhea. . oil based lube will break down latex condoms. use sensitivity water-based lubricate.Woman should have neg.Do not use male condom in addition could cause tearing.Does not have to be fitted..Prescription only.Discomfort during sex. not feeling well.Interruption. etc. .Avail. Read Evidence Based Practice on p. Disadvantages. Side effect similar to OCP's Male Condom Typical users 15%. .2% w/in 1st yr with Mirena .. vaginal discomfort. efficacy are similar to COCs.With ParaGard T. one size fits all . pain w/ sex. Warn her that her partner may feel poking f/the strings... None . . oil based lubricates. . . Similar to OCP's . Vaginal Ring (flex. None .latex .One time use ..Potential complications: Ectopic Pregnancy severe abd pain.. . insertion. sensation altered. fever. presence of device outside or inside the cervix or in vagina. . ring of ethylene vinyl acetate copolymer) 8% first yr of use Vaginitis.Woman should report any S/S of . wrap them around the cervix. a late or missed period. Correct and consistent users 2%.Increase risk for of pelvic . Good for partner that doesn’t like or can’t wear male condom. and possible consent formed signed before uterine perforation.With Mirena uterine cramping and bleeding slight improved with this device but irregular spotting common first few months after insertion. abnormal discharge. chills. - . indicate increase in expulsion.8% w/in the 1st yr with copper IUD 0. infection.Wear 3 wks with ring and then 1 wk w/out or or change every 21 days.natural skin condoms < protection against STIs and HIV Same as above.Latex allergies. prevented.aka "Copper T" 380A (copper IUD) may experience bleeding or cramps w/in 1st yr after insertion can be treated with NSAIDS for pain. readily spillage of sperm result in avail. ring should not be removed longer than 3 hrs. septic miscarriage.Nulliparity is related to an influenza-like illness. inflammatory disease (PID) . 115 Teach patient how to check the strings of the IUD. HX for dysphsia. cervical uterine perforation of the culture to rule out STD’s and device. abnormal spotting or bleeding.Condoms lubricated with N-9 not recommended for prevention of STI’s and HIV. Safe. . .Signs of Potential Complications.Inquire about latex allergies.Check expiration dates.Inserted by trained provider. prego shortly after placement. condoms can break/tear. possible test. no side effects. w/drawl bleeding w/ “no ring” week. . changes in cervix prego.Mechanism of action. ring 21% in the first year use. 2 Female Condom (made of polyurethane and flex.

104-107 16% in 1st yr of . Diaphragm (3 types: coil spring.Requires prescription.Some spermicides need to be inserted least 15 min prior but no longer than 1 hour before.Inserted high in to vagina to make contact with cervix. . Disadvantages. can increase transmission of HIV if used more than 2x/day.Angle of uterus.Irritation of tissue use. major wt loss/gain. See p. find it difficult to insert or remove. or recurrent UTI’s . soft domes firm brims) -Toxic Shock Syndrome ..Replace Q 2 yrs. and watching for signs of TSS. miscarriage or abortion that occurs after 14 wks of gestation. -Cap refit gyno surgery. history of TSS or cervical infections. during menses.Not goo for women who exper. and muscle aches. . diarrhea. birth. during menses. a rash that looks like a sunburn. Similar to diaph. and the shape of the cervix may interfere with ease of fitting and use. .Signs of Potential Complications. the vaginal (TSS) reported muscle tone. placem. allergic reactions to spermicide/latex. .Patient instructions see p.Reduction is TSS is prompt removal 6-8 hrs after sex. .Need to be reapplied for each act of intercourse . Patient must check fit after each act of sex. abnormal Pap test results. 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. -Patient instructions p. or pelvic surgery. 108 for patient self management. not able to fit with existing cap sz.. and Side Effects of Contraceptives Spermicides (reduce sperm mobility) 29% if used alone. .Not a good option for women w/ poor vaginal muscle. 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. not using the diaph. . and watching for signs of TSS -Remains in place for no < 6 hours and no more than 48 hrs at a time. arcing spring. but can be inserted hours before intercourse w/out additional spermicide and none needed for repeated acts of sex. & wide seal rim) p. fainting. vomiting.Don’t use Latex dia.6 degrees C). every term pregnancy. ? Cervical Cap’s (3 types made of rubber or latex free silicone. abd.Contraindicated for women with pelvic relaxation (uterine prolapse) or a lg cystocele . .106 -Reduction is TSS is prompt removal 6-8 hrs after sex.Annual gynecologic exam to assess fit needed.Irritation of tissue with contact w/ spermicides Nonoxynol-9 (N-9) most common destroys sperm cell membrane. w/ latex allergy. Heal time is 3 months for both men and women Teach that sterilization won’t affect sex life Sterilization 3 . sore throat. not using the diaph. . headache. . otherwise check 1/yr.106.Refit for 20% wt fluctuation. sometimes a sudden fever. .

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.Severe leg pain may indicate a thromboembolic process. Disadvantages. Irregular cycles decrease effectiveness Does not protect against STDs Combined oral contraceptive pills (COC) . Assessment after 3 months after the beginning of COC’s to detect any complications Signs of potential complications (p. H . don't have to do anything in the heat of the moment. Must do frequent feeding q4 hours during day and q6 hours during night Only fool proof method Teach Menstrual Cycle: 3 phases.Signs of Potential Complications.  .Eye problems may indicate a vascular accident or HTN. .abdominal pain may indicate problem with liver or gall bladder. 4 .Taking pills does not relate to sexual act. 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 woman’s body temp and vaginal secretions. C . regulation of period and irregular cycles. E . and reduced incidence of premenstrual syndrome (PMS). 641% fail rate 27% Nausea/vomiting Pregnancy. if mom has not had period or if infant is under 6 months of age. . .Also protect against the development of functional ovarian cysts and salpingitis and decrease the risk of ectopic pregnancy.Chest pain or SOB may indicate possible clot problems w/in the lungs or heart. suppressing ovulation. 111) A .Know what to expect menstrual flow is comforting to some women. therefor follicles do not mature.HA (sudden or persistent) may be caused by CVA or HTN. iron-deficiency anemia. and Side Effects of Contraceptives Emergency Contraception Ineffective if woman is pregnant. Infertile phase: before ovulation. Fertile phase: approx 5-7 days around the middle of cycle.Decrease menstrual blood loss.suppresses the action of the hypothalamus and the anterior pituitary that inhibits production of the follicle-stimulating hormone (FSH) and LH. S .COC’s also affect the endometrium by but altering maturation of the endo Advantages: . Requires medical examination before being prescribed and then yearly thereafter.

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