February 23, 2015

NURS 330Human Reproductive Health

Agenda

• Review 2.16.15 In-Class Assignment• Quiz• Group Project Review & Preparation• Contraception Lecture• No In-Class Assignment

Quiz

Group Project

• Project and presentation due on 3/2/15• Assign order of presentation• Q &A

CONTRACEPTION

Methods of Contraception and Birth Control

Birth control any means of preventing a birth from taking

place; includes contraception and abortion Contraception

The prevention of conception Technique designed to either prevent the release

of an ovum, prevent the fertilization of an ovum, or prevent a fertilized ovum from implanting in the uterine wall

Alternatives to IntercourseAbstinence-refraining from sexual intercourse

(vaginal, oral, & anal)Celibacy-not engaging in any kind of sexual activityOutercourse-a method of birth control using all

avenues of sexual intimacy except sexual intercourse

Choosing a Method

Best method is the one you will use consistently

Theoretical effectivenessUser/Typical

effectiveness

Failure Rates

• Typical use failure rate– Percentage of typical users of a contraceptive

method who will get pregnant within one year • Theoretical use failure rate– Percentage of users of a contraceptive method who

will get pregnant within one year while using the method perfectly each time

Chance

• Not a “method” at all• Withdrawal (aka: Coitus interruptus)• Douching

• Assumption: cleanses the vaginal canal by squirting a liquid into the vagina• Actuality: Not recommended for any use; no good

purpose and can promote infections

• Urination after intercourse

METHODS

BARRIER HORMONAL LONG-TERM NATURAL FAMILY PLANNING

Cervical Cap Depo-ProveraLunelle

Female Sterilization

Basal Body Temperature

Diaphragm Emergency Contraception

IUD Cervical Mucus/Ovulation Method

Female Condom Implants Male Sterilization

Rhythm Method

Male Condom Patch  

The Sponge Pill  

  Ring  

Hormonal Methods work by..

• Preventing the release of an ovum

• Can also cause the cervical mucus to thicken which prevents sperm from entering the uterus

• The ingestion or injection of estrogen or progestin or a combination of the two.

Emergency Contraception

Emergency contraceptive pill (EC) Also known as Plan B Estrogen and progesterone or just progestin. For use within 72 hours of unprotected sex. No later

than 5 days. “morning after pill” is not an appropriate name

Must be taken well BEFORE implantation.

Two forms of pills Estrogen & Progestin (the combination pill)

Most women choose this method Side effects from estrogen include severe headaches and

high blood pressure Progestin (the mini pill)

Mostly selected due to side effects experienced from estrogen in the combo pill

Oral Contraceptives (OC)– The Pill

Combo pill is best for:

• Any woman (including those over 35) with no risk factors that preclude OCs.

• Women with mild headaches or migraines• Women who have diabetes without any blood

vessel related complications• Women with a history of abnormal,

precancerous Papsmears (displasia).

Implants

Works by inserting progestin rods under the skin and continuously release tiny amounts of progestin into the bloodstream– Norplant (used five rods and lasted five years)

• is no longer available in the United States

– Replaced by implanon• Uses one rod• Provides protection against pregnancy for up to three years

– Can be removed at anytime– After removal, can resume menstruation in one month

Injectiblesunder a clinician's supervision

• Depo-Provera– Progestin – Administered four times a year

• Lunelle– Estrogen + Progestin– Administered every 4 weeks

Ortho Evra Patch

• Estrogen and Progestin

• A once-a-week birth control option that's as effective as the Pill.

• It is the first weekly, non-invasive form of reversible contraception

• How does it work?

• What are advantages and disadvantages?

Nuva Ring

• NuvaRing® delivers steady low-dose contraceptive hormones around the clock.

–Progestin and Estrogen

• One ring is used each month. The ring stays in for 3 weeks and then is removed for one week. Then you insert a new NuvaRing®.

Barrier Methods work by…

• Preventing fertilization of an ovum

• Providing a physical barrier between the semen and the cervix in order to prevent sperm from reaching the egg cell

Condoms

• Male

• Female

• Use either one or the other at one time– Never both at the same time

Today Sponge

• Back on the US market• blocks sperm from entering

the uterus and absorbs and kills off the sperm.

• Intended to be used with spermicide

DiaphragmCervical cap

• Work to prevent sperm from entering the uterus – Intended to be used with spermicide

• Diaphragm– a flexible ring around the top, the diaphragm is inserted into

the vagina prior to sexual intercourse. • Cervical Cap– smaller and fits more tightly around the cervix when in place – must be fitted by your doctor and then purchased from a local

pharmacy – can leave the cervical cap in place for up to 48 hours

Spermicides

Spermicide - substance toxic to sperm Contraceptive foam Contraceptive film Creams, jellies & Vaginal suppositories Non-oxynol 9??

Long-term Methods

• IUD

• Female Sterilization

• Male Sterilization

Intrauterine Device (IUD)

Tiny T-shape plastic or copper device inserted into uterus Multiple theories on how it works Insertion can be painful, heavy cramping and menstrual flow Two currently available in the United States:

– Progestasert (~ 10 years)– ParaGard (~ 1 year)

Sterilization

WOMENLaparoscopy- closing the

tubes by electrocauterization– Minilaparotomy-tubes are

tied off or sealed– Culpotomy-tubes tied and

cut– Culdoscopy- Same as

Culpotomy; however, leaves less visible scars

– Hysterectomy-surgical removal of the uterus

MEN

Vasectomy cut or tie off the Vas deferens

Abortion

• Spontaneous abortion– aka miscarriage– Loss of baby before 20 weeks of pregnancy

• Induced abortion– Surgical– Drug-based

Surgical Method

• Vacuum Aspiration– First trimester method

• Dilation and Extraction (D & X)– Late surgical method

Drug-Based Methods

• Mifepristone (RU 486) –Injection, 0rally– An anti-progesterone

• prevents progesterone from making uterine lining hospitable for implantation

• If fetus is already implanted, causes the uterus to shed its lining and, along with it, the fertilized fetus

– Approved by FDA in September 2000 for abortion• As an alternative to surgical procedure

– Effectiveness is increased if used with another drug, Misoprostol (95-98%)

– Most effective within 7 weeks of fertilization

Drug-Based Methods (cont)• Methotrexate –Injection; orally (rarely)

– Prevents cell division and multiplication– Can be used to induce an abortion

• Effectiveness is increased if used with another drug, Misoprostol (95%)– Approved by FDA for treatment of cancer, arthritis and psoriasis– Most effective within 7 weeks of fertilization

• Misoprostol – orally or vaginally– Legal Drug used in conjunction with above drugs– The second drug used to complete the abortion procedure

• Taken a day or two after administration of the first drug– Causes the uterus to contract and expel its contents– Approved in the US for coating the stomach of people who take stomach-

irritating anti-inflammatory drugs.

Abortifacient

• A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled.

• Which of the drug-based methods is an abortifacient?

Source: Perspectives on Sexual and Reproductive Health

Incidence of Abortions

• Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion.

• Twenty-two percent of all pregnancies (excluding miscarriages) end in abortion.

• In 2005, 1.21 million abortions were performed, down from 1.31 million in 2000. From 1973 through 2005, more than 45 million legal abortions occurred.

• Each year, about two percent of women aged 15-44 have an abortion; 47% of them have had at least one previous abortion.

Source: Guttmacher Institute

When women have abortions

Cost

• Surgical – In 2005, the cost of a non-hospital abortion with

local anesthesia at 10 weeks’ gestation ranged from $90 to $1,800; the average amount paid was $413

(Source: Perspectives on Sexual and Reproductive Health)

• Drug-based– most providers do charge more for this method

Abortion and the Law

• Roe v. Wade– 1973 Supreme Court decision stating • 1st trimester abortions cannot be regulated by states and

the decision to abort is between woman and physician• 2nd trimester abortions permitted when mental or

physical health of mother at risk• 3rd trimester abortions allowed when life of mother at

risk

Source: Alan Guttmacher Institute

California Law

• California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states.

The Pro-Life and Pro-Choice Controversy

• Anti-abortion (Pro-life) position• Pro-choice position