Birth control resident survival guide: Difference between revisions
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| Line 70: | Line 70: | ||
Absolute contraindications | Absolute contraindications | ||
* Less than 6 wks postpartum | * Pregnancy | ||
*Less than 6 wks postpartum | |||
* Smoking (age ≥ 35, and ≥15 cigarettes per day) | * Smoking (age ≥ 35, and ≥15 cigarettes per day) | ||
* Hypertension (systolic ≥ 160mmHg or diastolic ≥100mmHg) | * Hypertension (systolic ≥ 160mmHg or diastolic ≥100mmHg) | ||
* Venous thromboembolism (VTE) (current of past history) | * Venous thromboembolism (VTE) (current of past history) | ||
*Prior history of throboembolic event or stroke | |||
*Thrombophilia (factor V Leiden, APLS) | *Thrombophilia (factor V Leiden, APLS) | ||
* Ischemic heart disease | * Ischemic heart disease | ||
| Line 81: | Line 83: | ||
* Breast cancer (Active) | * Breast cancer (Active) | ||
* Diabetes with retinopathy/nephropathy/neuropathy | * Diabetes with retinopathy/nephropathy/neuropathy | ||
* Severe cirrhosis ( | * Severe cirrhosis (active or severe decompensated liver disease) (impair steroid metabolism) | ||
* Liver tumor (adenoma or hepatoma) | * Liver tumor (adenoma or hepatoma) | ||
*Hypertriglyceredemia | |||
* | * | ||
Revision as of 00:35, 18 August 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Birth Control Options
Female birth control options
Long acting reversible contraception(LARC): 99% effective, high rate of satisfaction, long-term use, quick return to fertility when discontinued
- IUDs (> 99% effective)
- Copper IUD: effective for up to 10 years, used for patients with light menstrual periods, desire long-term contraception, not prefer using hormonal contraception
- Progestin-releasing IUD, effective for up to 5 years, for patients with heavy menstrual bleeding and dysmenorrhea
- Subdermal implant (> 99% effective), effective for up to 3 years, SE: unscheduled bleeding, weight gain, headache. Ovulation and fertility occur within one month after removal
- Depot Medroxyprogesterone, IM injection given every 3 months (94% effective),
- Combined hormonal contraceptives
- Oral contraceptive (estrogen/progestin pills) (OCPs) (91% effective)
- Birth Control Patch (91% effective)
- Vaginal Ring (91% effective)
- Barrier Methods
- Diaphragm
- Cervical Cap
- Sponge
- Spermicide (80% failure rate if used alone). Should be used with cervical cap or diaphragm, may damage the genital epithelium and increase risk of acquiring SDIs
- Natural contraception (Natural Family Planning and Fertility Awareness)
- Lactational Amenorrhea Method (LAM) (Breastfeeding can help with child spacing)
- Abstinence
- Permanent Sterilization
Male birth control options
Barrier contraception (Condoms) (80% effective), the only type of contraception that prevent sexual transmitted infections
Vasectomy
Withdrawal (coitus interruptus) (75% effective)
Note:
- You can use IUD in a nulliparous female
- Progestin subdermal implant is more effective that IUD (failure rate .2-.8%) and female fertilization (.5% failure rate)
Emergency contraception
Indications
- Pregnancy prevention
- Treatment of different conditions such as:
- Polycystic Ovary Syndrome (PCOS): OCPs are used for menstrual regulation
- Endometriosis
- Amenorrhea
- Dysmenorrhea
- Premenstrual Syndrome (PMS)
- Primary Ovarian Insufficiency (POI)
- Heavy Menstrual Periods
- Acne
Contraindications
Combined hormonal contraceptives
Absolute contraindications
- Pregnancy
- Less than 6 wks postpartum
- Smoking (age ≥ 35, and ≥15 cigarettes per day)
- Hypertension (systolic ≥ 160mmHg or diastolic ≥100mmHg)
- Venous thromboembolism (VTE) (current of past history)
- Prior history of throboembolic event or stroke
- Thrombophilia (factor V Leiden, APLS)
- Ischemic heart disease
- Cerebrovascular accident history
- Complicated valvular heart disease (pulmonary hypertension, atrial fibrillation, history of subacute bacterial endocarditis)
- Migraine headache with aura or focal neurological symptoms
- Breast cancer (Active)
- Diabetes with retinopathy/nephropathy/neuropathy
- Severe cirrhosis (active or severe decompensated liver disease) (impair steroid metabolism)
- Liver tumor (adenoma or hepatoma)
- Hypertriglyceredemia
Relative contraindication
- Age ≥ 35 and smoking < 15 cigarettes per day
- Adequately controlled mild hypertension
- Hypertension (systolic 140 - 159mmHg or diastolic 90 - 99mmHg)
- Migrain headache over the age of 35
- Currently symptomatic gallbladder disease
- Mild cirrhosis
- History of combined OCP-related cholestasis
- Medications that interfere with OCPs: Lamotrigine, Rifampine
- Inhirited thrombophilia carrier and family member with thrmbophilia plus thromboembolism
IUDs
- Uterine anomalies
- Active pelvic infection
Subdermal implant
- Progesterone receptor-positive breast cancer
Do's
- Increase the levothyroxine dose in patients with hypothyroidism who started taking OCPs. OCPs (estrogen) increases the liver synthesis of thyroxin-binding globulin (TBG)
- OCPs also decrease the effect of Warfarin, so consider increasing the dose
- Oral contraceptives (estrogen) alter the transport and tissue delivery of thyroid hormone by increasing the synthesis of throxine-binding globulin , relative hypothyroid state in patients with hypothyroidism. Increase the dose of levothyroxine when starting OCPs.