METHODS OF CONTRACEPTION

Contraception

Nursing Role

Care
Management

Coitus
Interruptus

Fertility
Awareness
Methods (FAMs)

CONTRACEPTION OVERVIEW
Intentional prevention of pregnancy
Birth control is the device or practice to decrease the
risk of conceiving
Family planning is the conscious decision on when to
conceive or avoid pregnancy
May still be at risk for pregnancy
Nearly half of all U.S. pregnancies are unplanned
Assess womans & partners knowledge about
contraception and commitment to particular method.
Assess womans level of comfort with touching her
genitals & cervical mucosa.
Determine religious and cultural factors.
Counter myths and present facts.
A multidisciplinary approach to assist the woman in
choosing an appropriate contraceptive method
Ideally the method should be
o Safe, simple
o Available, Acceptable
o Economical
Contraceptive choice must meet personal, social,
cultural, and interpersonal needs

NATURAL METHODS OF CONTRACEPTION

Involves male partner withdrawing penis completely
from vagina & away from external genitalia before
ejaculation
Depends on mans discipline to withdraw
27% failure rate during first year of use
Costs nothing

Rely on avoidance of intercourse during fertile periods

FAMs combine charting menstrual cycle with
abstinence or other contraceptive methods
Free, acceptable, safe
Natural family planning (period abstinence)
Provides contraception by relying on avoidance of
intercourse during fertile periods
Only form of contraception approved by Catholic

Church
Failure rate is 25% during 1st year use.
Low cost
Women must understand the 3 phases of the
menstrual cycle:
o Infertile phase before ovulation
o Fertile phase: 5-7 days midcycle
o Infertile phase after ovulation
Standard days method
Calendar rhythm method
Basal body temperature method
Cervical mucus ovulation-detection method
Symptothermal method
Predictor test kits for ovulation
o Marquette Model
o Creighton Model
Two Day method
Breast-feeding (lactation amenorrhea)

Calendar

Rhythm Method

Based on length of cycle: see formula for calculation

Need to determine womans fertile period
Abstinence during fertile period: 4 days before and 3-4
days after ovulation
o Subtract 11 days from shortest cycle
o Subtract 18 days from longest cycle
o Gives the window to abstain

Basal Body
Temperature
Method

Definition of BBT
Use of BBT to determine ovulation
A slight drop (0.5*C) occurs at Ovulation, followed by
an increase (0.4-0.8 * C)
Abstinence during fertile period
Not necessarily good when used alone
Can be used with cervical mucous method

Cervical
Mucous Method
(Billings
Method)

Woman needs to recognize and interpret cyclic

changes in amount and consistency of her own
cervical mucous.
Needs to keep BBT log
Fertile period needs to be determined
Requires abstinence during fertile period

Spermicides

Male Condoms

BARRIER METHODS OF CONTRACEPTION

Physical barriers to sperm penetration that also have
a chemical action on sperm preventing sperm from
reaching cervical os.
o Foams, tablets, suppositories, creams, films &
gels
o Nonoxynol-9 decreases sperm motility
o Inserted 1 hour before intercourse, repeat with
additional acts
o Failure rate is 29%
o Frequent use may put person at risk for HIV,
lesions

Thin, stretchable sheath that covers the penis

Many different types (latex, polyurethane, lamb
cecum)
Those lubricated with nonoxynol-9 not recommended
for preventing HIV or STIs
Failure rate is 15% in first year of use

Female
Condoms

Polyurethane sheath with flexible rings at each end

Only one size
Failure rate is 21% in first year of use

Cervical Cap

Soft, natural rubber dome

o firm but pliable rim
o fits snugly around the base of the cervix
Come in varying sizes
Remains in place at least 6 hours, but no more than
48 hours after intercourse
Additional spermicide not needed
Contraindicated for those with abnormal Pap test
results, not fitted properly, history of TSS, history of
vaginal infections

Contraceptive
Sponge

Small, round, polyurethane sponge containing

nonoxynol-9 spermicide.
Fits over the cervix, and is one size fits all.
Moistened with water before insertion
Protects for up to 24 hours and for repeated acts of


Diaphragm

Oral
Contraceptive
Pills

intercourse
Risk for TSS
Shallow dome-shaped rubber device
Woman needs to be fitted (+/- 10 pounds)
Must remain in place at least 6 hours after intercourse
Spermicide needed with additional acts of coitus
Failure rate:12% in first year
Contraindicated for those with poor vaginal muscle
tone or recurrent UTIs

HORMONAL METHODS OF CONTRACEPTION

Types of OCPs
o Combined estrogen-progestin: suppress the
action of the hypothalmus and anterior
pituitary, leading to inappropriate secretion of
FSH and LH
o Progestin only: inhibits ovulation, thickening
and decreasing the amount of cervical mucus
and thinning the endometrium.
o More than 30 different types available
o Available in 21, 28, 91 day packs
o Must become aware of information about each
specific pill
Types of combined OCPs
o Monophasic: fixed dose of hormones
o Multiphasic: altered doses of hormones
Biphasic
Triphasic
Advantages of OCPs
o Not related to sexual act; use is more
acceptable
o Regular menstrual flow
o Some non contraceptive health benefits
o Overall effectiveness almost 100%
Disadvantages and Side Effects of OCPs
o Does not protect against STIs
o Must be avoided if certain contraindications
apply
o Can have severe adverse effects, esp. CV
o Nausea
o Breast tenderness

o
o
o
o
o

Side Effects with

OCP Estrogen

Side Effects with

OCP Progestin

Nursing

Considerations

Fluid retention
Chloasma
Bleeding irregularities
Liver disease
Associations between long term OCP use & CA
(long term use prior to first full term
pregnancy, > 5 years)
May increase breast, liver, cervical cancer

Breast tenderness
CVA
Chloasma
Fluid retention
Headache
Nausea
Nervousness
Irritability
Thrombophlebitis
Breast tenderness/fullness
Decreased high density choles
Depression
Decreased libido
Fatigue
Increased appetite/weight gain
Pruritus
Alopecia/Hirsutism
Sebaceous cysts
Teaching must include insert information
Directions related to missing 1-2 pills
Discussion of break through bleeding
Signs of potential complications
No protection against STIs or HIV
ACHES
o A Abdominal pain: may indicate a problem
with the liver or gallbladder
o C Chest pain or shortness of breath: may
indicate possible clot problem within lungs or
heart
o H Headaches (sudden or persistent): may be
caused by cardiovascular accident or
hypertension
o E Eye problems: may indicate vascular

Contraindication
s to OCPs

Progestin Only
Pills

Injectable
Progestin

accident or hypertension
o S Severe leg pain: may indicate a
thromboembolic process
o
Pregnancy
Previous Hx of thrombophlebitis or thromboembolic
disease
Acute or chronic Liver or Gallbladder disease,
Presence of estrogen dependent carcinomas
Undiagnosed uterine bleeding
Heavy smoking
Hypertension
Diabetes
Hyperlipidema
Epilepsy
Mini-pill contains low dose of progestin
Taken same time every day (if later than 3 hours,
need backup method)
Some irregular bleeding occurs
Failure rate is 8% in first year of use
Caution: Hx of depression
DMPA (Depo-Provera)
o Given subq or IM
o Begun during 1st5 days of cycle
o Administered every 11-13 weeks
o Causes a decrease in bone mineral density
o Delay in return to fertility may take 18 months
o Failure rate is 3% in first year of use
Side Effects
o Abdominal pain
o Acne
o Breast tenderness
o Decreased libido
o Depression
o Headaches, Dizziness
o Irregular menses and bleeding
o Weakness and fatigue
o Weight gain
o Nervousness
o Bone loss
o Alopecia

Subdermal
Implants

Transdermal
Contraception
(Patch)

Levonorgestrel (progestin) implanted in the

womans arm
Norplant 6 capsules implanted lasts 5 years
Implanon single capsule implant last 3 years
Work by preventing ovulation
o Produce a thick cervical mucous that inhibits
sperm penetration
Possible Side Effects
o Irregular bleeding (spotting, amenorrhea)
o Increase incidence of ovarian cysts
o Weight gain and fluid retention
o Mood disorders (depression)
o Decreased libido (sex drive)
Delivery of continuous levels of hormones
Applied to intact skin: upper outer arm, upper torso,
lower abdomen, buttocks.
Applied once a week for 3 weeks with one week
without
Menstruation during no patch week
Failure rate of 2% in first year of use.
Adverse Side Effects:
o Prone to blood clots especially with high BMIs

Vaginal Ring

Flexible ring containing hormones worn in vagina

Worn for 3 weeks, one week without ring
Menstruation occurs during week without ring
Failure rate is 2% during first year.
Cannot breastfeed with this

Emergency
Contraception/P
ost-coital
Methods

Available over the counter for those over 18 years of

age in U.S. (Plan B)
Progestin (levonorgestrel)
Used within 72 hours of unprotected sex or failed
birth control method
o Two doses: ASAP and second dose taken 12
hours later
High doses of COCs may also be used
Insertion of copper IUD is additional method

INTRAUTERINE METHODS OF CONTRACEPTION

IUD

Sterilization

Occlusion:
Essure

Nursing
Considerations

Small T-shaped device with small bendable arms for

insertion into uterine cavity
o Needs signed consent form before insertion
o Long term protection from pregnancy
o Immediate return to fertility
o Increased risk of pelvic inflammatory disease
(PID)
Two FDA approved IUDs
o ParaGard T-380A (CopperT)
Contains copper (serves as a spermicide)
Effective for 10 years
Increased uterine bleeding, cramping
o Levenorgesteral IUD (Mirena)
Releases levonorgesterel from reservoir
Effective for 5 years
Thickens cervical mucous
Decreased uterine bleeding

PERMANENT METHODS OF CONTRACEPTION

Surgical procedure that causes sterility
o Male vasectomy
o Female bilateral tubal ligation
Performed in doctors office
Flexible inserts passed through the vagina, cervix,
and uterus into fallopian tubes.
Tip of the device remains outside the fallopian tube
for immediate visual confirmation of placement
During this period another form of birth control (other
than an IUD) must be used.
It is not reversible

Medical Abortion

Assist with decision making

Insure correct information is available
Pre-op care/anticipatory guidance
Postop care
Discharge planning
Consent
Medical termination of pregnancy.
In U.S. available up to 9 weeks after last cycle.
Methotrexate, misoprostol, & mifepristone are used

to induce early pregnancy

Dilation and
Evacuation

Performed anytime
Third trimester abortions are legal and are performed
Cervix must be dilated
Cannula is used to suction out fetus and placenta;
curette may also be used.
Nursing Care
o Monitor vital signs
o Emotional support
o Analgesic administration
o Post-op monitoring
o Follow-up